Inpatient rehab spurs dramatic spinal cord injury recovery    

A bike accident left Steve Nelson with a broken neck and a severe spinal cord injury. But his determination and the help UCHealth therapists and other providers have him rolling again.
Nov. 29, 2021
Sheet music for the violin are positioned as they were the day Steve Nelson suffered a severe biking accident that left him unable to play. Photo courtesy of Steve Nelson.
Sheet music for the violin are positioned as they were the day Steve Nelson suffered a severe biking accident that left him unable to play. Photo courtesy of Steve Nelson.

Two pages of music covered with notations lie open on a stand against a room’s white wall. Beside them sits a violin atop a small brown table. The objects await someone to step in, take the violin in hand, draw a bow across the strings, and bring the notes to musical life.

But the scene is a tableau frozen in time. They represent a period of Steve Nelson’s life that will never return. Memories of coaxing music from his violin are all that remains. Yet he does not dwell on the loss He focuses instead on the many things he has regained after fearing that they might be forever lost.

A profound bump in the road

With many precautions, Nelson is back on his bike after inpatient rehab helped with his spinal cord injury recovery.
With many precautions, Nelson is back on his bike after inpatient rehab helped with his spinal cord injury recovery. Photo courtesy of Steve Nelson.

The music stopped for Nelson on July 24, 2020. A self-described serious violinist for much of his life, Nelson, now 74, practiced every day and played chamber music both for himself and others. He’d set the violin aside that day for another passion: riding his mountain bike on a single-track trail near his home in Erie, Colorado. He’d rolled across the course, dotted with berms and jumps, nearly every day for the three years since he and wife Wendy had moved to the quiet Boulder County community.

The routine ride hit a nearly deadly turn in an instant when Nelson took the largest jump on the trail. As the bike went airborne, Nelson lost control. He and his bike parted company and his head slammed into the dusty ground, cracking his helmet in seven places. Someone found him unresponsive on the trail, his bike lying some distance away. He emerged from blackness to find himself loaded onto a helicopter for an emergency flight to the Trauma Center at UCHealth University of Colorado Hospital on the Anschutz Medical Campus.

At the hospital, images of his injuries returned grim findings. Nelson had three bone fractures in his neck. Blood had gathered against and compressed his spinal cord, leaving him paralyzed. He’d also fractured a hip and several ribs.

A rush to surgery and intensive care

The trauma team rushed Nelson to the operating room, where neurosurgeon Dr. Jens-Peter Witt opened the front of Nelson’s neck and worked to stabilize and repair the fractures. Witt deemed the surgery successful, but Nelson faced serious challenges.

“My ability to function was essentially nil,” he said. “I couldn’t lift my arms.” He spent the next three days in the intensive care unit at UCH, feeling very little physically, but experiencing a “full range of emotions,” including a deep appreciation for the nurses, therapists and other providers who tended to him as he lay helplessly.

“The care I got in the ICU was simply extraordinary, and I mean that in the human sense,” Nelson said.

More than movement lost

We generally use the term “loss of life” to refer to death, but Nelson’s mishap reminds us that many survivors of severe injury lose parts of the lives that sustained them. In Nelson’s case, the physical activity he maintained into his 70s had simply continued a long commitment to athletics. He swam competitively during his college days in his native Ohio, skied cross-country, ran marathons and triathlons and raced on bikes across the Midwest and New England.

After 19 years as the head of a private school in Manhattan, Nelson and Wendy moved to Colorado in 2017 to be near son Chris, his partner and their two grandchildren. He took immediately to hiking and biking in the wide-open spaces of the state he and Wendy quickly called home.

The sudden disaster threatened all that. With his condition stabilized during his ICU stay, Nelson transferred to the Inpatient Rehabilitation Unit at UCHealth Broomfield Hospital. He admits that he had a distorted sense of his prognosis.

“I envisioned doing some push-ups and sit-ups and then getting back on the bike,” he said. His providers, however, painted a painfully realistic picture: that his still mostly paralyzed body faced a long journey toward that distant horizon.

“It was hard to hear that I’d be in the rehab unit a month,” said Nelson, noting that the stay was limited by insurance. He realized that he’d undoubtedly need more assistance once that time was up.

Riding another tough road

The COVID-19 pandemic complicated the formidable physical challenges Nelson faced. He could have only one visitor at a time, and he never saw his providers’ masked and shielded faces. Toward the end of his stay, a blood pressure drop and fever spurred fears of a COVID infection – thankfully not the case. Far from making him bitter, the ordeal increased his gratitude toward the many team members who cared for him.

“Their spirit was always upbeat,” Nelson recalled. “The human community was a big part of keeping my spirits high.”

But his recovery required plenty of hard work, much of it done in seven-day-a-week sessions with physical therapy (PT) and occupational therapy (OT) specialists. Nelson is especially grateful for the assistance he received from PT Marisa Leykam and OT Leah Muntges.

Leykam, he said, “pushed me to the limit, understood my potential for recovery and responded to the progress I was making in a very positive way,” while Muntges was “equally influential in getting a sense of what I could do.”

Broomfield Hospital occupational therapist Leah Muntges (left) and physical therapist Marisa Leykam helped Nelson through an arduous month of inpatient rehabilitation that helped with his spinal cord injury recovery.
Broomfield Hospital occupational therapist Leah Muntges (left) and physical therapist Marisa Leykam helped Nelson through an arduous month of inpatient rehabilitation that helped with his spinal cord injury recovery. Photo courtesy of Leah Muntges and Marisa Leykam.

