1 OVERLAPPING INDISTINCT CHATTER GENTLE, POIGNANT MUSIC OVERLAPPING CHATTER CONTINUES WOMAN: Can you open your eyes? You're in a place called ABI, which is Acquired Brain Injury. Copyright Able 2016. SIREN WAILS Every 15 minutes, a NZer has a traumatic brain injury. Over the course of a long rehabilitation, people need to learn to walk again, to talk again, to recognise family and make sense of the world. Brains function for us very well, and you don't generally have to think about it until something goes wrong. Hi, Portia. Can I just get you to sit here? Yep. Sure. Sure. I'll just remove your dressing. You're not gonna rip my hair off? CHUCKLES: Oh, no, no` You're gonna be careful? It's been three months since Terry Tansey crashed his truck. An open wound that spanned the length of his forehead is finally healed. His level of awareness today represents a massive turnaround for his Kaikohe truckie. How was that, guys? Was that all right? Yeah. Is that what you wanna see? What do you reckon? Oh,... I think it's marvellous. I see Terry in the mirror ` the guy that used to have a truck accident, but he's coming right now, so... yep. He's OK. Yep. (SIGHS) < Same, same, different guy? Uh, it's... Nah, it's` Nah, it's a different guy. He's a better guy. Yep. Definitely a better guy. (SIGHS) He's got a good family around him. Mm. Well, I had a truck accident, and, um... VOICE BREAKS: Which I don't have, ever. And, um, made it through. Every day is a challenge. The enormity that he survived is only just sinking in. It's not good. Not good. Even the mornings. You wake up and say, 'Well, what am I doing here for?' You can't walk properly. But I will. I'll come back. I know I'll walk properly. Mm. In any one year, 180 people pass through this facility. Jarrod. (WHEEZES) Morning. Morning. 15-year-old Jarrod has had a brain injury caused by a sudden heart attack. His brother Jason is staying with him. (WHEEZES) Are you ready for today? Yeah. 'So, we've been here at ABI for about a week and a half.' Lie down with me. I wanna move my arm. Things seem to be going very very well in terms of Jarrod... becoming more mobile. (WHEEZES) Until this week is over. (BREATHES RASPILY) Jarrod was in the middle of basketball training when his heart quite suddenly stopped. As he lay unconscious, his brain was starved of oxygen. POIGNANT MUSIC He was revived, but is now dealing with a brain injury. (CHUCKLES) (WHEEZES) Jarrod wants to play basketball again, but they're about to find out if he can even stand up. There we go. I think what we'll do a bit more today is actually look at how long you can stand for and just try to get you kinda moving on to both sides and just feeling that weight through each side. Standing for the first time is... is a big thing, and, you know, when you've been lying in bed and things, your muscles get a bit deconditioned, and just something like standing can be a lot more difficult. Can you lift your arms for me? Good job. That's all good. Yep. Well done. How are you feeling? Do you wanna sit down? It's sore on my arm. OK, we'll have a sit-down. So putting your arms... Yep. Good job. Cool. We might go outside, and we're gonna try do some steps. The` The gutter frame is just... you put your arms into it, um, we'll get you up on it, and it'll give you an idea of how it works. Push up to stand, mate. Yep. Good. Now I want you to reach out. Yeah. Stepping that left foot. Yep. And right foot. Are you able to get longer steps, Jarrod? Pardon? A little bit longer steps. Yeah. Yep. Sit down? (BREATHES RASPILY) Jarrod's mum lives on the other side of the city. She's raising six kids and works. Jason's not working right now, so can look after his brother. PHONE LINE RINGS WOMAN: Hello? Hello. Hello? Hello. Hello? Maia? Yeah. Is Mum still there? MUM: What are you doing? I took my first steps. You took` You took your first steps? Yeah. Oh cool! How does it feel? Amazing. (CHUCKLES) 'Mum finds it quite hard being so far away from where we live. 'She just started back at work this week.' It took ages. 'But she told me it's best... 'for Jarrod that I'm here with him ` 'that, kind of, hard love that I bring.' RELAXED MUSIC MEAT SIZZLES Do you wanna stand up for me? I'll have a go at it. OK. It's quite low. Yep. Good. I'll have a go at it. OK. So, I might get you to sit at the table over here. Terry's goal is to be back amongst his mates. The Friday barbecue simulates social interactions, sometimes one of the hardest things post-injury. Terry reckons he's not going to have any trouble passing this test. I normally` Oh, I can cook. Mm. Well, I used to be able to cook. I haven't been doing cooking for a long, long time. OK. We want to cut the capsicums up for the salad. OK. So you can do it` I'm pretty sure` I'm pretty sure I can still remember how to do that. I think you probably can too. Yep. So, an occupational therapist role actually encompasses a whole part of someone's life. So we'd look at helping people identify what they find difficult to do now, and then find ways that we can