The Golden Goose

As a clinician working with the vast array of Spinal Cord Injury (SCI) presentations in the community setting for almost 10 years, I can say that I've just about seen it all. Each person is so different, and each injury is so different - creating this vast array of colourful clinical presentations. Many health professionals can attest that amongst their clients there are a handful that don't listen to a word you might say, many others follow directions and are semi-committed to their program for health maintenance. Another handful follow their programs with motivation and dedication and often take the mantle for "the favourite clients". But rarely do we cross paths with clients that have the tenacity, dedication and will power to work as hard as required to see progress translate into meaningful outcome. Especially considering the complexities in the chronic population where significant and maintained progress is as rare as hen’s teeth. ?

But every so often one of those golden geese wander into the clinic that redefines what might just be possible.

Meet Phil…

Phil sustained a non-traumatic spinal cord injury following a relatively routine shoulder surgery over 14 years ago. This caused a cascade of events in Phil's life, starting him down a path of self-destruction and anger. Eventually Phil said to himself enough is enough, this way ends in only one desolate outcome – it’s time to forge my own path and see what I'm really made of. It’s time to (figuratively and metaphorically) stand up to that nipping black dog.

Phil has engaged with several health professionals across his recovery journey in the 14 years since his injury. A handful of these professionals have told him "your injury is permanent, why waste your time and your effort? You should be focused on maintaining what you’ve got, not fantasising about what you once had. You are only hurting yourself by pursuing this fantasy. It’s not worth it"

Switch places with Phil for one moment. Imagine you are the one in the wheelchair. Imagine it is you on the receiving end of that condescending conversation that your goals are pointless. Would you ever accept that you are not worth it? That your goals and aspirations are trivial and but a fantasy?

I know what I would say to whoever might say that to me – and it would be rather colourful…

Thankfully, the number of positive health professional engagements far out-weigh the negative and there have been far too many overwhelmingly positive engagements for Phil to count that have had a resonating impact on his progress. Many have challenged Phil and encouraged him to take the proverbial bull by the horns and get started on that next set, rep or set. In response Phil has gritted his teeth through these life challenges, and he would say he has emerged the victor.

There is a common misconception that every spinal cord injury is permanent. And by definition, yes - within current medical science there is nothing that will reverse the damage that is done. The misconception continues that the function you have when you are discharged home home is what you have and is what you've got forever. It is often phrased "a waste of time and resources" to work on the things that were cruelly taken from you.

I'm also not ignorant to the fact that every spinal cord injury is different, but that only highlights that we should approach every spinal cord injury differently. What I weigh as miniscule improvements may in fact mean the world to those that find themselves managing the complexities of an SCI. Who am I to weigh up what someone’s goals can or can’t be? I feel it solidifies that everyone is worth giving it a go, that every person we come across has this hidden potential that is "worth" uncovering!

What harm is there in "giving it a crack"?

Since Phil commenced at Compass Allied Health, he has outperformed almost every outcome we have established. Phil has been seeing me as an AEP every fortnight for the last 6 months. Phil's outcomes are below:

Phil’s program has had a core focus on education about his gait cycle, careful review of what his gait deficits are, interventions utilising the principles of neuroplasticity, discovering together what aspects of his gait are resultant from the neurological damage caused by his SCI and what is actually disuse or poorly developed compensations; and specific exercise prescription to address those weaknesses in clinic, at his community gym and at home.

At Compass we have access to some of the newest and most versatile technology for gait training available in the community allied health space. Professionally, I’ve also been (gratefully) afforded several opportunities across my career for ongoing education on how to apply the most up to date evidence into gait training practices in SCI. This mix of experience and specialised technology has opened new opportunities to Phil who lives in rural NSW to challenge himself on this ever-evolving journey – and by doing so has revealed the potential that he didn’t (initially) believe existed. Phil is testament that will-power, dedication and that hard work can pay off. He diligently follows his gait focused program, attends at least 4-5 highly intense progressive resistance training sessions per week, walks every day and pushes his limits both physically and mentally every session he attends. It is also worth noting that Phil does all of this around his part time employment - Impressive right? Puts things into a bit of perspective.

I encourage all health professionals out there helping people on their complex SCI journey to think outside the square - because that is what is often what is needed to have a significant impact. What haven't you tried? Take a moment to reflect on your current practices and re-think what might be possible.

Is it the client that has plateaued - or is it your clinical skill?

Think of Phil and rethink your expectations.

Golden Geese exist.

You can see more of Phil's story by following the link to this Post. Leave a comment and share the message.