April 1999

April 1, 1999 (from Jud Klooster *edited by lk)

The therapy team continues to work with Cherylin on many aspects of her recovery - paying special attention to exercises aimed at reducing the potential of "foot drop", encouraging her to lick her lips by swabbing her lips with a lemon-flavored spong tiped stick, and stroking the corners of her mouth to encourage a little smile.  They're also using small hand-operated toys to encourage her to use her hands.  Cherylin is responding to this therapy by repeating the motions demonstrated by the therapists. The therapists view this as purposeful respoonse to auditory stimulation.  Cherylin has also expressed her preference to not have the therapists put ice on her back or shoulders by pushing them away!  During today's therapy session, they had the  Passy-Muir valve in place, hoping to facilitate audible word sounds.   There were one or two guttural sounds, but   apparently she wasn’t quite ready  to make real words.

When Shelley (one of the therapists) and the others finished the session and packed up their little package of gadgets, Shelly turned to her and said, "Good-bye, Cherylin!"  Cherylin WAVED a few fingers at her, and again when Ann and Mary Lee said good-bye.  This waving was not the wimpy minuscule movements that we sometimes are glad to see—this  was a REAL WAVE. . . !! Fingers only, not the whole arm-- but a wave of the hand. . . !! And that, perhaps, was the Big Moment of her behavior that we always look for each day!  More tomorrow— we may start doing some of these "updates"  as weekly summaries, instead of in the format of daily reports.   Let us know by  e-mails which you would prefer, Net readers. . . . .!!!

April 2, 1999 (from Jud Klooster *edited by lk)

Today was the end of Week Eight since Cherylin's accident -- a lot has happened.  We're glad to be here for the little help we  can give, and we're glad that Clara (Bob's mother) is here. She's a great help to Bob, and that reflects on all of us as a blessing!  Today, Cherylin had a little vomiting spell early this morning-- not sure why, but it may be because of some change in her medications.  She was given Phenergan, and that soothed her very effectively, but it also made her even sleepier than usual, so her therapy session didn't have as much tangible response as we always hope for.  They used the tilt table, and Ann was able to get her feet FLAT on the footrest, thus assuring the her Achilles area ligaments were fully stretched.... that's the opposite of "foot-drop".  The nurse practitioner listened to her abdomen and said the stomach sounds were quite normal, and believes that the vomiting will not likely recur.  They keep a close eye on her whenever there's any irregularity of this kind.

In the therapy session (while her body was nearly vertical on the tilt table), she pushed the therapists hands away to keep them from using the ice too long in any one place-- she reacts quite promptly to it, and her reaction is directed to the source of the irritation.  They were able to get her to turn her head toward Phyllis and even wave (a wee bit) to her once or twice. . . .  in spite of her generally sleepy state.  They said the Phenergan is fairly short-acting, and thus will not have too long an effect on her awareness.  After the table was out of the room, Ann and Phyllis were gone, Mary Lee stayed on to work on the range of  motion of Cherylin's right arm... to get it "willing" to reach up behind the crown of her head, feel her hair, etc.  The right arm has thus far  been less fully "ranged" than the left.  Same for the right and left legs, but the difference in range and mobility is much smaller between the right and left legs, than between the arms.

We continue to be impressed with the devotion, energy and diligence of  these therapists, and with the splendid caring concern they show in all  their conversations with Cherylin, and with us about her.   Dr. Baez spoke truly when he told us that the PT, OT, ST and RT therapists are the center focus of whatever can be done to augment the rate of healing from the brain injuries.  What a team!!   That's about it for today, for this week. . . more to follow, as God's drama of healing unfolds in the days ahead.

April 4, 1999

The folks report that it was a fairly quiet weekend for all of them. The stomach upset occurred again, but they are now attributing it to movements of the trache tube.  One of Cherylin's nurses, Chloe, reports that Cherylin squeezes her hand (on request) each morning when she first goes in to greet her.  Chloe was the nurse on this service the day Cherylin  was admitted.  She thinks Cherylin has made a lot of progress in her general awareness during the weeks she's been her nurse.  Cherylin had numerous visitors yesterday and today-- the weekends give Dayton people a little more time to come here than would be possible for most of them during the week.  The folks will see another therapy session tomorrow and hope that Cherylin will be a little more alert.   

April 5, 1999 (from Jud Klooster *edited by lk)

Today Cherylin  had the vented trache tube in place all day-- it was still there in the evening when we left, however the Passy/Muir valve had been removed.   The plan of action is to see how well she can tolerate the vented tube, re-learning how to cough through her pharyngeal airway.

Cherylin responded as in recent previous days, to the use of  the little plastic toys that require her to press a button or squeeze two parts together and did fairly well, in an elementary way - much better with the left hand than with the right. Mary Lee and Phyllis had her working with little ten-inch colored plastic cones (like the orange traffic cones used to mark off street repairs, only much smaller!) to stack them one on top of the other.  She did fairly well at this, but required help to stay coordinated.  She nodded at me this morning when I first greeted her, and asked if she was delighted to see her Mom - just a little nod, but an affirmative response. 

When Ann forced her knees down to stretch the Achilles ligaments and force the feet flat on the step stool, Cherylin made some kind of  growly response with her throat. . . but no recognizable words!  Her body language combined with this throaty objection made her intent very clear, to get Ann to ease off!  But they couldn't get her to make words.  The throaty sound is made possible by the vented trache tube combined with the Passy/Muir valve.

When it was nearly time to quit (22 minutes of the half hour used up) Ann let her just sit on the bed without the other therapists holding her body up in a seated position-- she sat there for about two minutes without  help, holding her body from falling sideways with her two arms angling out to the bed, bracing on each side.  Finally she began to fall backward and Mary Lee just caught the motion gently and eased her down to a reclining position.  These therapists show a marvelous finesse in letting the client do all she can, but being there to instantly take over if the movements falter or get out of hand.

Bob will be here tomorrow-- we have a "family conference" scheduled with the objective of assessing her progress thus far, and trying to formulate some idea of where we go from here.  We're looking forward to this, as you may well imagine!

April 6, 1999 (from Jud Klooster *edited by lk)

Today seemed like real high point in the "Cherylin Recovery Saga", even though the specifics may not seem any more dramatic than in many previous days. But listen up, and tell me if you disagree!

First, Ann put the new shoes on Cherylin that we bought her yesterday.  She sent us out to get them, because she thinks the shoes will hold her ankle at a favorable angle better than the splints she been wearing for most of the last three weeks.  We got her some ankle-high Nike's-- they look pretty classy on her while she's laying there in bed!  They got her loaded into a wheelchair during the therapy session, with the intent that we could wheel her around the unit, or maybe even elsewhere in the hospital.   But then she had one of the nausea spells, so they had to put her back to bed.  

Cherylin was sitting on the edge of her bed when Phyllis first put on the shoes, at Ann's instruction.  They were quite charmed to see Cherylin lift her legs up so she could look at her feet-- Phyllis suggested she do this, telling her how great they looked, etc.. . . . and sure enough, she just lifted her legs from the foot rest and stuck them out nearly straight so she  could see them!  Just like you'd EXPECT Cherylin to do, with a new pair of shoes!  [Or perhaps ANY woman, with a new pair of shoes?]

