Physical Therapy Helps Bride Walk Down the Aisle

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Physical Therapy Helps Bride Walk Down the Aisle

October 23, 2004

In today's society there are still workers at The Brooklyn Hospital Center who are fulfilled by the labor of their love in helping patients to recover and resume the life they once knew or helping them to come as close as possible to the life they once had. The success of the patient does not solely rely on the worker, but is dependent on the patient as well. The Brooklyn Hospital Center, which is located in the Fort Green section of Brooklyn, is one hospital that was blessed with Mrs. Safiya Spellman and staff members who made a difference in her life.

Mrs. Spellman, a 31 year old resident of Brooklyn, NY, is well known in The Brooklyn Hospital Physical Therapy and Occupational Therapy Departments. She was diagnosed with Guillain-Barre Syndrome in January 1998, a few months after the birth of her son. According to the World Book Dictionary, Guillain-Barre Syndrome is an idiopathic, peripheral polyneuritis occurring between one and three weeks after a mild episode of fever associated with a viral infection or with immunization. This is followed by symmetrical pain and weakness which affect the extremities, and paralysis may develop. Prior to her diagnosis Mrs. Spellman was an independent individual with ambulation and activities of daily living (ADL). Her illness left her with decreased muscle strength in both upper extremities, and an inability to ambulate due to paralysis in both lower extremities; as a result she became wheelchair dependent. She also required some assistance to care for herself. Besides, Guillain-Barre syndrome, Mrs. Spellman has high blood pressure, asthma and is an insulin dependent diabetic. She has been hospitalized on numerous occasions because of asthma, respiratory failure and uncontrolled diabetes (300-500), and this has caused a lack of attendance in physical therapy, thereby, delaying her progress. She also has increased hypersensitivity and parasthesias in her right upper extremity and a decrease inability to bear weight during transfer activities. The Issue Approximately a year ago Mrs. Spellman was placed on oral medication and an insulin pump which administers 11.5 mg of insulin per hour; this new treatment made a drastic difference in controlling her blood glucose level. This has enabled her to attend physical therapy on a regular basis, thereby facilitating her progress. As a Physical Therapist Assistant, I had the opportunity to treat Mrs. Spellman here at The Brooklyn Hospital Physical Therapy Department. Mrs. Spellman's physical therapy treatment consisted of strengthening exercises of both upper extremities to facilitate transfers, stretching to facilitate flexibility and the use of the tilt table for standing. She also received Occupational Therapy for desensitization of both hands, and ADL training, such as dressing and grooming. Mrs. Spellman also was evaluated for, and trained in the use of a custom motorized wheelchair for independence and mobility.

The Motivation 
Mrs. Spellman's goal has always been to be able to walk again. She became more determined to achieve her goal after she became engaged on July 2003. Soon after her engagement, Mrs. Spellman informed one of the previous therapists Heather Smart, about her engagement, and her desire to be able to walk down the aisle. After reviewing all the possibilities, Ms. Smart contacted Tulio Rivera from Hanger Prosthetics and Orthotics and discussed the possibility of a brace that would facilitate Mrs. Spellman to ambulate, and on July 10, 2003 Mrs. Spellman was assessed for a reciprocal gait orthosis (RGO). Mrs. Spellman received the RGO brace on February 25, 2004 and this was the beginning of the training process for ambulation.

The Process
The initial process for donning and doffing the RGO brace, and gait training was time consuming, but it was well worth it. Initially, her ability to transfer from sitting to standing in the parallel bars required maximum assistance of two to three people, which also include locking the brace at the hip and at the knees. She required maximum assistance of two to three people to ambulate in the parallel bars, including tactile and verbal cues to maintain upright posture and for weight shifting. She also required assistance for advancing both lower extremities. One of these assistants was Tony Garcia, PT Aide. He made her day more cheerful by filling her time at therapy with laughter and encouragement, and by showing that he cared. He was a great motivator.

The difficulty that she initially exhibited with ambulation did not last very long because she had personal motivation and the motivation and dedication of a devoted staff who was willing to help her achieve her goal to ambulate so that she would be able to walk down the aisle at her wedding. Mrs. Spellman, developed the necessary skills needed, and she was able to master the technique for ambulating with the RGO brace very quickly. She then progressed to ambulation with a standard walker requiring moderate assistance of two people, and assistance for advancing only the right lower extremity. On her last visit prior to her wedding, Mrs. Spellman remained dependent with donning and doffing the RGO brace. Sit to stand transfers from the wheelchair to the standard walker required maximum to moderate assistance of two people, and this included locking the brace at the hip and at the knees. She demonstrated the ability to ambulate with a standard walker and the RGO brace approximately 90 feet in five minutes with close supervision, and requiring no assistance for advancing the lower extremities.

The Result
On September 18, 2004 Beata Nowak, PT, Brian Goonan, PT and I were privileged to attend Mrs. Spellman's wedding ceremony, and we were all ecstatic with tears in our eyes as we watched her walk down the aisle with her father on the right and her brother on the left. They both walked casually beside her with no apparent physical contact. She looked radiant in her gown as she walked with a standard walker which had been decorated with the same beautiful material as her dress. She walked approximately. 100 feet, and stood for about 15 to 20 minutes for the ceremony, and demonstrated the ability to ambulate another 100 feet with her husband as the bridal party followed behind her. Approximately 20 to 30 minutes later she reentered the room and walked another 100 feet and was able to pose standing for pictures. She has indeed demonstrated increased ambulation distance, as well as endurance beyond what I had expected.

The People
The Brooklyn Hospital Physical Therapy Dept. does have staff that show they care and Mrs. Spellman can attest to that. Her success story demonstrates what the power of determination and support can do. Mrs. Spellman is now a motivation and an inspiration to the staff as well as other patients who come to the Physical Therapy Department for therapy. I recall one patient in particular after seeing Mrs. Spellman walk with the RGO brace stated "I will never complain again". Mrs. Spellman was extremely motivated, and she worked with a staff which was more than willing to help her. Mrs. Spellman's family is supportive in assisting her in her daily task of standing in the hydraulic standing device, and ambulating with the RGO brace, which she does at home. It has been a privilege and a challenge to have the opportunity to work with Mrs. Spellman, and I had no doubt in my mind about her capabilities and her desire to achieve her goal, because of the dedication of staff members. Mrs. Spellman is indeed an inspiration to us, and she has taught me one valuable lesson-that one can achieve his or her goal once they have the faith, the desire, and the motivation to work towards achieving that goal, and with the help of others, like Beata Nowak, Tony Garcia and myself, the patients who I come in contact with, that goal can be attained. 

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