A Day in the Life of Cole Burton

Cole Burton takes a determined, if slightly, unsteady step.

Then he takes another.

Two physical therapists gently guide him. His destination: the Lokomat®, a robotics-assisted, treadmill training system.

Total distance: Six yards.

Cole’s parents stand nearby. Their eyes never leave their son: It’s the first time in Cole’s two months in Shepherd Center’s Brain Injury Rehabilitation Program that he’s made this short trip without a walker.

“Most parents only have the privilege to see their child walk for the first time once,” says Charlie Burton, Cole’s father, eyes still riveted. “Now, we’ve seen it a second time.”

Three months earlier, it seemed unlikely Cole would ever walk or talk again.

On May 24, 2018, Cole and 18 other geology students from Auburn University were studying rock formations off U.S. Highway 431, near Glencoe, Alabama. An oncoming pickup truck went out of control and hit Cole and another student. Both were airlifted to the University of Alabama at Birmingham Hospital.

Cole, 21, from Decatur, Alabama, sustained a diffuse axonal injury, along with broken bones and abdominal injuries. He remained in a minimally conscious state for three weeks. The other student later died.

A week after the incident, a doctor advised Cole’s parents of the option to withdraw treatment. After painful family discussions, Cole’s parents declined. On June 22, Cole was transferred to Shepherd’s intensive care unit (ICU), still largely unresponsive. A team of physiatrists, neuropsychologists, physical therapists, speech-language pathologists, occupational therapists, respiratory therapists and others met to address his needs.

“The way Cole showed up (given the severity of his impairments), he wouldn’t have been considered ready for admission by a lot of rehabilitation hospitals,” says Andrew Dennison, M.D., Cole’s primary physiatrist. “However, we feel an earlier admission is helpful so we can get control of medical issues that are limiting progress and start rehabilitation interventions that will help patients progress more quickly.”

As Cole became more aware of his situation, the team implemented Shepherd Center’s family- and patient-centered approach to help guide treatment.

“The team approach is important, as is having a patient’s desires and goals used to push therapy,” Dr. Dennison explains. “It only happens when you take a mindful approach tailored to the individual.”

A look at Cole’s daily care, near the end of his eight-week inpatient stay, illustrates Shepherd’s interdisciplinary approach to helping people on their road to recovery from traumatic brain injury. It focuses on individualized therapy, outside-the-box thinking, and a top-to-bottom culture of empathy, hope and real-world preparedness.

“Cole is such a reflection of the culture here,” says Chelsea Day, Psy.D., Cole’s neuropsychologist. “He’s a reflection of outlook and giving back and humor. At the end of the day, Cole is Shepherd.”

Cole puts it another way: “I never feel like a patient here. I feel like a person.”

8:30 a.m.: Breakfast as a Community

Cole exits his Auburn-bedecked second floor room in Shepherd’s Acquired Brain Injury (ABI) Unit at 8:30 a.m. and heads to breakfast down the hall, in the therapy gym. He’s dressed in what’s become his daily uniform: a yellow Navy t-shirt from the ROTC program he belongs to at school and gym shorts.

Other patients and families greet Cole and his parents as he settles at a table with a patient near his own age. They exchange progress updates and talk football. Dr. Dennison drops by to check on Cole’s status.

Cole overhears a therapist at the next table reciting a schedule with another patient, an older woman who’s having trouble comprehending. When she answers one of the therapist’s questions correctly, Cole leans over and encourages her with a, “Good job!”

“Some people come in and see other patients and say, ‘I want to be where they are,’” says Tina Burton, Cole’s mom. “We did that. Now, some look at Cole for inspiration.”

Cole’s parents take turns circulating among other families. Breakfast becomes a kind of unofficial support group, as do other meals in the cafeteria or outside in the Secret Garden. Shepherd also provides families with more formal counseling and peer support – services unique to Shepherd Center.

“You get to know the families,” Charlie says. “Everybody here has suffered loss one way or another. We encourage each other. We ask questions of people who’ve been there. Everybody celebrates every victory.

“A sense of family takes place,” Charlie adds, as Tina helps Cole cut through a pancake. “You build relationships that continue in the hallway and beyond. We’re in the ‘Shepherd Club.’”

10:00 a.m.: Speech Therapy: Winning!

Breakfast is cleared, and Amy Waite, CCC-SLP, Cole’s good-humored speech therapist, has him read a story and answer questions about the sequence of events. Later, they’ll play Yahtzee. It’s one of many games, puzzles and mental exercises Waite employs to strengthen and evaluate the cognitive skills, such as memory, problem-solving and speech processing of patients with brain injuries.

“It’s therapy in the context of a game,” Waite says. Cole rolls dice, strategizes, totals scores. He ditches his calculator at one point to add the figures in his head.

