Getting Back on Track After Spinal Cord Injury

Caroline Moore Brodmann was dog sitting at a friend’s house in July 2018 in Savannah, Georgia, when she spotted an idyllic backyard setting – a hammock slung lazily between two trees near the water.

Caroline told her then fiancé, Scott Brodmann, that she was going to step outside to try it out. He was following right behind her, once he could slip on some shoes. But the moment Caroline sat down in the hammock, one of the trees collapsed on her.

The blow caused a complete C-4 spinal cord injury, paralyzing Caroline from the neck down. She was rushed to Memorial Health University Medical Center in Savannah, her life suddenly on hold, if not altered forever.

An Unexpected Detour/A Life Interrupted

At 24, Caroline had earned a master’s degree in education in the spring of 2018 from the University of Georgia, and she had found her first teaching job. Scott was starting law school at UGA that fall. They were marrying in December.

Caroline was transferred from Memorial Health’s intensive care unit (ICU) to Shepherd Center’s ICU 16 days after the accident. Anna Elmers, M.D., a Shepherd Center staff physiatrist, and a multidisciplinary team addressed Caroline’s medical issues, including arms contracted at the elbow. Caroline was also on a ventilator, with a trach tube in her throat, for more than a month.

“We have the ability to get our patients early in their recovery compared to many other rehabilitation hospitals because we have our own ICU,” Dr. Elmers says. “We addressed the medical issues: If you can’t breathe properly, or stay upright because of blood pressure issues, or you’re sick with infection and throwing up, you probably can’t rehabilitate.”

A Personalized Approach to Get Back on Track

While no stay at Shepherd Center can be called typical – patients come from all 50 states and about 60 countries, with various degrees of catastrophic injury – Caroline’s four months in the inpatient Spinal Cord Injury Rehabilitation Program underscore what distinguishes Shepherd from other rehabilitation hospitals.

Guided by daily consultations from a team of physiatrists, physical therapists, occupational therapists, respiratory therapists, speech-language pathologists, recreational therapists, counselors, nurses and others, her care was individualized to meet her goals and needs.

A blend of expertise and creativity is ingrained in Shepherd Center’s culture. The result is one of the best hospital discharge-to-home rates in the country.

“What’s important to the patient, and what they want to achieve, is what we work toward,” says Jennifer Douglas, MS, CCC/SLP, therapy program manager for the inpatient Spinal Cord Injury Rehabilitation Program. “All employees who treat patients at Shepherd live and breathe that. We want their care to be individual, and special, in their time of chaos.”

That care was on full display during Caroline’s inpatient stay. She relearned how to eat, brush her teeth, sit up. She made use of Shepherd’s vast assistive technology resources. She had casts on her arms to help regain range of motion.

While discussing weekly goals, Caroline talked with therapists about returning to work, as well as her upcoming wedding, which she and Scott kept set for December 2018.

So, her therapists held a wedding cake tasting in her room, helped her think about a dress that would work best with Caroline’s wheelchair and held a surprise wedding shower.

One therapist arranged for Caroline to help teach at her son’s elementary school once Caroline moved to the day program. Like it is for most patients, Caroline’s rehabilitation has been made up of hundreds of small milestones and kind gestures.

Holding Steady

Two therapists maneuver a Hoyer lift to transfer Caroline from her wheelchair to the edge of a raised mat table, where she’ll practice prop sitting – sitting up on her own.

The task is important for her to eventually perform her own transfers from chair to other seats and back, or to sit on the edge of her bed and dress.

Sarah Leonard, PT, DPT, sits on a stool in front of Caroline and holds her steady with a towel wrapped around Caroline’s back. Another therapist supports Caroline from behind.

Caroline works through positions and exercises until she simultaneously sits back while leaning forward, counterintuitively learning to use her head for balance.

“I’m going to slowly let go of this towel,” Leonard then tells her. The therapist who is supporting Caroline from behind lets go, as well. Caroline is sitting up on her own.

The first time she tried this, she couldn’t sit up for 10 seconds. Now, she holds steady for almost a minute.

“Everyone wants to walk,” Leonard says. “But this is what we can do now, so let’s work on this. It’s important to have little milestones. Otherwise, it’s all too big, and you get lost in it.”

SIDEBAR: 
Treating the Whole Patient: Shepherd Center Helps Patients Cope with Loss

The Love and Hate Relationship with Therapy

Caroline sits before a small rubberized board, trying to fit soft pegs into a dozen holes. It’s a bimanual task: Because Caroline has no mobility in her fingers, she uses both hands to lift pegs from a small bucket and place them in the holes.

