Cheris and Val…

Today, I was hoping to post pieces written by two Physical Therapists I have worked with. They provide unique perspectives as my therapists in both the outpatient and inpatient setting.

Cheris Grasse, whom I have mentioned in several previous posts, has been my outpatient Physical Therapist since my discharge in May of 2013. My first impression of Cheris was that she ‘knew her stuff’[1] and that she was tough and had no problem pushing me to my limit (I remember several therapists passing by making the comment after seeing me drenched in sweat, “Oh, you must be working with Cheris.”). I have since become very good friends with her, and now know that in addition to my first impressions being correct, I’ve also realized that she also has an incredibly big heart—I can tell that she truly hopes that I get better and improve. She works with a bevy of patients and is always tough to get an appointment with. I often wonder if they realize or appreciate who they are working with. Many of the effects of my tumor mimic those of Parkinson’s disease (as well as other diseases)—one of these effects is a lack of visible emotion (or ‘flattened affect’ as we call it in the medical field). I look forward to every session I have with Cheris, but I know this eagerness and excitement does not show in my face during our sessions. I hope she knows how happy I am to be there. It makes me shudder to think of where I’d be in my recovery process without her.

I first met Valerie Collins (or ‘Val’ as I call her) while in the Sparrow Rehabilitation Unit in the hospital. Before I even had the opportunity to work with her, many of the other therapists noted that she had much experience in patients with cerebellar damage like me. I could tell immediately she was the type of person who ‘practiced what she preached.’ There are many people who don’t do this- i.e.: a diabetic ice cream vendor, or a physician that smokes.[2] But I could tell from Val’s athletic physique (she was an NCAA swimmer at Michigan State University) that she practiced many of the exercises she imparted to her patients. Besides her extensive experience with cerebellar patients along with her obvious athleticism, I knew nothing of her prior to our sessions. Again, my first impressions were correct—many times, she would do exercises with me. She, like Cheris, would always push me to my limit, then ask for a little more. In a previous post I described my experience in walking again for the first time without assistance; that came during a session with Val. It was obvious that she was one of the best therapists there. I even asked if she would be available in the outpatient setting.   I often trade texts with her with us both wondering how the other one is doing. I hope she knows that not only am I grateful to have had the opportunity to work with her, but I am also thankful to have gained her as a friend.

The courtyard of Sparrow- this picture brings back memories.  Often this is where I would go after therapy sessions.
The courtyard of Sparrow- this picture brings back memories. Often this is where I would go after therapy sessions.

I asked them both to write a little on what it was like to work with me. This is what they wrote:

Cheris Grasse:

I have worked as an outpatient physical therapist with a focus in neurological impairment for the past 14 years.  I met Chris over a year ago when he started Outpatient Physical Therapy at Sparrow.  Neurological injuries (head injury, stroke, brain tumors, and spinal cord injuries) are quite variable in their presentation as are the degrees of recovery that may be achieved.  Knowing this, I try to keep preconceived notions of people likely to achieve a full functional recovery out of my mind. That being said, Chris has been phenomenal to work with. From what I understand about the size and location of his tumor, Chris’ recovery has been astounding.  I have seen far fewer cerebellar injuries versus cerebral in the years that I have been treating patients with neurological involvement.  Cerebellar lesions are hard to treat and usually do not completely resolve. Chris has the “typical” presentation for someone with cerebellar impairment – ataxic gait with a wide base of support and impaired balance and coordination.  Yet, he is both amazing and challenging in the tasks and activities that he can perform.  Everything that I bring for him to do he’s ready and willing, which is so much fun!  It’s been really fun for me to bring in new ideas to “test out” on him, as the vast majority of my neurological patients would never be able to do the things that he does.  I had my husband make us an agility ladder to work on balance and coordination because I was running out of ideas to work on these

Me during a session with Cheris
Me during a session with Cheris

dynamically at such a high level.  While Chris continues to have ataxia, balance and coordination deficits, he also continues to improve.  ‘They’ used to say that what you don’t recover after the first year after a neurological injury you will never get back.  I have seen this disproven time and time again.  I can’t wait to see what Chris is doing one, five, ten years from now.

Valerie Collins:

I had the pleasure of working with Chris as one of his physical therapists while he was a patient on Sparrow’s Inpatient Rehabilitation unit. From the first session, he struck me as a patient that had a tremendous amount of focus and motivation to recover in addition to unwavering family support, both primary features of some of the most successful rehabilitation stories. As a Physical Therapist (PT) my job is to identify and address any mobility limitations a patient has. (How they are able to move, lie down, sit up, stand up, walk, climb stairs. The quality of the mobility must also be established, is it smooth and controlled, even between both sides or reciprocal and at a reasonable speed.)

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Chris presented with a significant level of ataxia (uncoordinated or jerky movements) affecting his core muscles as well as his extremities, one side greater than the other as well as his speech. He was also challenged by visual deficits. Given that ataxia and visual limitations are two of the most difficult physical challenges to maintaining one’s balance, Chris was facing a recovery process that was going to be long and occasionally frustrating. Amazingly Chris always came to therapy ready to work and put forth his best effort with every task presented to him. His level of physical fitness and endurance before his surgery were also a benefit to his current impaired state (often patients in a rehab setting have multiple conditions that need to be accounted for, but often slow the process, Chris luckily did not). Chris was a pleasure to work with as I could challenge him repeatedly with a task and progress him to more difficult tasks within a single session. Gains are more noticeable in this type of progression which helps reduce the frustration and subsequent delayed motor recovery some patients encounter.

I mentioned to Chris recently I consider the our setting the warm up phase of recovery, where we focus primarily on the skills he would need to get back home with his in the quickest manner which is the end goal of patients and practitioners in an inpatient rehabilitation setting. We worked together using several different treatment strategies and techniques such as PNF (proprioceptive neuro facilitation), NDT (neurodevelopmental technique) and FMT (functional manual therapy) to address his ability to move about his environment safely. With his great attitude and hard work ethic, a bit of coaching and cheerleading from me, other therapists and his support network was all Chris needed to get on his way.

 

 

 

[1] Several different inpatient therapists recommended her.

[2] The idea being this ice cream vendor has probably never tried his/her ice cream and is in fact, promoting diabetes with the ice cream. From the first day of medical school the negative effects of smoking (including but not limited to shortened life span, increased risk of cancers and heart disease) are engrained in us.

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