Prior to this, when she was first sitting up,  Phyllis asked her to lift her foot from the floor up to the footrest, and she did so.  Arlene saw this. . .   Phyllis showed her some of the flash cards that she (Cherylin) uses with her own speech therapy clients, to help them visualize sounds.  Phyllis was quite sure that she saw a momentary flash of recognition pass across Cherylin's face, somewhat as if she were thinking, "Why, those are like the cards I use. . . !"  One can only speculate if that's what she was thinking.  After the little nausea episode, they let her rest about  an hour.. . . then another OT, Bethany Hewitt, came in and worked with Cherylin a little while.  She gave her a little handful of colored wood pegs and asked Cherylin to hand them to her, one at a time.  Cherylin did so; they repeated this exercise two or three times. . . she seemed to enjoy doing it, since she repeated it so easily.

Today, she spent most of the day with the airway completely capped off; they went back to using a nasal cannula for the moisturized air/oxygen mixture.  When we talked with Dr. Baez about 6 this evening, he seemed very pleased with this step forward-- says if she continues to do well without the use of  the trache tube as an airway, they'll take it out altogether.  This has been the objective of this phase-out transition from full-time use of the tracheostomy to the time when it will no longer be needed.  He pointed out that, "If she can breathe, cough and swallow with that thing in there, she certainly can do so more easily without it!"  The therapists (and Dr. Baez) tentatively believe that the nausea is triggered partly by the presence of the trache tube, since any movement of that tube in her larynx tends to trigger a moment (or sometimes more of an episode) of layrngospasm.  Another contributing factor may be Cherylin's history of gastric reflux, for which  she has taken daily medication for quite some time.

Bob was in town this afternoon for a "family conference" led by the nurse case manager, Baya, and the three principal therapists (Ann, Phyllis and Mary Lee), Bob, Arlene and me.  Baya called on each therapist for an appraisal of Cherylin's progress-- each spoke quite specifically about the behaviors we have described to you in these reports, and the significance of  these as evidence of growing awareness of her surroundings, and growing responsiveness to questions and commands.  For example, Phyllis cited the fact that Cherylin sat up on the edge of the bed for periods of 1-3 minutes with little or no support from the attending therapist, each of the last three sessions.  Even when the ladies pushed her a little bit, she would right herself-- up to a point of course.   If you pushed her hard enough, of course, she would tend to fall over, and would need to be gently caught and either brought back to vertical or gently assisted to lay down.  Mary Lee noted that she is beginning to reach for things, even some with her right hand, which so far has been the less functional of  the two. No one can predict the timeline, that is, "how soon can she move back to Dayton?" but their optimism about the recovery trend line is VERY  tangible!!

Among his observations at her bedside, Dr. Baez examined her left eye-- he told her that he wanted to do this, and noted that her orbital musculature around that eye tensed up a little, just in anticipation of knowing that he would touch the eyelid to pull it back to look.  Another example of purposeful response to an audible stimulus.  He mentioned to me that a week ago she wouldn't have paid any attention if he had talked about  "examining her left eye".  He seems quite animated about the progress to date-- of course we share that excitement, even though the individual tidbits of behavior change may seem small indeed.

April 7, 1999 (from Jud Klooster *edited by lk)

Today’s therapy session seemed unremarkable, but in one respect it was a Big Moment..!  Ann, Phyllis, and Bethany (a new OT on the scene as of yesterday) conducted the therapy with Cherylin sitting on the edge of her bed.  One of Ann’s regular opening strategies is to push down hard on Cherylin’s knees, to make her feet go fully flat on the little stool at the bedside—thus stretching her heel ligaments, and bringing the bottom of her feet to an entirely horizontal posture at right angles to the long axis of her shin bone. . .  Her intent was both the "orthopedic" objective described above, and also to produce enough discomfort to elicit a verbal response.  It worked…! Cherylin SPOKE  the word, "stop", quite clearly.  Arlene saw this and heard it, and was appropriately delighted!

They then spent about five minutes practicing Cherylin’s control of her sitting posture. The goal here is for Cherylin to maintain a vertical posture of the trunk of her body without having the therapists hold her up.  She did well, exhibiting a stronger resistance to being pushed over than on any previous day.  Ann and Bethany continued this exercise while Phyllis tested her use of the little sparkler hand toy. . . she was able to push the little button repeatedly, with only a small amount of introductory assistance to help her initiate the movement.  She repeated this several times (3-5 plunger pushes each time with the left hand, only  one or two with her right hand).   Her performance with the right hand was much weaker and less coordinated than with the left, as previously. Following this, Phyllis introduced a "new" toy to this effort in which Cherylin pulled a little string out of a spring-loaded toy cartoon character, to produce a noise when the string returned into the toy.  She did work at this a little, but with a lot of help from Phyllis.  She used a little hand cricket that clicked when it is squeezed; asked Cherylin to click it three times.  Not successful—by this time she was getting pretty tired. 

When Ann pulled her arms up to an extreme vertical stretch; Cherylin indicated her displeasure by resisting, and with some growling throat sounds. . . but no one could identify any words she might have been trying to say.  Cherylin did pull herself up toward a sitting position when she was allowed to fall backwards—at least she helped in that effort. 

Another big step forward today:  Dr. Baez removed the tracheostomy. . !    No "button" to facilitate maintaining the opening for future placement—it’s just OUT!  Dr. Baez foresees no further need for it.   Naturally we’re all delighted!

And that’s the good news for today—thanks to all the Website readers for your faithfulness in keeping in touch with Cherylin’s progress, with such loving concern!

April 8, 1999 (from Jud Klooster *edited by lk)

This morning, while Sandra (a nurse aide) was finishing up Cherylin’s bed  bath, changing her gown and bed, etc. she started to clean Cherylin’s mouth with a swab and some lemon-flavored mouthwash they put on the swab. She never likes this swab routine, furthermore she was rather tired of the whole process.  Cherylin said, with some degree of annoyance, "Just forget about that!"   Imagine a four-word sentence actually spoken with vocal chords and full sound. . .  from a lady who hasn’t uttered more than  one word in the last eight (nearly nine) weeks. . . !  Sandi said this little sentence was said quickly, not hesitantly—just as one would expect to hear it from a person of regular speaking ability.  Curiously, though, that’s about all she  said for the rest of the day. . !

She had been completely off of the oxygen supplement for more than an hour and a half; it looked good to see her breathing comfortably without even a nasal cannula.  Phyllis reported that she had gone through some of the usual  ST routines, like the little toys she has Cherylin play with, and tries to get her to talk about.  Cherylin was responsive to Phyllis’ requests (handed her the colored pieces, pushed the button on the sparkler, squeezed where she was asked to, etc.) but did not respond to her efforts to get Cherylin to say words.  She showed her a picture we have on Cherylin’s bulletin board, with the Peach family group, and pointed to Bob, and asked, "Is this Chip?"  Cherylin shook her head No; then Phyllis asked her to point to Chip, and she did so promptly.

Later, Ann & Mary Lee took her to the "gym" – a PT therapy site, and moved her from the wheelchair onto a large treatment table.  This is about the size of a double or queen bed,  but lower, like chair seat height.    They sat her on the edge of this, and helped her practice the skills of keeping the trunk of her body erect without assistance.   She braced herself with her hands against falling sideways, after Mary Lee helped her find the right place to put her hands.   She was pretty good at righting herself after they would push her sideways, forward or backward. . . . a little better than yesterday, it seemed to me.  Then they laid her down on  her  back, and turned her over on her tummy, and helped her get into a position lying prone on her tummy, but with her trunk raised and supported by her upper arms and elbows, with her forearms on the bed surface—as if she were lying prone in a grassy field on a blanket reading a magazine, on a lovely sunny afternoon!   The therapists were pleased, and almost surprised that she maintained that position for five whole minutes before beginning to squirm  in fatigue from that exercise.    Needless to say, all this maneuvering from bed to chair, to table and being turned over, and returned to the wheelchair, and eventually back to her bed in the regular room was pretty tiring…. She seemed to sleep well for quite a while before she opened her good eye again.