The task’s usefulness goes beyond the board.

“You can’t replicate every task in life,” Leonard says. “But you can learn strategies and problem-solving that you can then apply to different tasks.”

This exercise exhausts Caroline almost as much as prop sitting. She gets one peg in, then accidentally knocks it over when she picks up another. After 10 minutes, she’s managed to fill seven holes. A few days earlier, she had filled two. It can feel like slow going, yet she makes steady progress.

“She probably wanted to throw the whole bucket at me,” Leonard says. “But when she first arrived at Shepherd, we didn’t think she was going to be doing these tasks this quickly.”

Shepherd therapists form a unique relationship with patients bringing to the table two seemingly opposing traits – empathy and tenacity. They push patients further than they think they can go, but no further than they’re able.

As Caroline stays focused, a friend who is visiting her smiles and says, “I sense the love-hate here.”

Caroline finally pushes the last peg into a hole and looks up proudly, her wide eyes searching the gym for Leonard and for confirmation of a job well done.

“Where’s Sarah?”

Patient’s Best Friend

Shanna Thorpe, CTRS, a recreational therapist, places a towel in Caroline’s lap like a waiter unfolding a napkin. Barboza, one of Shepherd’s four facility dogs, settles his chin on top. Caroline pats his head.

A family friend has offered Caroline an assistance dog when she returns to Savannah. Thorpe asked Mary Ashlyn Thiede, exercise physiologist, to bring Barboza to show Caroline what tasks assistance dogs can perform and some adaptive grooming tools Caroline can use to care for one.

Thiede hands Caroline a set of keys, tells her to drop them and call out, “Get!”

The yellow lab and golden retriever mix lifts his head, grabs the keys in his mouth and drops them back in Caroline’s lap.

Thiede explains that the keys could be a dropped debit card at a store, or a pencil in a classroom. She demonstrates how dogs can open doors or drawers, turn light switches on and off. They can retrieve items from a refrigerator.

Caroline rubs Barboza’s head, as he lies flat again in her lap.

Date Night

Caroline attends weekly sessions with Cheryl Linden, LPC, OT, counselor for Shepherd’s Spinal Cord Injury (SCI) Rehabilitation Program and SCI Day Program. They often discuss Caroline’s relationship with Scott under their new circumstances, and Scott sometimes attends with her. He delayed law school to stay with Caroline during her rehabilitation.

“Cheryl talked to us about moving forward and what that’s going to look like,” Caroline says. “At first, I didn’t know what it was going to look like for me by myself, let alone for the two of us.”

Linden suggested a date night, with Caroline making all the big decisions – what they’d do (dinner and movie), what they’d eat, what movie they’d watch.

“Caroline is not totally independent, but that doesn’t mean she can’t take the lead sometimes in the relationship,” Linden says. “When one person has to be in the role of caregiver in the relationship, the one being cared for has to feed the relationship, too.”

On a Friday night, Linden picked up meals that Caroline ordered from a nearby restaurant. The couple then dined alone on Shepherd’s seventh-floor balcony, overlooking Atlanta’s shimmering skyline.

They then moved downstairs to a classroom Linden reconfigured with a pullout couch, two husband pillows and a big TV. They watched “We Are Marshall.”

“It meant so much to Scotty that I planned a date night for him,” Caroline says, smiling. “It was one of the first times we were alone and not sitting in my hospital room. While we were still in a hospital, it was great seeing how, when we get home, we can go out on dates and be our normal selves.”

Life Outside the “Shepherd Bubble”

Caroline and Scott are handed boarding passes at the world’s busiest airport.

They arrived there by Shepherd Center bus, which brings patients to Hartsfield-Jackson Atlanta International Airport once a month, in partnership with Delta Air Lines, to learn how to travel post-injury.

The couple is preparing for their honeymoon in Mexico planned for summer 2019. A Delta official explains procedures for going through security – what TSA agents can and can’t ask about their injury, what to do about medications that exceed size limits. They then pass through security as if headed to an actual flight.

They take elevators and trains to their gate. A Delta plane is reserved there just for the group. They learn to transfer to chairs that can fit through an airplane’s aisles, and then into their seats. They’re told how to get help with overhead baggage or getting privacy for going to the bathroom.

The overriding lesson, says Alex Joynes, CTRS, recreational therapist, is that patients must advocate for themselves. As with other recreation therapy outings to restaurants, malls or ballgames, this trip shows patients how to respond to real-world challenges outside of the comforting “Shepherd bubble,” where things are accessible and planned with patients in mind.

Caroline and Scott find the airport outing invaluable.

