Some days are good days. Some days are challenging days. Sometimes good days come out of challenging days. Friday was a good day which came after a challenging Thursday. One thing that Ioana likes about physical therapy here in America is the fact that every day she is doing something different so she doesn’t get bored with the routine. But it can also mean that things come her way which she is not expecting. Thursday was a day where she got something she was not expecting.
We work with a great physical therapist named Katie at Children’s PT clinic in Broomfield. Katie holds Ioana accountable but also is compassionate toward her and maintains an excellent therapeutic balance in working with Ioana. One of the challenges that we are trying to resolve is that Ioana cannot fully extend (straighten) her right knee. It stops at about five degrees from complete extension and she needs to strengthen a specific muscle in order to help achieve full range of motion in her knee. She has vastly improved her ability to straighten the knee through daily exercises where she straightens her leg while lying on the floor with a rolled up towel bolstered under her knee. In the beginning she could barely lift her foot off the floor, but now she can lift it much more easily and hold it up. But in order to help to teach the muscle to fire correctly and get the signal from her brain it is necessary to use electrical stimulation. This is involves a little device that uses two patches on the front of her upper right leg and is wired to a battery operated unit. Basically you turn the unit on and it forces the muscle to contract through electrical stimulation (E-Stim).
The problem is that Ioana has had some traumatic experiences around E-stim in the past. As Katie rolled her pant leg up and began pulling out the unit, Ioana looked at her and said in perfect English “electrical stimulation?” with eyes wide open in fear.
From there it just didn’t go that well for the rest of the session. Even with allowing Ioana to have control of the E-Stim unit she couldn’t settle down enough to even begin to use it. It was a classic case of previous trauma. Ioana would tense up her entire body, wave her hand that the current was too strong, all while breaking down crying. Katie would then show her that she hadn’t even turned the E-Stim unit on yet! I had witnessed the same thing the week before when we began the work with the FES bike which uses the same technology. But this time it was worse. I became frustrated, Ioana moved from fear to anger and Katie was wise enough to know that it was pointless to push the issue at that moment.
But Katie made it clear that Ioana was not off the hook with the E-Stim. She put a device on her own arm and let Ioana control the unit and power of current. But Ioana was not impressed. “That’s okay” Katie said, “I’m going to send this home with you and you can practice with it there. It’s a gift for you.” The rest of her physical therapy that day consisted of a brooding teenager that was clearly not interested.
We finished up and left the clinic. As soon as we were outside Ioana said to me “This is the ugliest gift I’ve received in America.” I sighed inwardly and so badly wanted to begin a tirade but have had enough experience with her to know this would not be effective nor would it help matters. As we drove home she continued to fume over the E-Stim. “I thought I had escaped using the “electro” when I came to America!”
After we got home I didn’t bother pursuing it any further. She had to go to ESL classes shortly thereafter and I left for a bike ride to release some seriously pent up energy and frustration. Later in the day Pam came home and I told her how it went. I think we both went into planning mode as to how we could implement this at home but never conveyed that verbally. Many times in the last weeks Pam and I can read each other’s minds and find out later we’re on the exact same thought path.
That night after I had gone to bed Pam and Ioana were working on a jigsaw puzzle as they do most nights. Ioana loves jigsaw puzzles. Watching her work on one clearly shows that she can focus and is a bright kid. She becomes so ingrained in the task that she tunes out everything around her but it also brings about a sense of calm and peace. It created an environment where she and Pam could talk about the E-Stim and her past history with it.
As we went to therapy on Friday we pulled into the parking lot and were just a few minutes early. I had been thinking about how we could implement the E-Stim at home and knew that if Ioana used her faith it would be the best tool we could use. As she went to get out of the car I said “Hold on a minute. I think it might be a good idea if you prayed before you go into therapy today.” After, as she got out of the car, I expressed that perhaps praying will help her face whatever comes her way at therapy.
Of course, two physical therapists asked how the E-Stim was going at home. I related that I was still devising a plan to implement it, and truly I was! I knew that Ioana would come around because she doesn’t like being defeated at all. But I wasn’t sure how to set up the situation to be in her favor.
As we drove home I laid out my plan before her. We decided that she would do the E-Stim three times a day every day. We would begin at the very lowest level with her exercises and then progress from there as she got used to how it worked. I emphasized that we would not crank up the current to where it was traumatic but rather ease into it over time.
Later in the afternoon before she went swimming I told her we needed to do the E-Stim quickly before she went to the pool. Again, a comment from her in the bathroom, “Now, my day has been ruined.”
“Ioana”, I replied, “please, no more comments about ugly days and ruined days because of this.” We got set up on the floor and I explained exactly how we would proceed. The first two sets of exercises proceeded with tens seconds of current followed by twenty seconds of rest at a level of one on the machine. The third set we agreed to try the intensity at one and a half. The first two repetitions were intense and she wanted to go into tensing up, resisting and fear. After that she began to calm down and a few repetitions later she was talking to Pam about something else from her day’s activities. By the end she ended up doing more than ten reps because we lost count.
After it was all over I asked her if the E-Stim machine was what she feared most in life. Yes, without a doubt, it was. It didn’t cause her the same kind of pain as some of the emotional things she has faced in life but from a physical standpoint it was what she feared the most. She was even more fearful of this little black box than she was when they inserted two rods and twenty-two screws in her spine!
In a span of a little over twenty-four hours Ioana had been knocked to the ground, found her way back to stand up and began to fight back against something that has been a nemesis to her. This has been the story of her life. She loses many battles each week while she is here. But she always comes back with a plan and a determination so that she can win the war. I’ve seen this happen countless times since I’ve known her. Again, she is the teacher, and I am the student.