Transforming Moments

Jessica’s Story

Walking to Recovery

Eight-year-old Jessica was enjoying Superbowl XL with family and friends when she began complaining of a headache and lost consciousness. A resident of a small town about 30 minutes north of the North Carolina border, Jessica was flown to Virginia Commonwealth University Health System where she underwent emergency surgery for a cerebral or brain aneurysm. Doctors gave her 72 hours to live.

That was a year ago.

Following her surgery, Jessica had a stroke and underwent additional surgery to remove the right side of her brain. After spending two months at VCU Health System in a medically-induced coma and two more months at Children’s Hospital, Jessica was released to Children’s Hospital’s outpatient program where she continues to receive weekly physical, occupational and speech therapy treatments and is followed by a team of pediatric specialists from neurology, neurosurgery, orthopaedics and physical medicine and rehabilitation.

Caused by a weakness in the wall of an artery or vein within the brain, a brain aneurysm is an abnormal widening of that artery or vein. Although doctors do not always know what causes brain aneurysms, they can be caused by blood vessel malformations, infection or trauma or associated with family history. They are very rare in children. And while many people unknowingly have aneurysms, when they rupture, blood can spill into the brain, increasing pressure inside the skull and depriving the brain of oxygen.

The Weekly Commute

Jessica’s mom, Shannon, began making the weekly three-hour roundtrip commute to Richmond for Jessica’s therapies in June 2006. When Jessica began her treatments, Shannon described her “like a newborn baby with no coordination.” She had poor eyesight, could barely speak above a whisper and couldn’t roll, sit, walk, dress herself or handle any of the other daily living skills. Doctors also feared that Jessica would never regain use of her left side.

As part of Jessica’s medical team, Sandy Timok, PT, PCS, began working with Jessica on mobility issues including rolling, sitting, standing and walking. By September, Jessica had learned to walk with a walker and assistance from her family. She’s now focusing on walking only with her walker so she can walk without adult assistance into a party to celebrate her recovery.

“Jessica fought hard to stay with us,” recalled Shannon. “My goal is that by this time next year, she’s running.”

While Jessica’s not quite ready for the track, Sandy credits Jessica’s progress to the daily work Shannon does at home. Jessica has a gait trainer to practice walking without adult assistance and a therapeutic bicycle to build strength.

“Having her family so involved in her therapy has really helped,” said Sandy, who tries to incorporate Jessica and her family’s goals into her treatment plan. “If they are their goals, [the patient and family] are more apt to work with you.”

The Benefits of Multi-Specialty Care

Sandy also credits Jessica’s multi-specialty team of therapists and physicians with her recovery. Through constant communication and idea sharing, Sandy said the team can make quick adjustments to Jessica’s treatment plan so she can “continue to progress quickly instead of having to wait” to see the next specialist.

Eugene Monasterio, MD, FAAPMR, Director of Outpatient Rehabilitation, follows Jessica through the hospital’s spasticity clinic, which includes specialists from orthopaedics, physical medicine and rehabilitation, neurosurgery, neurology and physical therapy working together to treat spasticity and movement disorders. Treatment methods include oral medications, local injections and orthopaedic surgery. In addition to the convenience of allowing a patient to see a variety of specialists during one visit, Dr. Monasterio said the ability to communicate quickly “helps us all find the best way to care for long-term problems.”

As part of her treatment, Jessica has received three botox injections. Because botox works by relaxing muscles, Dr. Monasterio and Sandy communicate frequently to ensure that Jessica’s muscles don’t become so relaxed that Sandy is not able to strengthen them during physical therapy.

For Shannon, the constant communication with Jessica’s therapists has meant faster progress for Jessica. When Shannon noticed that Jessica could walk better without the foot braces she wears to keep her arches from falling, she mentioned it to Sandy. Sandy talked with Dr. Monasterio, and within a few weeks, Jessica had new braces to fix the problem.

Combining Therapies

Because Jessica initially had difficulty participating in nearly three hours of therapy each week, some of her therapists combined sessions to provide two therapies at once. Carrie Hughes, MS, OTR, occupational therapist, and Jackie O’Connell, MA, CCC-SLP, speech therapist, worked on fine motor and speech skills during co-treatment sessions by helping Jessica write and speak words simultaneously. These combined therapy sessions also are helpful when Jessica has a physician appointment during her weekly therapy times or when Shannon needs to get home to take care of one of her other four daughters, ages seven months to 14 years.

Jessica, who was a straight A student and read on a fifth-grade level in second grade before her aneurysm, now attends school three hours a day, four days a week. She enjoys reading and is working with her therapists to regain that skill. And when she goes home, Shannon continues to push her.

“If she does something new for me,” said Shannon, “I tell her therapists and they work it in.” While she’s made great strides since last summer, Jessica’s continuing to work on strengthening her muscles, completing daily living skills, improving her memory and organizing her thoughts.

To meet the last two goals, Jackie uses activities like Outburst® and word guessing games to help Jessica “focus not only on word finding but thought organization.” Jackie said she appreciates the hospital’s multi-specialty approach because it allows her to learn about other disciplines and how to incorporate those goals into her therapy sessions.

Carrie also incorporates fun activities like puzzles into her occupational therapy sessions. In addition to being able to dress and feed herself, Carrie said, Jessica is now more willing to try new things and unlike her initial therapy sessions, doesn’t get upset during treatment. And while Carrie focuses on using Jessica’s right side, she does utilize exercises for Jessica’s left side since some muscle activity has been observed there.

Despite the long commute, Shannon said she makes the weekly trip because Jessica is comfortable at Children’s Hospital, has a good relationship with the staff and will work for them.

“I’m very thankful for Children’s,” said Shannon, “because if it wasn’t for Children’s, I don’t know where we’d be right now.”

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