Small Muscles, Big Progress

Twenty-two-year-old Bryson Parker and his occupational therapist, Jasmin Torres OTD, OTR/L, meet for Bryson’s therapy session in Shepherd Center’s Day Program gym. A country music playlist floats from the speakers behind them. Bryson is used to tough workouts — as a college football player, he spent lots of time training. And his discipline and determination are serving him well in therapy.

He equates learning new things in therapy with trying new drills at football practice.

“Sometimes I have to do [exercises] that I'm not comfortable with,” he explains, “And I end up getting used to it, and I'll get stronger at it.”

Bryson sustained a C4 spinal cord injury when he experienced a seizure and fell from his bed in his dorm room last year. He participated in therapy at Shepherd Center and graduated from the inpatient Spinal Cord Injury Rehabilitation Program and Day Program. He went home for six months and has returned to Shepherd for a second round of the Day Program. He’s only been back a week, but in addition to occupational and physical therapies, he says he’s started learning to play the piano in music therapy, attended yoga, gone to the ProMotion Fitness Center, and practiced what he’s learning in therapy in the apartment he shares with his mom in the Irene and George Woodruff Family Residence Center.

He’s working with Jasmin on several occupational therapy goals, including improving his posture, lengthening and stretching his biceps, and refining his hand movement, which will allow him to do more things independently.

First, Jasmin helps Bryson transfer to the mat, and he works on prop sitting — sitting up straight with his arms behind him for support. Bryson’s biceps are strong, but also very tight, so Jasmin is choosing exercises to help him stretch and lengthen his biceps and strengthen his triceps. 

“The first time we got into prop sit and worked on these exercises, it took me at least 20 minutes to get him into that position because he was just so tight and in so much pain,” Jasmin says. “It took us a while to progress to this.”

But Bryson has made a lot of progress in the past week and can get into the prop sit position more easily and hold it for an extended period. He can definitely feel the stretch, but says he’s getting used to it now, so it’s more comfortable.

Jasmin is also helping Bryson refine his movements. She explains that as a football player, Bryson likes to put a lot of power into his movement, and he spent a lot of time at home after the Day Program strengthening his biceps. But having strong biceps without relatively strong triceps is, in part, what led to tight muscles in his biceps and elbows, so they’re working on lengthening his biceps and coordinating his scapular muscles (muscles that attach to the shoulder blade. 

“In addition to getting more range in his elbows and biceps, he's working a lot on posture correction,” Jasmin explains. “He holds a lot of tension in his neck and upper back. So a lot of it is coordinating the muscles. When you have neurologic weakness, it's really hard to pinpoint the muscles that help with upright posture and neck alignment. So that's a lot of what we’ve been focusing on.”

“I used to depend on my headrest a lot,” Bryson says. “I don’t even use that anymore. I just sit up.”

After doing some exercises to improve his posture and strengthen his neck muscles, Bryson and Jasmin move on to hand exercises.

Bryson is learning to put a universal cuff (U-cuff) on his hand. It has a small pocket that can hold things like a marker, toothbrush, or eating utensil. Bryson practices drawing and writing his name with a marker. He wants to get back to writing and typing and return to college for his junior year.

Next, he chooses to work on picking up items using his fingers.

“Another goal of ours is to refine his hand movement, his pinch pattern, so that he's able to grasp and release a little bit more easily,” Jasmin says.

Bryson is working on holding his wrist up while opening his hand wider and wider to pick up increasingly large items. He has learned how to use spasms to help him open his fingers.

“The first time it happened, I had a regular spasm, and I started moving my fingers with it. Then I repeated it,” he recalls. “Then [my fingers] got tired and actually stopped moving for two or three days. And then I ended up triggering another spasm, and I started using it, making it stronger.”

Jasmin explains that the small muscles in our hands fatigue quickly, so they only do a little fine-motor work during each session.

As he works, Bryson sings along to a country song — he knows every word.

Turns out, the playlist is no coincidence.

“I just know that this is always what he wants to hear,” says Jasmin.

“24/7,” Bryson replies with a grin.

Written by Ruth Underwood