Thanks to each dear reader of these updates for your loving concern for Cherylin—we value each of you highly, whether or not we have previous acquaintance!

April 9, 1999 (from Jud Klooster *edited by lk)

Today we were greeted by the nurse aide, Sandra, who told us that Cherylin said, quite clearly, "Thank you", when Sandi finished her morning bath, new gown and new bed linen routine.  Sandi  said she tried to say several other things of an instructive nature while the bed and bath procedures were going on, but none of these were understandable. 

Jennifer Eaton is the speech  therapist who works Fridays.  She began by using a lemon-flavored swab (sour, cold. . . ) to wipe her lips and inside her mouth.  As with other therapy procedures, each one seems to have two goals: one to clean an area or strengthen a function, the other to elicit comment, whether favorable or otherwise. . . !   In this case, Cherylin didn't comment  verbally, as she did yesterday, but   she kept her lips so firmly and tightly closed that Sandi couldn't get the swab inside her mouth. Instead, she got Cherylin to take the swab in her hand and do the job herself.  And she did quite a comprehensive sweep of the various inner recesses of her mouth-- better than the nurses have usually been able to do.  Jenny then showed her four plastic picture cards, each time asking, "What's this, Cherylin?"    On the very first card, Cherylin responded quite quickly, "Camera".   Very well articulated, not a garbled rumble. . .   But then she didn't respond at all to the other cards. 

Ann and Mary Lee then came in to do the OT and PT parts of the therapy session.  They got her seated on the edge of her bed, with her feet on  the foot stool, and began to practice the exercises that help her to sit upright without being held in place.   Each day she seems stronger and a little more assertive in this exercise.  And each day, they push her a little harder, as if they were trying to make her fall over, and then she rights herself.

Then, Mary Lee  put a large rectangular wash basin in front of her, and began to have her take the washcloth and wash her arms, her face, her shoulders, etc.  Not to clean, in this case, but to practice the skills involved, first with one hand, and then the other. Her left hand functioned fairly well in this test, right hand did some of these things, but more clumsily.  She had Cherylin put both hands in the water, to try to manipulate the washcloth-- wringing it out, etc.  Not too successful on this, since the inept left hand limited success of the right hand in doing its part. . .  But when it came to "wiping up the table", after Mary Lee removed the washbasin, she really did very well.  She wiped with her left hand way beyond the area the Mary Lee indicated, showing quite a bit of initiative in making sure she was thorough-- that she "got it all!"  She did some of this wiping with her right hand, but with more limited elan.

When Ann used the ice on her back, Cherylin made several verbal utterings, none of which any of us could understand.  But she was making an effort to tell us how it felt, and possibly to get them to discontinue. . . !  They finally allowed her to lie down again, after a full half hour of these workout procedures.   It isn't only the therapists who wear themselves out!

Bob came in with us for the evening visit to Cherylin'sroom-- we had just picked him up at the Columbus airport.  He brought her eyeglasses; when he put them on her face, her left hand immediately came up to push them up more firmly on the bridge of her nose!   He thought he could see a flicker of recognition, as if she might be thinking, "Wu-OH. . . that's more like it. . .!"    When he was ready to leave, he asked her if she would like him to have a little prayer with her-- she promptly said, "Sure".

Of the eight patients they have on the unit right now with similar types of brain injury, the therapists say that Cherylin is progressing the most rapidly.  For us, that's a good note to close on for this week-- with our profound thanks  to God for the advances of this "working part" of  the week.

April 10 & 11, 1999 (from Jud Klooster *edited by lk)

This past week has brought us several Big Moments of new behavior—real words, a short sentence, more frequent use of some gestures, better capacity for sitting on the edge of the bed without "falling over" (that is, maintaining her trunk posture with little or no aid from the therapist),  greater general awareness of her surroundings, and of people.   So of course, with our busy little minds programmed from the fulfillment of these hopes, we just can’t wait to see what’s next. . . !  She rested well, no nausea, responded to the nursing staff when they asked her to help with little tasks—moving an arm or a leg, etc.  In a way, these two days may have been a time to "consolidate her gains" thus far, and perhaps to be ready for larger micro-strides tomorrow, when the therapists again focus their considerable talent and  energy on her needs.

She’s been off the bromocriptine since Thursday morning; Dr. Baez thought it may have been a contributing factor to the two or three vomiting episodes of last mid-week.   Of course, we lose the stimulating  effect for which bromocriptine is intended and prescribed, when we have to discontinue it for several days.

So, faithful readers of the Website, don’t give up your interest in Cherylin’s progress—stay tuned for the next bulletin, which we hope will have substantive new indicators of the recovery trend.  -- Arlene and Jud

April 12, 1999 (from Jud Klooster *edited by lk)

Today’s therapy was centered on a trip to the "gym"—the therapy exercise room.  Ann and Mary Lee came in right after Cherylin’s morning bed bath, and transferred her to the wheelchair, and took her to the gym.  On the way, they stopped in the hall and checked her oxygen saturation level—this is done quite often now that she’s breathing entirely on her own.  It was a 95% reading, very satisfactory.

In the gym, she was transferred to the low exercise table.  Ann thanked Cherylin for "helping" her with the transfer—apparently she took some of her weight on her own feet so the therapists were not having to lift her whole weight. Ann sat her on the edge of the table and pressed her feet down to be sure they were flat on the floor.   After some relatively unsuccessful attempts at "catch", Ann had Cherylin place her hands on Ann’s shoulders and then lean way forward from the waist, thus stretching the muscles of the small of her back.  As they got ready for this, Ann placed Cherylin’s right hand on her (Ann’s) left shoulder, and then asked Cherylin to put her left hand on Ann’s right shoulder.  She DID, without much hesitation!  They then proceeded with a series of stretching exercises.

Then they transferred her back to the wheelchair, and had me push her around the unit on a kind of sightseeing tour!  We got her nearly back to her room after a full circuit of the unit hallways, and she had a bout of nausea.  Arlene tried to help Cherylin get rid of the bad taste by using a sponge on a stick, that had been dipped in mouthwash.   Cherylin didn’t want her poking this  in her mouth, so Arlene gave it to her, and told her to use it herself.  She did, and swabbed it out very effectively.   Everything considered, the therapists felt that today's had been a "good" session. We appreciate your prayers, and the interest you’ve shown in Cherylin’s recovery.  As Tiny Tim  would say, "God bless you, each and every one."