“163,” he says of his score.

Waite asks if he’s sure. He tries again: 168.

“Cole is good at giving an evaluation of what was difficult for him,” Waite says. “That self-awareness is important for a patient with a brain injury. His sense of humor is intact, as well.”

To illustrate the latter point, she asks Cole to repeat what he said the first time he beat her at Yahtzee.

Cole: “You just lost to a brain injury patient!

11:15 a.m.: Occupational Therapy: The Pool

When occupational therapist Elise Kirkby, MSOT, OTR/L, CLT-LANA, first asked Cole about his favorite activities, he mentioned swimming as part of his ROTC training. Elise relayed this to Cole’s team of doctors and therapists who meets weekly to assess his progress and adjust his treatment plan.

Cole’s therapy schedule soon incorporated Shepherd’s 100,000-gallon indoor pool.

“It’s a great example of a therapist listening to a patient and his interests,” Charlie says.

Cole’s parents also completed a Shepherd program that allows them to take Cole into the pool on their own, which they’ve started doing on weekends.

Cole does leg stretches, arm rotations and other movements in the water that extend his range of motion.

“We try to incorporate activities patients did before,” Kirkby says. For patients who can’t verbalize, she uses a picture book with activities they can point to. “It keeps them motivated, and they already have muscle memory we can tap into.”

After Cole dries off and changes, he ties his shoes on the deck. His left arm couldn’t move when he arrived at Shepherd. Now, Kirkby emphasizes it as often as possible. It takes him a while, but he finally knots the laces.

“Cole is the type who’s going to keep working until he gets full functionality,” she says.

1 p.m.: Individual Physical Therapy: One Step at a Time

Cole steps carefully down a hall while Isha Smith, a program tech, bounces a large plastic ball toward him for him to catch. Belinda Richardson, PT, DPT, NCS, his primary physical therapist, holds him by a gait belt to make sure he stays steady.

The routine emphasizes balance, coordination and depth perception.

“It’s something simple that incorporates a lot of different things,” Richardson says. “You get a lot of bang for the buck.”

Cole moves to a stairwell. He climbed it for the first time the day before. “I was just holding my breath,” says Tina, his mother, who watched from the bottom of the stairs.

Now Cole takes to the stairs again, with Richardson and Smith keeping him steady. When he comes down two flights, Richardson asks, “You tired?” Cole says no. He wants to try to climb.

“I’d rather do stairs again than sit down,” he says.

This time instead of painstakingly having one foot lead and the other meet it on each stair before taking the next step, going one step at a time – he’s more confident. He alter-nates feet, lifting one up and past the other to take the next step upward. When he finishes, Smith exclaims, “Beautiful!”

Cole and Tina exchange high fives.

2 p.m.: Group Physical Therapy: Goals

Cole seats himself on a NuStep™ machine, a recumbent cross trainer that builds strength and cardio endurance. Today’s goal: 500 steps, an accomplishment that seemed impossible a month ago. An older patient pedaling a stationary bike beside him urges him on.

Cole has no recollection of the first month following his accident, but he’s seen videos his family made. He mostly laid in bed, maybe lifted an arm and scanned his surroundings blankly. A break-through came when he performed a secret handshake with his younger sister, Libba, a freshman at Troy University in Alabama. Charlie says Libba really stepped up when he and Tina were consumed by decisions and details.

“Maybe we were still too broken,” he says. Family support is invaluable to patients with a brain injury, say medical team members.

“When I see those videos from early on, it’s kind of surreal,” Cole says, keeping pace on the machine. “I know it’s me, but I had no consciousness at all.”

Time’s up: 503 steps.

SIDEBAR: WHAT'S NEXT AFTER INPATIENT REHABILITATION?

3:30 p.m.: Physical Therapy Meets Recreation Therapy: Yoga

It looks like any other mid-sized meeting room, except for the electric candles flickering on the window sill, the wall tapestry, and the mats and pillows scattered on the carpeted floor. Meditative music drifts from a cell phone.

For Cole and the other patients here for adaptive yoga therapy, the room is literally a take-a-deep-breath respite from their intensive therapy schedules. In addition to therapy, their days can include regular neuropsychological testing and counseling, plus classes that teach patients and family members about their injury and how to manage day-to-day care after leaving the hospital. Yoga, like music therapy and animal-assisted therapy, is a distinctive tool in Shepherd’s broad, holistic approach to rehabilitation that is made possible because of donor support.

Yoga helps with balance, core strength and coordination. It also helps anxious patients who may need to relearn coping skills. It reacquaints them with their bodies as they recover and rebuild neurological connections with their minds.