help them re-achieve the roles or the activities they want to do. With Terry, it's then about looking at doing some building work, with him doing some metal prep roles that he'd do at home. We could go for a quick walk. OK, let's go for a walk. Yeah. When his truck crashed, Terry broke several bones. As spontaneous thoughts and feelings return, his brain is also beginning to register pain ` a feeling that's been suppressed for weeks. Um, I'm just trying to straighten my back out. It's very very sore. RHYTHMIC BEEPING Sit on the edge of the bed, Terry, and then we'll talk the belt off. Yeah. OK. Oh, I'm disappointed! No, no. It's all right. (SIGHS) It's not all right. It is, because last week you couldn't do the barbecue group at all. No, I started` So you did half of it this time. Started it and couldn't finish it. But, Terry, it's part of your rehab, and we're gonna work on you getting to finish it. Yeah, OK. Thank you. So it's all good. It's not been good, I tell ya. Well, it's an impact of the actual, um, truck accident that Terry had. So, one of the things that happened apart from the brain injury is that he broke... um, fractured his scapular, I think, from memory. < Yeah, scapular. That's right. That's right. Yep. < That's right. And so, for Terry, um, with the constant moving and everything else ` they've decided to treat it conservatively. < Yeah. And I suppose now, because you're becoming more settled and less confused, Terry, you're able to distinguish the pain, where before` < Yeah, that's right. ...it was so` Um, a couple of days ago, I said to you it was sore, didn't I? Yeah, you've been telling me it's sore for about 10 days now. OK. Do you want to roll over, Terry,... Yep. ...and I'll just put the wheat bag behind. Whereabouts do you want it? Right on here. It's a sharp reminder of the consequences of thousands of road accidents that never make the headlines. GENTLE MUSIC Wow. He's built. WOMAN: (CHUCKLES) Yep. OK. Feels good. And now when you stand up, you're gonna push up from the bed, OK? So, where's my wheelchair? (INHALES RASPILY) Not here! Why not? Cos you don't need it. Jarrod has damage in the part of the brain that makes sense of everything we see ` the occipital lobe. That's it. Jarrod can't tell what colour objects are or how far away they are. Cool. And I'm just` That's it. We're gonna take that out of the way and reach forward to the sink. (COUGHS) Reach forward to the sink. Bit further back. Can you feel the basin there? Cool. Good. And where's your toothbrush? It's on the other side of the tap. Other side. Yes. Well done. What colour is it? What, this one? Can you hold it up a bit into the light? Blue. Yes. That's right. Jarrod was given a tracheotomy when his heart stopped. So that's the actual tap, but the handle bit is just above it. Complications from this are causing noisy breathing. (BREATHES RASPILY) There you go. Well done. (CONTINUES BREATHING RASPILY) He seems to be accepting a lot of what's going on. He does get a bit stubborn at times, but, you know, that's how 15-year-olds are, I guess. Where is...? Where is J? (BREATHES RASPILY) Do you see J? Oh, right there. Yeah. (LAUGHS) Just gonna get you to stand up, OK? Standing up. Three days on, he's independently standing. There's a tissue box in front of you, and I want you to try bend down and pick it up. Good. Just careful when you're coming back, eh? It's just stabilising, keeping your weight a little bit forward. Now turning a full circle, OK? Yep. Ready, set, go. Oh. (BREATHES RASPILY) Ultimately, in the journey of a person's brain injury, it's gonna be the family that are gonna be there long-term. The staff here at ABI Rehab can hand over their skills and hand over their knowledge and give their management strategies to the family. It then gives the family the tools to manage when we're not around any more. (BREATHES RASPILY) Good. So, we're gonna take a few steps back. OK? What were we remembering to do? I put my weight... forward a bit. Yep. Perfect. Good. Good job. We'll probably get you to do some stuff over the weekend. Um, and we might actually get you involved, so we're thinking about getting him, um, to come up to the gym if possible. And some of those sit-to-stands. LIGHT MUSIC Um, so we'll go into the bars, actually. MUSIC CONTINUES I'm feeling pretty good, actually, to be honest with you. My brain feels normal. But I think I can make it better. LIGHT MUSIC CONTINUES It is quite hard because you're not` you're not, um, 100%, so you're not thinking as hard as what you should. Um, but, yeah, it's not too bad. And Kevin's been good because he's had a brain injury. VOICE BREAKS: And he's been helping out quite good. Excuse me. Kevin is Terry's eldest son. 10 years ago, he too suffered a traumatic brain injury. He's calling in. I'm all good. Three weeks ago, Terry barely knew he had visitors. Now he watches the clock and waits. He comes into that car park there ` that car park out the back. We can` We can` We can hop in and walk out there, if we want, see where he is. Oh, was