April 13 & 14, 1999 (from Jud Klooster *edited by lk)

Yesterday and today have been significant days of progress for Cherylin. Let me "count the ways". . . or at least some of the indicators of these forward steps:
* From a flash card picture of yellow pencils,  she recognized, and then said, "Pencils".
* She passed a small hammer, and other similar items back and forth from one hand to the other when instructed to do by the therapists.
* Responded quite consistently to therapist's request to turn her head to the left, and to the right, to extend the range of these motions.
* Placed colored pegs in a peg board correctly-- held each peg up to study it carefully before placing in the correct position on the small peg board. This required a little help occasionally from the OT, to help her initiate each movement, particularly at first; but the longer she worked at it, the less help she needed.
* She also matched flash cards with pictures, to flash cards with words that identify those pictures:  a book, a cup, and a bed. She took the group of six cards in her hands, and studied them a little bit. . .  and  then handed them back in matched pairs, one at a time, as the therapist had instructed her to do. . . !  Quite remarkable, we thought. . . !
* With help, she used lipstick, rubbed her lips together to smoothly spread it after initial application, when told to do so by the therapist.
* When nurse John said, "I'll be back", she said, ". . . apparently so". . . !  On some other occasions when he would say that he'd be right back, she waved, as if saying good-bye!
* When he was doing a little procedure that cause her a moment of pain, she said, "that hurts. . !"
* In the gym today, she held her trunk in vertical position WITHOUT help from the therapists, for more than five minutes. Also, held a position on hands and knees for several minutes with little aid, same for a position  of standing upright on her knees (this required more support to keep her upper and lower body straight).
* During these exercises, when asked if she needed a rest break, she said, "yes, a little one..."   Then, when asked, "are you tired?", shook her head No.
* After kneeling, she was seated on the edge of the bench, again maintained the trunk of  her body vertical for several minutes, while Ann put on her shoes. Ann pushed down pretty hard on her knees, to stretch the ankle ligaments so her feet would go flat to the ground.  Cherylin made some sounds to object, but wouldn't actually say stop, even though they  encouraged her to do so.
* Next Ann had her do several "forward bends" from the waist, toward Ann-- who encouraged her to come as far as possible (about 60 degrees from vertical) in each bend. Then they helped her stand up, closely facing Ann, who then executed a "standing pivot transfer" to seat Cherylin in the wheel chair.   What a work-out. . . !  After all this gym exercise, she was taken back to her room in the wheelchair, and left to sit for about half an hour before they put her back to bed.

We were encouraged to hear, as independent opinions, from two therapists and from the nursing case manager, Baya, that Cherylin may be eligible for return to a rehab unit in the Miami Valley Hospital in Dayton, "in a week or so".  Small wonder, then that we think these two recent days were VERY encouraging!   More tomorrow.....!

April 15, 1999 (from Jud Klooster *edited by lk)

Today’s progress was marked by physical exercise maneuvers, not by verbalization.  Cherylin was fairly quiet today—even Phyllis, our skillful speech therapist wasn’t able to elicit verbal responses.  She worked with her for about 30 minutes, using flash cards; a calendar to identify date, day of the week, and month;  a lemon-flavored  swab; a little penlight;  and one or two other "teaching aids". . . . but none of these produced any speaking response.   Phyllis was very philosophical about this—some days one can get a coma patient to speak (like the multiple-word phrases of the last two days), and some days, nothing comes.  This is what the coma level descriptions refer to as "inconsistent" responsiveness to stimuli.

The PT/OT session, however, was quite productive.  Ann got Cherylin up to a seated position on the edge of her bed, pressed down on her knees to get her feet flat on the little stool they use, then  Mary Lee used the wash basin (previously described) to help teach her to bathe the upper half of her body.  Then they helped her change into a sweat suit she had asked us to buy for her last evening.  Even this change of clothing was used as a teaching-learning opportunity.  She helped Cherylin stand, assisting her in holding that posture until she could do it steadily for about two minutes, with little or no assistance support.  Then she pivoted her around to seat her on a straight-backed chair for a few moments to rest.  Ann is pretty short. . .   about a head shorter than Cherylin, so her skill in managing Cherylin’s larger frame in these major changes of posture was remarkable.  Mary Lee was helping, wherever a two-person assist was indicated.

She then had her stand up again, and this time assisted her in taking about three full steps forward from the  bed to the window area!  Pretty clumsy steps to be sure, but STEPS just the same!  Remember, you parents, when you first aided your infant children to take their first steps?  Well, this was a lot like that, except Cherylin has a much higher center of gravity!   And if she were to fall. . .  well, adults aren’t "made of rubber", as infants sometimes seem to be. Then Ann had her sit on a regular chair with arms—part of the room furnishings, for about an hour before helping her get back in bed.  While she was sitting there, I read some of her e-mail messages, and greeting cards that have been sent to her.  When I asked if a certain writer was a man or a woman, she responded with appropriate nods or shaking her head NO to  my questions, to give the correct answers.  I was tickled with her ability to process my questions, and to show that she remembers the identity of some of these who have written to her. A very good session today, even though it was not marked by verbal output!  Thanks for reading – more tomorrow. . . ! -- Arlene and Jud

A Good Question!  (April 16, 1999)
One of the web-site readers emailed an excellent question about how Cherylin can be talking and in a coma at the same time. It seemed like something that all us "non-medical" people would like to know!  Question and answer follow:
Q:  Cherylin seems to be very alert, if not awake....I have read and re-read the updates and have not found one saying that she is out of her coma.  Is she still in a comatose state and if so, is she still at level three?  I have been reading about the different levels, but I am not medically minded enough to really understand where she might be.
A:  (from Jud Klooster)  Certainly I understand your confusion about a person who speaks, but is said to be in a coma!  I think you're watching the Website to keep up on her progress-- there's a page of descriptions of the various levels of coma, developed many years ago at the Rancho Los Amigos Hospital in Los Angeles, and now used nationally (Rancho Coma Levels).  You'll see levels of apparent consciousness in the upper levels of  the Rancho scale where there is more awareness than Cherylin now exhibits, but which are still, by definition, part of the "coma" concept.  I, too, had always previously believed that a person is "in a coma" until that magic moment when he or she "wakes up" . . . . as if they could open their eyes, and say, "Hey kids, what's for lunch?". . . !   But we're learning it isn't really like that. . .the stages of recovery are often very gradual and incremental. 

April 16, 1999 (from Jud Klooster *edited by lk)

A big happy Big Moment today was when Cherylin gave us a BIG SMILE as we came into her room this afternoon.  

Cherylin responded again today with physical responses (rather than verbal) in her therapy sessions.  She nodded "yes" to some inquiries, shook her head "no" to others, followed verbal instructions to raise her hand to her cheek, etc.  Arlene saw the therapist "playing ball" with her—Jenny would push the small beach ball toward Cherylin, and then ask her to push it back. 

When the physical therapist pushed her feet down with some vigor, to stretch her ankle ligaments and get her feet flat on the little stool, Cherylin showed some objection (by body language) when this pressure began to look painful, but would not SAY anything to get Lynn to stop.    The therapy team worked with Cherylin on several standing exercises, which were successful in Cherylin standing twice for 2-3 minutes each, followed by a standing pivot transfer to the wheel chair and a slow ride around the 5th Floor South unit. Cherylin was then allowed to sit in the wheel chair for about 45 minutes, before she was returned to her bed.  Cherylin followed Lynn’s instruction to "lift your right foot" and "put both feet on the foot rests", etc.doing much of the actual moving with her own muscle power.  She also responded to various inquiries about whether she was comfortable, or tired, or wanted to go back to bed, etc., with nods "yes" or shaking her head "no". . . but no words were successfully  verbalized.  Now we’ll watch to see if her weekend brings verbal responses, or if she again will use the weekend days to mark time, and as we said last week, to "consolidate her gains".  -- Arlene and Jud

April 18, 1999 (from Jud Klooster *edited by lk)

At the close of another week, the agreement seems to be that Cherylin is continuing an upward progress toward recovery.  She is more aware of her surroundings, and whatever responses she gives appear (1) more prompt, (2) correct, and (3) well-focussed to the stimuli that have elicited the response.  They are not random or irrational.

