It was supposed to be a normal afternoon outing to the park with his family in May 2017. But that changed drastically when Jason Haley went over the front handlebars of his bicycle, fracturing multiple bones in his face and suffering a spinal cord injury that left him without use or feeling from the neck down. After extensive inpatient and outpatient physical therapy Jason was making a miraculous recovery, being able to transfer independently, push himself in his wheelchair, and even walk with the assistance of a walker.
Jason returned to outpatient rehab in November 2017 with physician orders to begin a treatment plan including aquatic therapy. After the evaluation, Jason’s treatment plan consisted of two days per week of one land-based therapy, and one aquatic-based therapy for Physical Therapy (PT) and Occupational Therapy (OT).
In the beginning, Jason’s 60-minute aquatic treatments were overlapping co-treatments between Occupational Therapy and Physical Therapy. In these treatments, we focused on core strength and stability, base of support, and balance recovery combined with trunk twists, upper extremity movements, and reaching in standing (position). These movements included transitions from squatting and sitting to standing position in waist high water.
With improved stabilization, we began to shift treatments to 30-minute PT, 30-minute co-treatment, and 30-minute OT. The split treatments allowed PT focus on ambulation with the aquatic walker, specifically on leg positioning during the gait cycle, and decreasing upper extremity movement during swing phase. The treatment focus shifted to more dynamic treatments, and simultaneous bilateral upper extremity movements to work on balance recovery and stability. OT has continued to work on upper extremity strengthening and coordination on land and water during trunk control, trunk rotation with reaching, and bilateral upper extremity strengthening.
As ambulation, stabilization, and gait cycle progressed, Jason has been able to ambulate in chest high water without any assistive device with continued focus on foot positioning and reciprocal arm movements. We also have added ambulation backward and lateral sidestepping to improve movements in all planes.
Currently, we have progressed to adding the use of the lazy river to challenge Jason’s strength and stability with ambulation. We have also added ladder climbs for full body strengthening and coordination. We are continually advancing Jason’s treatments based on function with his daily life. Jason would like to be able to lift his wheelchair into the bed of his truck, and drive his truck with hand controls on his own. His ultimate goal is to be walking on his own without an assistive device.
Jason has been able to guide his treatments secondary to his intense motivation and ability to communicate any functional movement deficits. The water has allowed intense training on balance, strengthening, and ambulation with gravity eliminated to facilitate progress to carry over to land-based therapies. Having gravity eliminated has allowed strengthening in specific positions that Jason was unable to achieve on land in the beginning. Jason continues his treatment plan with a combination of land and aquatic based treatments. Keep up the hard work, Jason!
by Jennifer Fallert, PTA