that Kevin at the front door? Go and see. > Should we go and see? Go see if it's Kevin? Go and see who it is. Could be. Hey, boy. You're here. Yeah. This guy here ` he likes Holdens today. Today. Today only. (CHUCKLES) Just today. Yeah, just today. Turned them. Yeah, turned them around. I was a pedestrian, got hit by a car. I was with` Yeah, I was with, uh, two of my friends. We were walking into, uh, Kaikohe ` the place where I grew up in, where Mum and Dad live. He was thrown 32m. Only suffered, um, head injury. No` No other broken bones at all. Um, no bruising or anything, just` just his head. Yeah, and then I was` As far` Yeah, I think I was in intensive care for probably a week ` ICU for a week. And... (LAUGHS) I forgot what I was doing. So the` the doctor said, um, that the damage in Terry's brain was only showing up to, sort of, this size. And, um, then Kevin's, on the CAT scan, the last one we had was` is about that big. Um, but Kevin had bruising to the front and back lobes. So he had, sort of anger issues and, you know, a lot more language. Yeah, that was quick. 'Yeah, I remember them explaining to Kevin once that "think of your brain as a filing cabinet, '"and you've tipped all the files out in a big pile, '"and you've now gotta put them back in the right place." And that made the most sense to him.' Well, I did get knocked out, did I? I got put in a coma, apparently. And that's` That's why I, sort of, tell Terry as much as I can that, you know, 'Oh, you're just like Kevin. Kevin got better, so so will you.' You know. Cos he remembers Kevin's accident. He was actually talking to me about it before. Putting your own shoes on now, mate? Yeah, I am. I'm putting my shoes on every day, yeah. Yeah? Yourself? < Yep. Yeah, they keep saying to me, 'Are you OK?' Yeah. Nah. I say, 'Nah. Get in my way, I'm gonna have a shit.' BOTH CHUCKLE I think, like, Dad's accident's made me really think about it, because I've learned to live without thinking about it. Cos for me, it was, like, anger, man. It was like I was pretty angry. < Yeah, he was angry all the time. Um, I think it would just seed from, like, just my own frustration with, like, how different things were working for me. Heaps of issues of speaking and, like, word finding and stuff like that. So it's like having a dictionary and someone ripping a couple of pages out. So, like, substitute words that you know, but they're stuck on the tip of your tongue. You just learn to live with it, and then you stop thinking about it, and you learn other ways to do this or that. GENTLE ACOUSTIC GUITAR MUSIC MUSIC CONTINUES Jarrod over the last couple of days has made some really good improvements. He's no longer needing the wheelchair to come up to the gym. He's now able to walk outside by himself and with Jason or one of the staff members helping him out a little bit, just guiding him. It's mainly to do with his vision. So a lot of what we're doing... we're doing today is we're scanning for things, and, um, we've got an obstacle course set up. Right. I've got some cones on each side, and I want you to go along. I want you to pick up those cones, all right? (CHUCKLES) Cool. Keep coming. Try to bend down and find it. So it's here. Good. Keep going. While Jarrod's making great progress, his heart is still weak. Therapists need to be cautious about how much therapy they give him. Might just have a little sit down. Yeah, your heart rate's just started getting up a little bit. < You're not allowed to get past 150, yeah? (WHEEZES) (WHEEZES) GENTLE ACOUSTIC GUITAR MUSIC MUSIC CONTINUES Terry's out of the rest phase. He's been living semi-independently, and tomorrow he'll visit home. My goal's to get better and get out of here and go home. I wanna start working again. Terry is aware that he won't be able to drive for a stand-down period of six months. And actually, to get back into driving with a commercial licence is going to be extremely difficult. Hi, Terry. > Hi. So, what I thought we might do today is have a look at some of those building skills of yours. OK. Yeah, you talked about this other day, about putting some locks up. Yeah. So remember, we've done some assessments, and we looked at different types of skills you have. Yeah. That's right. And now I just want to look at the practical skills that you'd use around home. OK. So that's your window. Let's have a little bit more light. So, what do you think? Can we shorten these so they can only open up so far? No. Cos they're not on a ratchet. I was looking at Terry's cognition and his thinking, planning and problem-solving skills. And in talking to Terry, this is something he would have done quite easily beforehand. He would have just gone and got it. Cos if we placed it in a certain place, would it reduce the opening? Um, I could open them, but I think it'd be a waste of time. Cos I don't think they will. This is the shed here, Terry. OK. Just looking at the really practical ` is he able to plan it, can he sequence it, does he have all the information, can he process the written information, can he translate to how he's going to use the tools, has he got the right tools, can he do the task? What about if you read number one? OK. I can read that, number one. OK. READS: Use the cam spanner. READS: 'Using the cam spanner, disengage the arm from the fork. 