Sabbath, she didn’t verbalize much, but she did smile a bit when Angie and Kelly were recalling humorous incidents in their home.  When Bob gave her a picture to look at, she took it from him promptly, turned it over and then back to the face of the picture, and seemed to study it carefully.  When Bob helped her with the "ranging" exercises, he asked her to lift her leg, and she did so promptly, rather than having to have him do it, or to prompt her by initiating the movement.    When we left her room,  she waved "bye" to me, with her right hand.

Sunday,  a friend visited her and left a note in her guest book, chuckling about one of her typically sarcastic bits of humor:  he had told her that he had sung in a Messiah performance at Easter, and she said, "oh, they let you in there?".    The nurse aide, helped her get from the bed into a "Jerry chair"… one that has adjustable slope for both back and leg support.  She was in this chair for nearly 1.5 hours.  We wheeled this chair out into the hallway, and to a lounge area, to give Cherylin a change of scenery.  While Debbie was helping her back to bed, she said "thank you"  (quite softly, as if it were a private message!).  When Debbie put on her wrist support, she asked Cherylin "will it be OK to put on your wrist support?"—Cherylin replied, again very quietly, "for just a little while". . . ! 

Do you believe in miracles?  Give thanks with us for these miracles, and remember Cherylin in your prayers. . . more miracles are needed as she moves toward full recovery. --  Arlene and Jud

April 19, 1999 (from Jud Klooster *edited by lk)

Today’s therapy sessions totaled  more than three hours!   Phyllis, the speech therapist was working with Cherylin when we first arrived, using little toys that she encouraged Cherylin to sort, stack, push on, or squeeze.   Phyllis gave her a little bubble-blowing toy —Cherylin took it and immediately blew on it—not strong enough to blow any bubbles, but enough so Phyllis knew she was using it correctly.  She was successful in clicking the little cricket toy to make the cricket sounds.  Phyllis used a little wooden toy train whistle, to see if   Cherylin would recognize and verbally identify this sound.  When she got little or no response, she just moved on to other topics.  At one point, she picked another kind of whistle, saying, "this is a different one, Cherylin—it’s a party whistle".  She blew it, and the Whee-ee-ee-ee sound seemed to intrigue Cherylin’s fancy.  She growled a few throaty sounds, which I think MAY have been an effort to say, "Well, I LIKE that one!"  Phyllis is more intellectually honest, however, and she couldn’t really confirm that those were Cherylin’s intended words. . .  !

The therapy team helped her stand, and with one therapist on each side helping to support her by her arms and shoulders, she was encouraged to WALK across the gym toward a full-length mirror.  She got there in about twenty  short steps!   They let her have a standing rest for a minute or two, then turned her around and helped her walk back across the gym, and out the door into the hall--  another 30 steps!  Another short standing rest, and they encouraged her to walk down the hall toward the nurse’s station.  After about 25 steps, she faltered a little, so Ann   suggested  she sit down, on the wheel chair that had been following her closely, for just such a need.  Then, after only a one-minute rest, she got her back up again, and she walked another 25 steps or so (I think I lost count, at this point. . . !)  These were just little steps, about the length of one of her shoes, not major strides.  But with a total of approximately 100 steps, we were tremendously impressed!

Mary Lee worked with her a little while, doing the ranging exercises with her upper arms, particularly the right one.  After a few minutes of this they "released her to my care" in the wheel chair. . .  to go back to her room and sit a while, before putting her back to bed.  She was in the chair in her room for more than an hour before she went back to bed.  Total of one hour speech therapy; one hour in the PT lab, and walking;  and one hour seated in the wheel chair.   We think she had a great day. . . !  No nausea whatever.  Remember she isn’t walking independently, she needed support.  Her steps were very small, not big strides.  At first, she needed one of the therapists to nudge her foot forward on each side to get her to take each step…  but after about the first twenty steps, she was taking each step without prompting. Can hardly wait for tomorrow’s chapter in this saga.  Thanks to each Web page reader for your prayers. . . we need them, she needs them…! -- Arlene and Jud

April 20, 1999 (from Jud Klooster *edited by lk)

Another impressive day, during which Cherylin WALKED, about the same distance as yesterday!   But first, let me outline her experience with the speech therapist.  Phyllis delayed her visit to Cherylin’s room for over an hour, when she learned that the nurse had given her Phenergan at about 8 a.m. this morning (to quiet her incipient nausea). The drowsiness that follows the Phenergan dosage reduces her awareness somewhat, and makes it harder for Phyllis to elicit verbal responses from her.  Cherylin answered five of  the nine questions correctly, that Phyllis asked her about common aspects of life,  such as "do you live in an apartment?" (prompt shake of the head, NO);  "do you have brown eyes?"   (head shake NO);  "do you like pizza?" (nod Yes);  etc.   No incorrect answers, just some non-answers.

Ann (PT) and Mary Lee (OT)  came in with a wheel chair, to begin the PT/OT session. They helped her turn and sit up on the edge of her bed, then brought a plastic wash pan, and helped her wash face and arms, and after they removed her gown, she was encouraged to wash the upper half of her body.   Arlene observed this part of the session, and felt that she did very well, in this important part of her learning.   [As regular readers of this Web page know, we are regularly impressed with the resourcefulness of these great ladies; their thoroughness—never missing an opportunity to urge the learning for Cherylin that each situation provides;  and their clever use of leverage to maneuver the greater weight and height of Cherylin’s body (compared to their own) in each move, or transfer.  All of this with distinctive kindness, and caring concern for her comfort.  But they are relentless in pursuing their goals for her progress.]

Ann and Mary Lee then helped  her put on the top half of her gym suit—after getting it started over her head, she reached up and pulled it down jut as anyone would need to do. They thought she did this much better than he has done it in previous sessions during the last few days.  Then they transferred her to a regular wheel chair (no special headrest, as in previous days), and brought her out into the hall, where I had been waiting. 

They helped her stand, and then with a little urging to get her started, they helped her walk down the hall toward the gym.  She walked better than yesterday—that is she didn’t trap the edge of one foot as she set the other down beside it.   She didn’t require help to initiate each step (after the first two or three steps), and didn’t seem to require quite as much pressure on her seat reminding her to stay erect, instead of bending at the seat.  [In walking, a vertical posture is pretty important—not only to avoid collapse, but also to minimize fatigue.]   After walking about 60 or 70 feet down the hall, she began to be a little unsure, wavering a bit, indicating fatigue.  So Ann had her sit down in the chair, which I had been pushing close behind them for just such a need.  After a few moments of rest, we pushed her into the gym—since we had the footrests off of the wheelchair,   Ann just asked Cherylin to hold her feet out in front of her for that remaining distance, so that her feet wouldn’t trip on the hall carpet.  She did this, without much further urging or reminding.   Still in the wheelchair, Cherylin was led in forward bends from the waist, reaching forward toward Ann, and using the big 3-foot rubber ball as a prop.   During this activity,  Dr. Baez came in and talked with Ann about Cherylin’s progress.  Responding to something they said that reminded him, he began to recite the words to a fairly current song, that seemed to fit the situation.  Cherylin picked up on this and made a throat sound that sounded like she said "…groovy!"   Perhaps tomorrow Ann or Mary Lee will be able to tell me what those words were, so that some of this will make better sense!   Mary Lee said to Dr. Baez, "Did you hear that?  Didn’t she say ‘groovy’?"  Dr. Baez said he "couldn’t quite make that out of those sounds", so we let it go.  But at least two of us thought that’s what she said!  Unless you are looking right at her mouth when she makes those indistinct efforts at verbalization, you really can’t tell what she may be trying to say.

