It takes a team to put a broken life back together

Wednesday, November 27, 2002

By CAROL SMITH
SEATTLE POST-INTELLIGENCER REPORTER

Doctors can suture a broken body back together, but it takes a team of specialists to help restore a life.


	The story of a young woman's grueling quest to walk again -- and rebuild her shattered life. - Kellie's story - Audio interview - Q&A with Kellie - Photo gallery

Rehabilitation medicine is a group effort, drawing on physical, occupational and speech therapists, psychologists, social workers, recreational therapists, nurses, neurologists, orthopedists, prosthetic and orthotic device-makers, and more.

And perhaps the most important participant of all: the patient.

Although the multidisciplinary approach to rehab is several decades old, Seattle's Harborview Medical Center has been at the vanguard of programs putting patients and family members on the team.

Harborview's rehab team often starts developing a treatment plan before patients arrive -- when they're still in intensive care.


	Dr. Peter Esselman helped pioneer a new method of rehab.

Once the patient gets to the rehab floor, the team meets once a week with the patient and family present, said Dr. Peter Esselman, who helped pioneer the approach about three years ago.

"The purpose is to build up rapport and trust," he said. "The patient knows any concern she has will be addressed."

It also helps patients set and modify goals.

"Patients and their expectations change over time," Esselman said. "Part of our job is to teach them what they can still do, despite their disability or current problems.

"They can get out in the community, work again, be active in sports -- even with some sort of disability. Sometimes it takes years for some people to work all of that out."

But first, patients have to learn how to take care of themselves.

That's the specialty of rehab nursing.

"Elsewhere in the hospital, nurses do things to and for the patient," said Pam Smith, nurse-manager on Harborview's rehab ward. "Here, we do things with the patient."

That includes teaching them not only to do what they can on their own, but to direct others to help them. A patient paralyzed from the neck down, for example, has to learn how to tell a friend, family member or caregiver how to feed them, or turn them.

"Everyone on the fourth floor has lost something," said Kellie Cosner, who spent nearly two months doing intensive inpatient rehab there.

A support network of friends and family, as well as hospital staff, is critical to a good recovery, Esselman said. People who have strong coping skills prior to a devastating accident can draw on those during rehab.

"Kellie's a great example of that," he said. "She brings to this process strong social and family support. The more intact that is, the better patients do."

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