“I couldn’t imagine us traveling and not have done this,” Caroline says. “We would’ve been lost.”

The Shepherd Way

Caroline and Scott leave a seventh-floor elevator and head into a surprise wedding shower the staff planned for them.

A big room is filled with food, presents and dozens of friends, family, staff and fellow patients. It could be an office party in any Atlanta high-rise. This one just happens to include therapists and many people using wheelchairs.

Caroline and Scott sit at a table with her brothers and friends. Scott fixes her a plate of food prepared by patients in the Adolescent Spinal Cord Injury Rehabilitation Program. A few patients give speeches.

Scott opens presents. He’s as befuddled as any just-out-of-college male might be.

“A scooper!” he says, holding up a spatula.

A therapist calls out, “Caroline, it’s not too late (to change your mind)!”

Laughter erupts. It goes on like this for almost an hour.

The scene feels light years away from the one-in-a-million accident that brought Caroline here three months earlier. It’s filled with jokes and small talk and hugs. It captures a Shepherd culture that affirms humanity, dignity and big victories gained one small win at a time.

“It was a long time before we could laugh,” says Caroline’s mother, Kathy Moore, as the party winds down. “Any hospital that can get you back to smiling and laughing and enjoying life, well…”

She takes a breath.

“The minute we walked through the door, we could feel that loving atmosphere,” she says of Shepherd. “They’re caring and compassionate, and they’ve really embraced Caroline. It just shows it’s like family around here.”

SIDEBAR: 
Treating the Whole Patient: Shepherd Center Helps Patients Cope with Loss.

Emily Hilaire was 29 weeks pregnant with her first child when she and her husband, Fred, a local sheriff’s deputy, went out to get something to eat near their Deltona, Florida, home.

They never made it: Their car collided with another vehicle parked in the middle of the highway, lights off and the driver asleep. The crash sent Emily to the hospital with a paralyzing incomplete C-4/C-5 injury. Because of the trauma, doctors soon delivered her baby by emergency C-section. Weighing 2.4 pounds, baby Lauren died six days later of complications from the collision.

Emily transferred from Orlando Regional Medical Center to Shepherd Center in July 2018. She arrived not only with a catastrophic spinal cord injury, but understandably with emotional trauma, as well.

The staff at Shepherd Center addressed both, employing the hospital’s unique ability to adapt rehabilitation to a patient’s individual needs.

Emily had several surgeries at Piedmont Hospital, which is adjacent to Shepherd Center, during her first few weeks, and that limited the amount of physical rehabilitation she could do. But she began working on other challenges. It’s not uncommon for a patient at Shepherd to be dealing with the loss of someone who died or was severely injured in the same incident that they were. Shepherd’s multidisciplinary medical teams are ready to help with emotional healing as part of assisting the whole person on their recovery journey.

“Initially, I didn’t even deal with her injury, just the loss of her daughter,” says Cheryl Linden, LPC, OT, counselor for the Spinal Cord Injury Program. “I took my cues from Emily, and that opened the door for us talking about her daughter.”

Emily showed Linden photographs of her baby, including one taken at the hospital of her, Fred and Lauren together. When they finished, Linden suggested they get frames and paint them.

“It just helped knowing I’d have pictures of her (Lauren) and of us for when we got home,” Emily says.

Fred was often included in counseling sessions with Linden. He also talked with Shepherd Center chaplain Ben Rose. Fred soon played guitar during chapel services – just like he did at the couple’s church in Florida. It helped Fred with his own emotional recovery and spiritual needs.

“It felt like back home, just playing guitar and doing things we used to do,” he says. “It was like having a piece of what we had before the accident.”

After two months, Emily moved to the Spinal Cord Injury Day Program. Shepherd patients often have reduced mobility in their hands and need to learn news ways for holding, changing and feeding their young children. Therapists use weighted dolls, adaptive cribs and other items to prepare patients for parenting with a spinal cord injury. Linden knew Emily and Fred hoped to have more children, and she again took cues from Emily to see if she wanted to include that kind of training.

“I sort of pushed her gently and let her make the decision,” Linden says. “Some days were easier than others.”

Emily returned to Florida in October 2018. She’s continuing rehabilitation at a center near the couple’s home, and she is ready to have her car adapted so she can drive.

“The nightmare seemed like it would never end, but we’re kind of back to normal now,” Fred says. “We can kind of look ahead a little because of how far we’ve come.”

Of her time at Shepherd Center, Emily adds, “It’s one of the best places you can be for someone in our situation. They address the whole family and their needs.”

Written by Drew Jubera