After a few minutes of the bending exercises, Ann put the footrests back on the wheel chair, made Cherylin as comfortable as possible, and told us to take her for a ride around the unit, to her room, or wherever we liked.  Ann wanted her to have an additional hour and a half of  "sitting-up time" in the wheelchair, before she let her go back to bed.  Today’s total time in therapy was about 3 hours, including the sitting-up time after therapy.   Big contrast to the early days in this unit, where they used only about a half hour each day, and felt that was about all that would be appropriate or useful.   Even toward the end of the therapy session when Ann asked Cherylin whether she was tired, she shook her  head, NO.   That’s a kind of endurance she didn’t have, just a few days ago.

So another day of progress, another day of uncertainty, another day to wonder what is coming next. . . !   But another great day to be very thankful for God’s healing power in this dear lady’s brain. -- Arlene and Jud

April 21, 1999 (from Jud Klooster *edited by lk)

Our little lady had a busy day. . . !   Her first activity was an 11 a.m. appointment with an ophthalmologist in a doctors’ office building adjacent to the Riverside Hospital.  She was transferred to a wheelchair at about 10:30, and transported in the wheelchair to Dr. Boyle’s office, for him to re-check her eyes for any possibility of retained lens fragments from her contact lenses.  A report had suggested that some fragments had been found at the accident scene, and Bob (Cherylin’s husband) wanted to be sure that such fragments were not retained, which might possibly compromise her recovery potential.  Dr. Boyle found that both eyes are clear of such involvement.

She was returned to her room, and continued to sit in  the wheelchair until approximately 12:45 p.m. . . . . Ann wants her to have one to one and a half hours of sitting-up time each day, at this stage of her recovery.  While there, Arlene and I visited with her , read some of the messages on cards from her friends, and asked her if she remembered this person or that—she responded with nods Yes and shaking her head No . . .  the only words we heard were the words ". . . next week . . . " in the middle of  somewhat "growly" verbal noises.  My   extrapolation of these sounds would suggest that she might have been trying to say something like, "What’s going to happen next week?"  But that is much too adventuresome a construction, to report as factual.

She was then wheeled down to the lab, where Phyllis did some speech therapy exercises, using flash cards for matching exercises, a cup with ice chips to begin her re-learning of tasting/swallowing functions, having Cherylin count out loud when Phyllis held up one, two, and three fingers, etc.  Cherylin responded with nods Yes and shaking her head No to some of the questions, but offered only meager attempts at verbalization.

Ann and Mary Lee did not have Cherylin walk today, since she had already been tired by being out of bed so long.  They brought her wheelchair up between the parallel bars, and had her do several standing exercises, were she could use the bars to steady herself.  She did these well, but it was obvious she was tiring.  Ann gave her a wash cloth-- continuing a washing exercise from yesterday, she had her wash her face, hands and arms.  She was then returned to her room, where Mary Lee worked with her right arm, and spent some time massaging the knuckles of her right hand, working   to expand the tiny range of motion for each finger segment.  Total time out of bed and in treatment: 3.5 hours.

When Cherylin’s progress does not produce dramatic new behaviors, like walking 20 yards (!) we depend on the perception of the therapists to evaluate the effectiveness of the therapy session.  All three of them were quite pleased with Cherylin’s more rapid processing of requests or questions (less delay from the stimulus to the response), and the appropriateness of her responses.  They are also impressed with the growth of  her awareness of her surroundings, the way she follows movements of people or objects in her field of view, and her attentiveness in eye contact with those who are talking. God continues to bless—we are thankful. . . ! --   Arlene and Jud

April 22, 1999 (from Jud Klooster *edited by lk)

One thing I neglected to report earlier (4-20, perhaps. . ?) was an interesting utterance from Cherylin.  Some friends had come to visit her; after a little while they left her room to go downstairs for a little lunch in the hospital cafeteria.  When they returned to her room, she looked up, and said, "Oh, you're back!".....!)  She hasn't  been saying as many words lately, so this was an interesting vignette of her recovery that I thought you'd like to hear.

Today we visited with Michelle Weaver, a "network manager" for Paradigm, which in turn is a Case Management Resources entity.  She will be a key figure in orchestrating   Cherylin’s transfer back to Miami Valley Hospital, as soon as her recovery status qualifies her to enter MV’s rehab facility.   Michelle had driven up here from her Louisville, Kentucky headquarters to check out the latest developments by first hand observation.

Ann and Mary Lee had started her OT/PT session at about 11 a.m., while we were talking with Michelle in the dayroom.  They had changed her to the gym suit; done some of the bedside exercises to stretch her ankle ligaments, and waist-bending exercises; then they transferred her to a wheelchair and moved to the hallway.  At this point, Arlene, Michelle and I joined them for Cherylin’s morning WALK down the hall.  We were glad Michelle got to observe this; Dr. Baez also watched the promenade down the hallway from a desk in the nursing station.  She did quite well, but required quite a bit of urging and prompting at times to initiate the next step.   About 25% of her steps seemed to require this help, whereas she initiated the other 75% of steps without such detailed prompting.  She was assisted and supported by Mary Lee and Ann at her sides—in this respect it would be inappropriate to say that she was "walking under her own power."  Thus her "strolling down the avenue"  was no such piece of cake;  rather it was four-person endeavor, with Ann and Mary Lee performing a major level of support, and with me pushing the wheelchair along just behind her, in case she needed to sit down on short notice!   Her total length of this walk was about 20-25 yards, similar to that of two days earlier this week. [I mention how much support she needs, not to demean the quality of her effort, but in response to some e-mail messages we’ve received, showing that perhaps we were too glowing in our descriptions of her previous two walks.]

Following her walk, she was returned to the gym, where the therapists worked with her on some stretching exercises on the treatment table.  After about ten minutes she was transferred back to the wheelchair.  Mary Lee worked on her knuckles (right hand) to stretch the ligaments and augment the tiny range of motion for each finger segment.  We took her on a wheelchair tour of the unit, then downstairs to see the beautiful  sunshine, and the tulips blooming outdoors in front of the hospital;   it was quite breezy, so we only stayed there a few minutes.  Back to her room. . . then, about 4 p.m., her nurses took her to the whirlpool bath.  They said she seemed to enjoy this experience. . . answered "OK" to some of their questions about her comfort, the water temperature, etc. All in all, a very good day. .  !   Once again, we’re thanking God for answering the many prayers for miracles, that so many have offered on her behalf.  -- Arlene & Jud 

April 23, 1999 (from Jud Klooster *edited by lk)

During her speech therapy session today, Phyllis asked Cherylin if she’d like some ice chips. . .  Cherylin shook her head No.   Well, then, how about some ice cream?"  Cherylin nodded Yes.  Phyllis then queried concerning Cherylin’s flavor preference --  she could offer either vanilla or lemon custard.  Cherylin chose vanilla, by nodding yes to this option.  This is her first experience with nutrients by mouth since the accident.  She only ate three small spoonfuls,  but it was a first in this category of dietary intake!  After all, "since life is so uncertain, Eat Dessert First!" . . . she seemed to imply.   The therapist continued working with Cherylin to test her ability to process questions or visual stimuli then react to them in a reasonable time. Phyllis thought she did very well in this session.  I heard her apologize to Cherylin  for the childish simplicity of these questions, but then identified them as "little things to make her brain work some . . . !"  Today, as on many occasions, Phyllis reminds her that both of them are speech pathologists, and talks to her as "one therapist to another".  Dr. Baez stopped by during the hour that Cherylin was sitting in her wheel chair after the ST session but before the OT/PT team came in.  He seems very enthusiastic about Cherylin’s progress thus far—noting how much progress she has made "just in the last week".