Inpatient rehab pushes spinal cord injury recovery

Leykam and Muntges worked in tandem to help Nelson rebuild as much as possible the physical strength and skills he’d lost in the accident. With Leykam, he relearned and practiced basic movements, like squatting and pivoting to transfer himself from one surface to another, sitting up in bed, finding balance points so he could move safely, and using his legs to compensate for his disabled arms. Muntges taught him how to apply those skills to everyday activities, such as moving from his wheelchair to the toilet or pulling a shirt over his head.

The work was not an end in itself, but rather essential steps along a continuum of care that included getting and inching toward possibly standing, feeding himself or still distantly, walking or riding a bike again.

Nelson did very well with his PT work, in part because of his positive attitude, but also because he understood that it could help him reach those goals, Leykam said.

“We get buy-in from patients once they learn why they are doing something,” she said. “Steve understood that to get back to walking and biking we had to take him where he was.”

Positive attitude proves a plus

Muntges noted that Nelson’s attitude made it easier for her to broach the difficult subject of what lay ahead for him with his therapy. He initially struggled, for example, with proprioception: that is, the awareness of his body in space. He couldn’t tell where his legs were. As a result, in an early session, he nearly kicked her in the face when he raised a leg.

But he was highly receptive to her efforts to help him harness that strength, Muntges said. “Steve was very balanced in terms of how he received information and maintained his ultimate goals for recovery. That’s pretty tough to do when you are in the circumstances he was when we met.”

Wendy also prepared for Steve’s eventual discharge and return home. She had to understand how Steve moved so she could assist him within the limits of her own physical capacity. Leykam compared the process to “learning how to move with a new dance partner.” The work was manageable more quickly than expected “because Steve had put in the work” to learn how to move and balance himself, she added.

As with the patient, Muntges said, caregivers need plenty of education. “You have to meet that family member where they are,” she said. “You learn the boundaries for the person who is going to primarily provide the help.” Wendy’s commitment to aiding Steve meant he could head home after discharge rather than to an assisted living facility.

“Wendy had her life turned upside down because of me getting turned upside down,” he said. “I have a wonderful partner.”

Therapists tap a reserve of physical strength

Steve’s excellent physical condition and competitiveness also helped both of his therapists fire his positive motivation. “We tapped into his athletic mentality a lot in therapy,” Muntges said. Leykam added that Nelson benefited from a “great baseline of strength and activity,” which gave him a heightened awareness of his body and how to adjust his movements.

On leaving the Broomfield unit, Nelson sat in a wheelchair, propelling it with his feet as the staff rang a bell to signal his departure. He was moved by the “collective power” of the providers who had pushed him physically and buoyed him emotionally. He was ready for the next leg of his journey.

Returning home, he rolled into a first-floor room, converted from what had been a playroom for the grandkids. He couldn’t eat, drink or do what had once been everyday activities without Wendy’s assistance. But with the help of a new team of PTs and OTs, he continued to work on his recovery for the next several weeks.

Using the skills he’d built in the Broomfield unit, his progress was remarkable. Within a couple of weeks, he was able to move with a walker. After more therapy, he took short, unassisted walks and cautiously ventured outside. On a landmark day, his PT told him he didn’t need a walker and asked Nelson to try walking all the way up the stairs of his home, which he did successfully.

“It was exhilarating and terrifying,” he said. But he was on his feet again, and in short order, the first-floor hospital room was dismantled and he was back to sleeping upstairs in the bedroom and could use the bathroom on his own.

“These were great steps toward independence,” Nelson said.

An athletic approach to recovery

He worked hard to rebuild the strength in his upper body with weights, taking on the challenge “like an athletic program.” A little more than a year after he left Broomfield Hospital, Nelson met an ambitious goal that had seemed unthinkable after his surgery. Accompanied by daughter Jennifer, who had gathered granddaughter Quinn and driven straight from Vermont to Colorado after the accident, Nelson climbed more than 1,200 feet to stand atop Mount Sanitas in Boulder.

About a year after the accident, Nelson stands atop Mount Sanitas in Boulder. Photo courtesy of Steve Nelson.
About a year after his spinal cord injury, Nelson stands atop Mount Sanitas in Boulder. Photo courtesy of Steve Nelson.

With the less than enthusiastic assent of Wendy, he’s also back on his bike, making relatively cautious runs with son Chris on nearby bike paths and flat trails.

Today, Nelson estimates that he has recovered about 85% of his pre-injury function. The most difficult loss was the fine motor skills he needed to play the violin. He accepts the setback philosophically, relishing the memories he garnered from years of playing.

“I have some musical friends who can’t play anymore, and they didn’t crash their mountain bikes,” he said. “When you realize how quickly it can all be gone and go through an extended time of very serious impairment, it’s very easy to recognize with extreme gratitude the ability to do what I can do,” Nelson said.

Appreciation for many helping hands

Nelson dwells not on the music stilled by the accident, but on the new notes that he is still free to write for his life. The help of his family and his health care providers has given him “a new perspective,” he said. He’s kept in touch with Leykam, Muntges and others at the rehab unit to keep them apprised of his recovery, a gesture Leykam called “bright spots in our days.”

Having survived a physical disaster that nearly severed him from his life, Nelson now relishes the connections he formed during his recovery, noting in particular ICU nurse Krystal Brownfield and rehab nurses Katie Emmons and Colette Hefty. He expressed his newfound appreciation as he rolled in his wheelchair toward the elevator in the rehab unit, listening to the tolling bell that signaled his departure.

“I told [the providers] that they had changed my life in ways that I could never express and that I would be grateful to them for the rest of my life,” Nelson said. “I haven’t lost that feeling at all. They are the unsung heroes.”

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.