“Our goal is to teach each patient how to relax and be aware of their bodies,” says Mary Ashlyn Thiede, an exercise physiologist and one of six registered yoga instructors at Shepherd.

After a dozen standing movements and poses, Cole lowers himself to the mat with a bit of help. He executes a half dozen more moves before finishing on his back – eyes closed, body still.

“It’s almost like there’s no objective,” a refreshed-looking Cole says afterward. “I guess the objective is to… relax.”

6:40 p.m.: Shooting Pool as Recreation Therapy

Cole greets recreational therapist Maddy Weber, MS, CTRS, at a pool table in the first-floor rec room, where another patient joins them.

Rec games like pool require patients to adapt motor skills, eye sight, critical thinking and other aspects previously taken for granted – all through a game they can play after leaving Shepherd.

Weber scrolls through her phone in another teachable moment. “What do you want for music?” she asks. “You can’t shoot pool without music.”

Cole watches as the young woman playing with him knocks the cue ball at the 10 ball. It nearly drops in.

“Nice!” Cole tells her.

“Close.”

He has a clear shot at the 1 ball. But he steers his chair farther down the table to take a crack at the 5, even though it’s behind two other balls. He remembers a previous shot and calculated the odds.

“I don’t want to shoot at the 1 again. I missed it before,” Cole explains.

“This way I have a better shot at hitting something.”

His shot scatters both balls. One of them nicks the 5.

Cole looks pleased.

“I think it was good practice,” he says.

7:30 p.m.: Neuropsychology Group

A dozen patients crowd into a cozy room. When a latecomer arrives,

everyone shifts their wheelchairs to make room.

Led by Lisa Hoyman, Ph.D., a neuropsychology postdoctoral fellow, these group sessions are a chance for patients who have sustained brain injuries to share stories, fears and advice. They’re all ages, all income levels, from all over the country. They’ve been in car wrecks, diving accidents, had strokes.

“It’s absolutely level ground,” Charlie says of Shepherd. “It doesn’t matter what neighborhood you’re from, if you’re rich or poor. Everyone is over-coming something and trying to get better.”

Dr. Day, Cole’s neuropsychologists, who has private sessions with Cole and his family, says recovery for patients with brain injuries usually continues long after they leave Shepherd. She calls the process, with its mix of hope and realism, “a journey.”

For Cole and others in this room, Shepherd Center is where that journey begins.

“The goals Cole and his family had when he came in here are not the goals they’ll leave with,” Dr. Day says. “Their hope for Cole was just to make it through what-ever it was. Now, they’re having conversations about returning to school.

“Cole has defied many of the odds the family was given,” she adds. “He’s not alone in that.”

As he leaves today’s session, Cole has his own take.

“We’ve all beaten the odds,” he says, “just by being here.”

SIDEBAR: WHAT'S NEXT AFTER INPATIENT REHABILITATION?

Rehabilitation doesn’t end when a patient is discharged from the inpatient program at Shepherd Center. As part of bridging the gap between the hospital and the real world, Shepherd Center offers a continuum of care through various programs.

Shepherd Center's Assistive Technology Center
Patients can be fitted with everything from wheelchairs to specialized mounts or voice- activated devices to help them become more independent and engage in preinjury activities like tending to email and sometimes driving. Thanks to donor support, occupational therapists evaluate each user’s lifestyle requirements and functional abilities. They can then provide recommendations for custom modifications to hardware, software, electronics and other appliances. 
shepherd.org/adaptive-tech

Shepherd Pathways Day Program
Patients with brain injury who no longer need 24-hour nursing care may be eligible to continue their recover and rehabilitation with this program. Located in nearby Decatur, Georgia, Pathways offers treatment rooms, two large therapy gyms, a computer lab, outdoor sports equipment and a putting green. Activities include practice with grocery shopping, accessing transportation, dining out and pre-vocational and vocational assessment and counseling.
shepherdpathways.org

Transition Support Program
Clients may be referred to receive an average of eight weeks of follow-up support from this donor-funded program. The primary goal of the program is to prevent rehospitalization, improve health and safety outcomes, and promote patient and family autonomy once the patient is discharged from Shepherd Center. Case managers also work to locate therapy and medical facilities close to home for out of town patients and can provide refer-rals to help them find adaptive sports or other opportunities.
shepherd.org/TSP

Beyond Therapy®
Beyond Therapy® is based on research suggesting the central nervous system is capable of synaptic plasticity and anatomical reorganization through “activity-based” therapy. This process is called neuroplasticity. Beyond Therapy® combines the concepts of athletic training and physical therapy to promote health, wellness and recovery for people with a variety of neurological disorders.
beyond-therapy.org

Written by Drew Jubera
Photos by Louie Favorite