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In late June, the physical therapist deemed Matt ready to graduate from walking along the hallway rail for support to a regular wheeled walker or one that included platform attachments for his elbows to lean upon. After watching him try them, we felt the platform walker served him best. It offered him better trunk control and, unlike the standard walker, didn’t necessitate sustained elbow extension to lean over it —a problem for his right arm. Since the wheeled platform walker was less secure and stable than the rail, once again, an entourage of helpers was called in to assist—including me. Some days, I was tasked to prod Matt’s left leg into taking larger steps while the PT helped move and support his right leg, and a third person prevented the walker from “running away” and, of utmost importance, him from falling. For some time, the therapist scaled back how far they would walk to 20-30 feet to provide a much-needed rest break for everyone before repeating the process several more times.
Out of sync with Matt’s ability to walk with PT and me, therapy had yet to give nursing staff clearance or training to advance from the mechanical lift, which demanded no effort on his part. When the nursing staff requested Matt be upgraded to a sit-to-stand lift device, the physical and occupational therapists readily agreed. The sit-to-stand lift device would involve him in getting out of bed while continuing to reduce the risk of a fall or injury to the staff or Matt. Over the next week, the therapists trialed and trained staff with the new lift and successfully banished the mechanical lift to an equipment closet. This was a milestone for our family as well. If Matt were to need a lift when he finally came home, this device would be much simpler to manage. Pleasantly, this wouldn’t be necessary. By mid-July, this lift was discontinued, and Matt could stand up with one or two aides and pivot to the chair, bed, and toilet.
Components of gait were broken down and practiced between parallel bars, such as stepping up or over a block, walking backward and sideways, and doing mini-squats. Matt graduated to a one-sided, right-armed platform walker that raised the bar—expecting and demanding more from him in this regard while backing off on how far they wanted him to walk. Gradually, Matt became less dependent on others, still far from independent but better. He was learning to keep erect, bear weight through his right leg, advance it alongside or occasionally step beyond his left foot, and take a few small steps backward.
Stairs came next. Matt draped, once again, over the physical therapist’s shoulders as they grunted up four steps. Equipped with grit and the arms of an octopus, the therapist nudged and prodded him to move his hand along the rail and lift and place the right foot on the next step. Meanwhile, she prevented his trunk from jackknifing and his knee from buckling, and upon reaching the landing, they completed an about-face to head back down. From experience, I recognized this audacious bravado that convinced herself and others that she would succeed—the hallmark of a particular breed of therapists. It was something to behold. Soon, she down-graded from the bilateral platform walker to one that just supported the right arm and required him to bear weight through an extended left arm.
Excitedly one day, his therapist glowed like a mighty warrior when she announced in early August that Matt could get out of a chair and walk with his one-armed platform walker, taking unaided steps with his right leg and minimal assistance from her. Upon hearing the news, I shared her exuberance, grinning like a Cheshire cat.
On weekends, Matt worked with substitute therapists. One experimented with a forearm crutch with a cuff around the forearm and a handle below to grip, which required more balance, synchronization, and an entirely new rhythm. It was sloppy-looking and uncoordinated, just like it was every time the stakes were raised. I stood close by in hopes of preventing a fall. I followed the therapist’s lead and, in my head, encouraged Matt “to hang on for dear life.” His primary therapist did not go off on this tangent but did swap out the one-armed platform walker with a regular-wheeled walker. Having just gone through the previous adventure, this was much easier for Matt in every way imaginable.
The physical therapist knew that Matt’s time at Sunnyview was running out. She worked diligently to augment and improve his gait before passing the baton to the therapy staff at the sub-acute rehab facility. With the same goals, the new therapists would build upon Matt’s function and finalize the preparations for a smooth transition to living at home.