Families

My name is Jana Kuhns, and I am 15 years old. I received my injuries from a car accident. My parents and my younger sister Jennie were in the accident as well, but my sister Jennie went to be with Jesus.

The night of the accident I was taken to Lancaster General Hospital then transferred to Hershey Medical Center right away because Lancaster General doesn’t accept trauma pediatric patients. I was in Hershey’s pediatric intensive care unit for 18 days with many differnt injuries, including a severe brain injury. Then spent 3 months and 3 days in the Lancaster Rehab Hospital.

I am told I had a breathing tube and a brain probe, and they also had me on life support at Hershey. But I don’t remember any of that.

The day of Jennie’s viewing they removed my breathing tube.

I don’t remember the first two months, but I remember the big events. My nurses, techs and therapists sang “You are my sunshine.” I remember being sung to, but I don’t remember when.

I had no physical abilities because my left side was stiff, and my right side was curled. But now my left side is my good side, my right side doesn’t work. I also had a fractured jaw and pelvis, but I don’t remember any pain. I am told I had a feeding tube as well. I wasn’t responsive in Hershey or when I first came to the rehab hospital.

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Jana couldn’t talk for the first two months after the accident. It took another month to be able to get around without a wheelchair. She has made huge improvements since then, but the effects of her injuries linger. The damage to the left side of her brain has left her with limited function on the right side of her body.

She started coming to Schreiber for therapy in July, about four months after the crash. She comes three times a week: for physical therapy (each visit), occupational therapy (twice a week) and speech therapy (once a week).

The physical therapy is the most arduous. PTs Laurie Miller and Lisa Stachler Volk are working to restore strength and range of motion to Jana’s right arm and leg. For the ankle and foot, Lisa and Laurie are using a therapy technique called serial casting. Because of the brain injury, Jana’s foot became locked in a flexed position. The muscles were stuck.

With serial casting, Jana’s doctor injected the muscles in her lower leg and foot with Botox to temporarily shut down and relax the muscles. Then Laurie and Lisa put her foot and ankle in a series of casts that will gradually allow her foot to be moved back toward the correct position. Each week, they take the old cast off, adjust the ankle position and put a new cast on. Each week is a little more progress toward normal.

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When I started at Schreiber, I couldn’t do anything to help at home. Now, with my spare time, I wash dishes, read books, clean and sometimes cook.

I hate it when Lisa and Laurie put a cast on my leg and ask me not to talk, but I know what they’re doing is going to help me in the long run. Also, I love asking almost everyone to sign my cast, and I understand why they’re asking me, so that helps me to stand it.

I love it when Laurie does the exercise that helps me hold my shoulder back when I’m walking, because I just lay on the table and roll this way and that. I love it when Lisa has me do wall pushups because that’s making my left arm stronger. I love it when Isaak (Schreiber OT Isaak Ross) has me cooking because I’m doing something that will help me at home.

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Jana’s mother RoseAnn didn’t know exactly what to expect when she started bringing Jana to Schreiber. She saw the progress in the first four months – learning to talk and walk again – and thought she had come a long way pretty quickly.

“I think I thought she’d get back to normal,” she says. “The more I learn about brain injuries, the more I know that ‘normal’ might take a long time, if ever. Jana has a new normal.”

The new Jana is a chatty, cheerful teenager who teases her therapists while taking some teasing from her little sister Jenessa. The new Jana shows no signs of any woe-is-me wallowing. The new Jana is a smart girl with lots of support from her family, her faith and her friends at Schreiber.

Consider the case of little Elaina Sauder. Pink pants and a matching pink ribbon in her red hair. A happy, giggling little 5-year-old.

Except where bugs are concerned.

She’s on the autism spectrum with lots of sensory-processing issues. Her mom Joslyn says Elaina has been coming to Schreiber for occupational, physical and speech therapy for about two-and-a-half years. Show her a plastic container with some planting soil and earthworms, and she will pull away like there’s a spider in front of her.

“She’s afraid to go outside,” Joslyn says.

We hear similar versions of this story from the parents of the children they treat each spring through the summer. There are strategies occupational therapists and parents can use to help kids be more comfortable playing among the bugs and dirt.

1. Listen to the child to identify what exactly the anxiety is. Is it about crawling or flying insects in general? Or is there a particular insect that is upsetting? Once you narrow down the issue, begin to work through it.

2. Educate inside the house. We begin with non-threatening bug games like “Spin the Beetle” (Milton Bradley), “Up the Water Spout, a Spider Racing Game” (International Playthings), “Squiggly Worms” (Pressman), and move on to “Cootie” (Milton Bradley). The games are modified depending on the age level. For example, “Cootie” can be played with spelling words or math problems for elementary children.

3. Progress to more vivid illustrations of insects. The children design their own bugs using multiple media, including colored pencils or molding clay. And parents can use electronic games such as “Bugs N Buttons” (little bit studio, 2014) and “Bugs N Bubbles” (little bit studio, 2012) that have lifelike graphics.

4. Have the child build stories. Social sensory stories are written specific to the child with photos or pictures included. I work with Elaina to have her draw pictures in response to a series of prompts about what she can find outside. The combination of the prompts and the pictures helps Elaina create an Elaina book about things outside her house, starting with everyday objects she’s comfortable with (like grass and dogs and cars), then working gradually up to bugs. So one prompt and picture — “Dogs and cats like to play with people. Bugs are afraid of people” — leads to the next — “Because people are big, and bugs are small.”

5. Shift their focus. Sometimes, you can redirect a child’s attention to a goal-specific task, such as a treasure hunt. Praise every success, even if it’s just taking one step out the door. The next time hide more treasures.

These are just some of the steps that our OT’s have used successfully to desensitize children who fear bugs and won’t go outside. At Schreiber, we customize our treatment, so that each child has a specific program to suit their goals.

Bernie Hershey is an occupational therapist at Schreiber Pediatric Rehab Center in Lancaster, Pa. She has been helping kids slide on scooters, balance on balls and climb on ropes for more than 30 years, all in the name of helping improve the quality of their lives.