This is not a story but a memoir of one of my best professional experiences in Neuro Physiotherapy – rehab for a 27 year old patient at ReLiva, named Shreya (name changed for patient privacy) who returned to life from being comatose for several months, and doctors saying “Take her home. She will not survive!” She proved them all wrong!
I was to meet Shreya for the first time at Reliva Physiotherapy & Rehab, on 17th December, 2014 for consultation and initial assessment. The only information I had about her was that she was in coma 2 years back and is now wheelchair-bound, dependent on her family even for self-care.
An expert in treating Neurological & Psychosomatic disorders, I always analyse the patient through observation and behavioral traits apart from clinical examination. At the very first glance, I did notice a faded smile on her face as she greeted me. I instantly gathered that she was not so happy about her family’s decision to bring her for Physiotherapy.
The consultation included assessment of her available functions, capability and incapability and most importantly – the higher functions which determine whether the patient is conscious, oriented and has a good memory & attention. Shreya had short-term memory loss (inability to recollect events that have taken place in the recent past) but intact long-term memory (Shreya remembered past events related to her birthday, school friends etc.) Having higher functions intact, plays a key role in rehabilitation.
After speaking to her family members, I got to know more about Shreya. She was a well-educated girl with Post Graduation in Computer Applications, a brilliant dancer, a bright student, a topper in her academics and a brave NCC cadet at High School. Unfortunately, nobody knows what exactly happened to her and how & why she landed up in coma. But her parents suspect that she was a victim of domestic violence as she slipped into coma just one month after her marriage. She was admitted to one of the best hospitals in Mumbai in 2011 and was unconscious, with repeated epilepsy attacks and fractured right thigh bone (femur). I wonder how that fracture would have occurred as Femur is known to be the “strongest bone” in the human body. After spending several months in the hospital, the family was advised to take Shreya home – comatose!
In situations of great adversity, it is often seen that when one door closes, another door always opens to one’s rescue. Her family, thankfully was extremely supportive and optimistic. They opted for Ayurvedic treatment to regain her consciousness. With successful therapy, Shreya regained her consciousness in a year’s time, recognized her family members but couldn’t accept that she was married. She hardly remembered anything about it !!
Getting back to the present – I was to see Shreya a week after the Consultation, for the first treatment session. Given the lapse of her short term memory – she didn’t even recognise me. In fact it was like a very first meeting! Within 15 minutes of the session which included simple exercises, she suddenly started screaming; closed her eyes and held her hands tightly together. I noticed an abnormal outburst of emotions and Shreya did not co-operate at all for next 3 sessions. In line with our work culture at ReLiva, I chose to maintain a compassionate approach towards Shreya and continued to counsel her to keep her motivated and encourage her to participate in therapy. My therapeutic goal was to gradually make her as independent as possible. I decided to start with Cognitive-behavioural counselling where the main goal was to build self confidence, rebuild trust and motivation for self-development and elimination of all negative emotions. To my surprise, Shreya responded very well to counselling and a marked difference was noted in her behavior within just 7 sessions.
I recall asking her during one of the sessions, “Do you remember me?” And she said “NO” and we both had a laugh. In another session she called me Rimmi, a name rhyming with my actual name. At any session, she could barely recollect one or two exercises from earlier sessions. Her therapy sessions included stretching and strengthening exercises, postural correction, fine motor training to improve hand activities and counselling as and when required. Unfortunately, due to her right hip deformity and osteoporosis (complication that developed as she was bed ridden in 2011), I couldn’t train her for walking as it was not advisable.
After 43 physiotherapy sessions, Shreya could eat, comb her hair, brush her teeth independently and could do upper-body dressing with minimal help. There were improvements in cognitive aspect as well. She no longer gets any emotional dysregulation episode and has now filed a case against her husband for domestic violence.
During my last therapy session with her, I asked her once again – “Do you remember me?” She replied “Yes, Dr.Bini, and I will – Forever!”
Contributed by Dr.Bini Arun (PT), Consultant Physiotherapist, ReLiva Physiotherapy & Rehab. She specializes in Neuro and Psychosomatic disorders and is constantly liked by her patients for her compassionate approach. You can reach her at ReLiva clinic or write to her at firstname.lastname@example.org