Her PT/OT therapy session was vigorous and tiring, but not remarkable in terms of new experience or new dimensions of  achievement.  The therapists had more trouble getting her feet flat on the floor (that is, at right angles to the long axis of her lower leg) than has been true in most previous days. They had her use a walker to stabilize herself  for standing several minutes, while they continued working on the ankles, using her body weight and standing posture to accentuate the pressure on the ligaments that needed to be stretched. Mary  Lee worked on her knuckles (mostly on the right hand) for a few minutes near the end of this session. Total time out of bed today, was substantially more than three hours.

This has been a good week for our little lady—very likely the therapists’ agenda for next week will be to deal with the apraxia (mental obstacles to processing what her mind is trying to tell her muscles to do) and gentle motivators to elicit verbal output.    we pray for her, and for all of you who read these pages, that God will continue His remarkable work in her life, and in yours and ours! --   Arlene and Jud

April 24 & 25, 1999 (from Jud Klooster *edited by lk)

Another fairly quiet weekend, which we might be tempted to regard as a little flat spot in the upward trend line of Cherylin's  recovery.  But as we look at the larger picture, I think we need to make some allowance for her healing process to "back off and re-group"  as the old-time military strategists are reported to have said, when the going got tough. . .

Sabbath, as customary, Bob and Clara  came to the hospital after having attended early church in Kettering; they usually get to Cherylin’s room considerably before we do, as we have attended the 11 a.m. service at the Worthington church.  It was a beautiful sunny day,  so the nurses helped Cherylin get into her "sweats" and walking shoes, then transferred her into the wheelchair.   We let her sit for a few minutes to get acclimated, then slowly wheeled her to the elevator bay and down to the lobby floor. . . another stop for a few minutes, and then outdoors to the beautiful tulip bed in front of the hospital.  She stayed outdoors about an hour. 

Sunday morning we learned the nurses had taken Cherylin to the whirlpool bath, and shampooed her hair.  They got her up in the wheelchair, and we spent the first hour just sitting in her room.  She had several visitors today, and we think she was glad to see them—however, she really didn’t overtly welcome them with facial expressions, or waves of her hands, as she has done in some past visitations.    Each of them talked with her about their past experiences together, and we saw some moments of nodded agreement, or a tiny smile at the corners of her mouth as they recalled amusing incidents.  We believe these visits from long-time friends are very important.  When she is able to return to the Dayton area to begin her more aggressive rehab program, it will be a lot easier for her many friends of that area to visit her room and provide such stimuli.  Tomorrow, Ann plans to begin specific exercises on the tilt table to address the next level of her needs.  And so the new week will begin, to move her closer to that next phase of her recovery.  --   Arlene & Jud

April 26 & 27 (from Jud Klooster *edited by lk)

The physical therapist were able to help Cherylin achieve a fully normal ankle posture today by utilizing the tilt table raised to a nearly vertical position.   While she was in this upright position, the ST & OT team worked with her on some standard exercises.  There was a good level of response (through appropriate nods "yes" and "no"), but almost no effort to verbalize. After about twenty-five minutes on the tilt table, Ann’s goal of good ankle posture was well-fulfilled.  With the tilt table, the patient is secure in her standing position, with less apparent apprehension about losing her balance.  Further, the apraxic response of muscular resistance to whatever the therapist is trying to accomplish is largely absent.  Those two factors probably best explain how Ann was able to get the ankle problem neatly resolved with the tilt table, whereas the previous day, it seemed not solvable.  When it was time to come off the tilt table, she walked, with assistance, the few steps to the wheelchair.  The stretch of her ankle ligaments is not, of course, without some discomfort.

Cherylin was returned to her room in the wheel chair, and Phyllis continued the ST exercises, using flash cards with pictures for visual identification.   Later Phyllis told me that she had responded to about 8 or 9 of each 10 questions, with only one incorrect answer. Again in this exercise, her responses were all with nods or shakes of the head, not words. Phyllis asked her if she’d like some ice in a cup— her response was prompt and vigorous, a "No" shake of the head!   "Well, then, how about some ice cream?"  Cherylin’s special little shrugging grin seemed to be an affirmative response, and  Phyllis brought her a tiny carton of vanilla ice cream.  She only ate a few spoonfuls, but seemed to enjoy it! Following the therapy session, she sat in her wheelchair for about another 1.5 hours.  Phyllis left the little cup of ice cream, in case she might want some more. . . by the time she was ready to go back to bed she had finished the entire carton (maybe a half cup, altogether—not a big overdose!).  Phyllis had tried at first to spoon feed it to her, but she did the best when she used the spoon herself, and (with help) held the little carton in her other hand.  Significant: she preferred to use the right hand for the spoon!  Total time our of bed, including therapy:  about 3.25 hours.

Tuesday, Ann handled the bed to wheelchair transfer by herself, partly because of her excellent procedure sequence, but also because Cherylin helped her with each requested movement:  like, "now lift this leg", or "raise your feet"` or "bring this knee over as you turn". . .  in each case our little lady responded promptly and correctly to do the motion requested.  Due respect, however, for the methodical steps of procedure that Ann uses so skillfully, and her application of leverage principles I suppose she learned in PT school—she’s really great at what she does!. . .  and she never seems to get clear to the bottom of her "bag of tricks". . . !

In the gym, Ann and Mary Lee helped her change into her gym  shirt, and then they decided to "take a walk".  Cherylin WALKED, today, about 200 feet without any sitting down for rest on the way.  She did stop once after about 160 feet, for a moment or two of standing rest, then continued.  While stopped, Ann asked her, "are you getting tired, Cherylin?"  C. shook her head NO, so they kept going. . . !

In this walking, her right foot tended to lag behind; that is, to not initiate the next step forward without reminder, in about 20% of her steps.  In these moments, Ann would grab her right pants leg and pull up and forward, to get that foot moving.  She told me later that she only provided about 20-30% of the forward force to get this motion started, Cherylin furnished the other 70+%.  She was wearing a pair of her own gym shoes that Bob brought from Dayton, which enabled her to walk with much more stability in each step, than at any time thus far.  After the walk, she sat down in the wheelchair and rode triumphantly  back to the gym!  Mary Lee worked on improving the range of motion for her right shoulder and arm, had her deal a few cards to mom and dad (for digital skill experience), played a little with the 6" rubber ball, before being wheeled back to her room.  She sat in the wheelchair for about another hour and a half,  during which time Phyllis came in for some more of the speech therapy exercises described earlier from yesterday’s activity.    Total time out of bed today, including  therapy sessions, about 2.5 hours.  She was pretty tired, but somewhat more durable than yesterday!

