Brain-injured patients regain mobility with restraint therapy

Sean Wyko of Amsterdam was injured in a diving accident in 2005. But through modified constraint-ind
Sean Wyko of Amsterdam, who was injured in a diving accident in 2005, works with physical therapist Lori Reichel at Sunnyview Rehabilitation Hospital.
Sean Wyko of Amsterdam, who was injured in a diving accident in 2005, works with physical therapist Lori Reichel at Sunnyview Rehabilitation Hospital.

Sean Wyko, 24, of Amsterdam, knows he’s a very lucky man.

On June 5, 2005, while swimming in a lake in Texas with friends, he dived headfirst into a rock, nearly breaking his neck.

“I’m lucky my friends pulled me out,” recalled Wyko, an easy-going young man. “I tried to move my legs, but I couldn’t.”

At the hospital, he learned he had an incomplete break of the C-5 vertebrae in his spinal cord. Doctors removed bone fragments and fused C-4 and C-6 together.

Although at first, Wyko couldn’t walk, he vowed that by September that year he would be walking again.

When he was stabilized, he went to Sunnyview Rehabilitation Hospital in Schenectady for inpatient therapy for three months.

Although he was walking again by the end of September, his right arm and hand remained extremely weak.

Beginning treatment

Working as an outpatient with occupational therapist Lori Reichel last year from September to November at Sunnyview Hospital, Wyko began treatment with modified constraint-induced movement therapy.

That is a type of therapy involving intensive training of the weaker arm while restricting the use of the stronger arm with a mitten or a sling for much of the day.

“I’m working on getting my fine motor skills back and strengthening the muscles in my hand,” said Wyko, who is ambidextrous and writes with his left hand. “I still have a way to go, but the therapy has been doing some good.”

Reichel said people wear a mitt on the unaffected arm for about five hours a day during times of peak use, forcing them to rely on the affected arm for eating, grooming and light household activities.

In addition to wearing the mitt, participants attend three therapy sessions each week, 30 minutes per session over a 10- to 12-week period.

Therapy consists of exercises called “shaping tasks’ that are designed to improve motor control and functional use of the affected extremity. Patients also complete those exercises at home.

“It’s definitely helped me get some movement and strength back in my hand,” said Wyko, who wears the mitt on his left hand at home and practices as often as possible.

“I try to do things like pick up a cup or set down the remote on the table,” he said.

Wyko admitted he gets frustrated at times.

“When you’re in therapy, you have someone to support and help you,” he said. “When you’re home doing it by yourself, sometimes you just feel like throwing stuff.”

Reichel said most people who use the therapy have had strokes or spinal cord injuries. Candidates must have some movement in their hand and wrist, as well as any two fingers plus their thumb.

Need for commitment

“Patients have to be able to commit to participating fully in the program,” said Reichel. “It’s not for everybody. There’s definitely patients who aren’t willing to wear a mitt for five hours a day.”

Patients must also be able to follow directions and understand how the program works.

Sunnyview has used modified constraint-induced movement therapy since 2006.

“The goal of therapy is to regain as much functional use of the affected extremity as possible,” said Reichel.

Wyko, who worked in construction, at a gas station and in a daycare center before his accident, recently earned his GED. He plans to get a job for the summer before attending college for business in the fall.

Before modified constraint-induced therapy, he was unable to get his hand around or pick up a cup.

“Today, I can pick up a cup again,” said Wyko, who has had botox injections in his arm to help relax certain muscles that are spastic. He also exercises other muscles that are weak.

“My biggest goal is to get some of my fine motor skills back,” he said.

On a recent afternoon, he practiced putting rubber bands on a small cone on a table while Reichel encouraged him.

“Oh, you got one,” said Reichel, as Wyko slowly placed a rubber band on the cone.

“My hand feels tight now,” said Wyko. “I do a lot of stretches throughout the day. So it loosens up and relaxes just about the time I’m ready for bed. That’s been frustrating.’’

Reichel said when Wyko started doing modified constraint-induced movement therapy, he had a hard time stacking cans, which he can do now. He also went from being unable to bounce a ball to bouncing and catching it 10 times in 15 seconds. He can also flip over cards.

Positive outlook

Wyko described himself as a positive person.

“I never really got that upset at anything that happened,” he said. “It doesn’t get you anywhere. I’ve learned to push it aside and just deal with it.”

Wyko, who lived in California for 12 years, hopes to return to mountain biking and skateboarding within the next few years.

“I’m doing so well I’m more motivated than ever,” he said.

Still, he is also realistic.

“I know I’ll never really be 100 percent, but I’m hoping for 90 percent. If I can just hold things and lift and put them back down again, I’ll be happy.”

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