Special patient gains major strides through teamwork

Kayla, age 24, is “one of the most rewarding patients” the therapy team in Oskaloosa, Iowa has ever worked with. She started outpatient rehab with RehabVisions’ therapists this past February, but it’s been more than a year since the initial accident and severe traumatic brain injury (TBI) that began her long rehab journey.

In August of last year, Kayla was involved in a head-on motor vehicle accident (MVA) that left her with multiple life-threatening injuries, including lacerations, broken bones, fractures, cerebral artery injuries and a bilateral subarachnoid hemorrhage (SAH). She was stabilized in surgery and placed into a medically induced coma. Two days later, she was rushed to a CT scan that revealed swelling in the brain and she was taken to surgery involving a decompressive craniectomy and partial lobectomy. The TBI and stroke affected two-thirds of the left side of Kayla’s brain. She spent 60 days in the intensive care unit.

That fall, Kayla began an inpatient comprehensive brain injury rehabilitation program where she was diagnosed with both apraxia of speech and right homonymous hemianopsia. The TBI and SAH also resulted in hemiplegia on her right side, along with spastic movements. She received intensive daily therapy for four months, until she was discharged home to begin outpatient therapy in Oskaloosa.

Aimee Wagner, OT, April McKain, COTA and Sara Schroeder, PT, were the primary-treating therapists. Kayla’s sister, Holly Bogatzke, PTA, has also been able to assist in treatment. Holly is constantly working with her sister at home to progress functional performance. Her knowledge has been beneficial as she reminds Kayla to do her exercises and help her to better understand the reasoning for certain interventions.

Aimee’s initial treatment plan for occupational therapy was to develop the right upper extremity muscle tone and muscle activation, as she had minimal movement or function. Sara’s initial treatment plan was to focus on gait and transfer mobility (Kayla came to her first session in a wheelchair) and to work on the right lower extremity muscle tone and neurodevelopmental patterns.

Kayla has received three hours of physical therapy treatment and two hours of occupational therapy treatment every week. “She went from a wheelchair to platform walker for short distances and now a small-based quad cane,” says Sara. “It took a few months, but Kayla can now walk using her cane.”

Sara found the most effective treatment strategies that focused on the lower extremity to get Kayla walking included:

  • Weight-bearing activities
  • Utilizing vibration for muscle activation
  • Neurodevelopmental positions
    • Quadraped position
    • Prone on elbows
    • Half-kneeling and tall kneeling

“Kayla has always responded the best to functional treatments,” says Aimee. For the progression in the right upper extremity, Kayla received vibration treatments initially and then e-stim to activate her muscles. After that, rather than active range of motion, Aimee and April focused on the following:

  • Goal-directed reaching
  • Functional grasp
  • Functional placement (one such example is a ring tree)
  • Kinesiotaping to support and improve muscle activation of right shoulder that tended to sublux

“We try to individualize and find what is most motivating,” says Aimee. “Lately, Kayla likes to work with beads and beans as she is getting sensation back. We have her search through a container of them to work on functional grasp.”

The therapists constantly worked together to communicate how Kayla responded to treatment to make progress across both disciplines. Working with Kayla to reach new milestones has been an incredible experience for everyone involved.

“Kayla is such a hard-working person and an inspiration to work with,” says Sara. “To see her accomplish certain transfers and progression of developmental patterns is so rewarding.”

“Because Kayla has such a complicated diagnosis and was affected in so many areas, it’s difficult to address everything in one treatment,” says Aimee. “However, every treatment is rewarding because she is a champion, determined to get her life back on track.”

Kayla is engaged to be married and was supposed to tie the knot last June. It is a great joy to know we are making steps to get her down the aisle and to that first dance.


Michael Goldsmith

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