Soon we think she will  be ready for transfer to the Miami Valley Hospital rehab facility.  While we welcome the added convenience this will bring for visits from family and friends, we will have at least some misgivings about leaving behind us the splendid team of therapists who have played such an important role in her recovery in these recent weeks.  They have been the personification of  God’s healing ministry in her progress thus far, and we are very thankful to these ladies, who have become Cherylin’s most tangible blessing and our good friends! -- Arlene and Jud

April 28, 1999 (from Jud Klooster *edited by lk)

Today was particularly significant for two reasons:  (1) Cherylin had a very good therapy session, and (2) we learned that she will be ready for transfer to the Miami Valley Hospital rehab center (in Dayton) THIS WEEKEND. . . !  As you know, we've looked forward to this level of her recovery ever since we arrived in Ohio on March 10. She's had excellent care here in Columbus, but of course the distance from Dayton   makes it impossible for her husband, Bob, and her daughters, Angela and Kelly, to visit her except on weekends.

Today, Phyllis (ST) spent about an hour with her in her room, prior to our arrival.  Phyllis and I had an interesting conversation about Cherylin's lesser level of verbalization efforts over the last two weeks or so.  She points out that infants and toddlers often become temporarily less verbal when their full attention is focussed on learning to stand and walk.  She believes, but cannot support this with scientific evidence, that recovering coma victims may show the same pattern. . . becoming less verbal while walking skills are being re-learned.   Phyllis observes that Cherylin has made good progress in her recognition of items and response to questions with nods and shakes of the head, and her general awareness of her environment.

Cherylin's walking skills certainly are advancing impressively.   Today, Ann (PT) and Mary Lee (OT) worked with her nearly an hour helping her learn to get her clothes, socks and shoes on, to wash herself and use deodorant, and eventually they had her stand before the mirror in her little washroom and brush her teeth!   Following this, she was helped to turn around (still standing) and walk out through her room and about 125 feet down the hall.  Less help and support was required than in similar efforts yesterday. . . she obviously used more energy to do this in a less dependent way, which may account for the fact that she tired and began to wobble a bit before reaching the full distance she realized yesterday.  We all felt very good about her accomplishments today.  She still would be unable to just stand up and walk confidently down the hall without the therapists guidance and limited support, but she is making good progress.

After the therapy session we took her for a slow ride to her room and then down to the main lobby of the hospital.  Arlene played some songs familiar to Cherylin, on the big grand piano in the lobby area; she seemed to enjoy this.  Then back to her room, and to bed-- she was getting pretty tired. We feel very thankful to these splendid therapists, and to God who gives them these talents and this spirit of dedication.  Certainly we'll miss each of them when Cherylin transfers to Dayton.  
-- Arlene and Jud

April 29, 1999 (from Jud Klooster *edited by lk)

Today’s therapy session was early, starting about 8:15 a.m. . . . it was a shower bath event!  Ann and one of her OT colleagues gave Cherylin a shower as the next step in her learning about personal hygiene techniques.  You’ll remember that in recent previous sessions, Mary Lee has used  a wash basin at the bedside, or on the gym treatment table to help Cherylin learn to wash her face, hands, arms, upper body, thighs, etc.  Today, she did all this in a shower environment, in a seated position with a hand shower device.  Ann told me that she wrung out the washcloth several times, using her two hands with a little help, but largely on her own.   The therapists washed her back and lower legs, and shampooed her hair.  She brushed her teeth, put on a little make-up, and then played a major role in putting on the pants and top of her gym suit.  The session lasted more than half an hour—it was nearly an hour from the time she left  her bed, until she returned as a glowing clean product of this session!  Sometime during this session she was introduced to a lady named Linda—Cherylin said, "Hi, Linda" . . .  and when Linda left the room Cherylin said "bye". . . !

She sat in her wheel chair (in her room) the rest of the morning, finally returning to bed with Ann’s help at about 12:30 p.m.  Here again, Ann told her what to do, and Cherylin did most of the initiating and follow-through of the movements: "lean forward"—she did; "give me your arms"—she did place them on Ann’s shoulders; "now, stand up"—she did, almost without Ann’s hoisting force;  "now, turn"—she did, and sat down quite gently on the edge of her bed.  Ann was very pleased that she followed these request/commands so well, with so little prompting or repeating of each request.  Not surprising that she was visibly tired from the morning’s events. . . soon she was fast asleep.

The other major finding in today’s experience was that arrangements have been confirmed for Cherylin to be transferred to the  Miami Valley Hospital rehab facility NEXT MONDAY . . . . !  As readers of  Website know, this is a threshold of the next era of her treatment, that we have been anticipating with eager expectation since she first began her sojourn here in the Select Specialty Hospital (one unit of the Riverside Methodist Hospital complex) in Columbus.  We have greatly appreciated the splendid quality of  care, the resourcefulness and energy of the therapists, and the caring concern shown by each member of this well-integrated team. . . !  We wish that, as Cherylin moves to a locale where family visits will be far more convenient and frequent, that we could "box up this team"  (gift wrap would be a more appropriate description) and take them with us to Dayton!

We are confident that well-skilled health care workers will also be part of the Miami Valley scenario, and we are looking forward to that new phase of Cherylin’s return to health.  But the people here in Select have become friends we will not soon forget. . . !  -- Arlene and Jud

April 30, 1999 (from Jud Klooster *edited by lk)

Cherylin’s ST session  was done early today, before we reached the hospital.  Jennifer, the ST who works Fridays, told me she was responsive at an encouraging level, in the identification exercises, in the question/answers, and in following her requests and  commands.  But her responses were entirely by gesture (nods and shaking the head, etc.) rather by attempts to verbalize.  Jennifer has seen her now for several successive Fridays, and is impressed with the general trend of progress she can observe.

Her PT/OT session came at noon today;  Phyllis and Mary Lee continued the personal hygiene and grooming exercises they have used for several previous sessions— having her dress herself, comb her hair, brush her teeth, put on her socks and shoes, etc.   Each of these activities went well, but of course Cherylin’s role in each process was done with varying degrees of  adequacy.  For example, she was much better at wringing out a washcloth than in putting on her shoes.  We are regularly impressed with the way the therapy team uses each opportunity that each of these simple tasks presents, as a training exercise. They aren’t merely interested in getting the shoes on—they want Cherylin to participate more and more fully each time they do each task.   

After about half an hour of these preliminaries, Cherylin was encouraged to stand, and to walk out into the hall and down toward the PT gym.  She didn’t walk quite as well today; she seemed to be up on the balls of her feet a bit because her heel ligaments were pretty tight.  After about 75 linear feet of this, Ann let her sit in the wheelchair, and we went to the gym, where Ann sat her on the edge of the treatment table, and worked on the ankles, while Mary Lee worked on her shoulders and upper body.  After about another half hour, she seemed too tired to continue, so Ann transferred her to the wheelchair, and we took her for a ride downstairs and out by the tulips!   Even in that warm, sunny and beautiful setting, she began to fall asleep, so about 2 p.m. we took her back to her room. Her nurse, Lynn, with Ann’s help, transferred her back to bed. Each day, we rejoice in the successes of that day, however great or limited they may be.

Tomorrow afternoon, one of Cherylin’s good friends, Martha Jean Divnich, will bring a group of her students, the Koraliers, to sing for Cherylin.   Probably they will perform in the main lobby of the Riverside Hospital, since there is a grand piano in the lobby.  MJ says they can go anywhere, but "of course they do get along a little better when they can have piano accompaniment."    Martha Jean is the organist who has arranged coverage for the Springfield   church where Cherylin has been the regular organist—MJ plays two weeks of each month, and gets another organist friend to do the other two Sundays. She also is a music teacher at Spring Valley Academy, in Centerville.  Naturally we look forward with enthusiasm to this special event.  It is a student-generated initiative—these kids really want to come sing for Cherylin! -- Arlene and Jud