'Using an Alan key provided, remove the screw located at the end of the arm.' There. OK? Yep. I think we've got the right stuff here now. These are around the wrong way. Take it outside and put it on the outside wall. If we put it on the outside wall, how would it work? Yeah, that's why we're gonna think about it. I'm just going back outside, all right? When we did the window, Terry did struggle with how he was going to do it. That will screw into there, all right? But he made some really good choices. When he was going to screw the bolts into the window where he thought it would be, he was concerned he would break the glass, and he was probably right. I think it would annoy the crap out of me too if I lived here and something was sticking out this far, cos you'd smack your arm on it every time, every time. Yep, absolutely. That's why we're trying to fix it. Yeah, it'd annoy ya. Yeah. Don't wanna cause anyone any injury, do you? No. Nah, nah. GENTLE ACOUSTIC GUITAR MUSIC Knock, knock. Hello, Jarrod. Actually, we're probably gonna do some breathing exercises right now. Yeah. So your vocal chords, normally, when we breathe are open. But sometimes when you're breathing, they get too close together, and that's where we hear those sounds like... (WHEEZES) All right? And that's what we wanna avoid, right. So you can control it. You can kind of feel how it feels in your throat when you... (WHEEZES) All of this ` I'm just gonna touch your neck real quick ` this gets a bit tense, right? But when we're breathing, right, when we're concentrating on our belly, you're like a balloon that's inflating and then deflating. When you breathe out, I want you to make a... (HISSES) sound. (HISSES, CHUCKLES) (CHUCKLES) Good. And then another cool effect of this kind of breathing is that it's lowering your heart rate quite a bit, which is another goal of ours. (WHEEZES) I do go if I do that. (CHUCKLES) Is that right? Yeah. Jarrod's now two months post-injury. So, I think we're gonna do some running. We'll do some upper limb stuff as well. Running inside on the treadmill? Nah, probably not on the treadmill. Might do a little bit of walking on it, though. But running, so we're just gonna do two lifts, OK? And we'll sit down. There and back, there and back. Yeah. OK? Ready? OK, go. (WHEEZES) Try going and landing on your toes, OK? That's what I want you to do, all right? Keep going. On your toes. (WHEEZES) So, what are you gonna do this time? I'm gonna do the steps. (WHEEZES) And maybe last time I was doing it. Yeah. And to do that, you need to get what with your knees? What are you gonna do? High. Higher knees. Cool. All right. Three, two, one. Go. It's amazing how fast he's progressed... from what we were told. He was motivated to prove the doctors wrong, but show them that he is strong. (WHEEZES) (CHUCKLES) (WHEEZES) ALL LAUGH So, there's a number of different ways that we measure success. Um, we have a lot of outcome measures. Um, so we can objectively measure how people are changing. We also measure change based on feedback from clients and families, how successful it's been from their point of view. As Jarrod prepares to make a home visit, his family must learn how best to support him. So, yeah, that's the main thing we wanna highlight is that heart rate when you're going home, um, that you just have to be very diligent with that. And those oxygen saturations, those same sort of stuff you've got, you use precautions. < I think that probably that the three main things that we're working on when you do go out are getting you to look at your watch yourself and check when you need to, uh, take a bit of a rest; and your eyesight, so scanning around and looking for things. And when we're inside, scanning round to find where the cookies are, for example. So getting used to doing lots of work with your eyes. OK, bro. Good luck with it all, bro. Enjoy. I'll see you when you're better, eh? Did you wanna have a photo? Hongi. Yeah. I'll headbutt you, eh? (WHEEZES, LAUGHS) So, what did you think about the meeting? Um, I can go home. Yes. Yes, you can go home. but in your progress, what did you... how did you feel? (WHEEZES) About what they were saying? Yes. Do you agree with the... with them still wanting you to have someone to support you when you're walking around and stuff? Yeah. Yeah? And being home for the weekend ` what are you looking forward to? (WHEEZES) Just being home. How do you feel about me not being here all the time? (WHEEZES) It was hard, because Mum wasn't there. You know it's hard for me not being here all the time, don't you? (WHEEZES) And you understand why? Yep, cos you couldn't always. (WHEEZES) I missed you. I missed you. Let's get you home. Terry's off home. GENTLE MUSIC Best-case scenario would be he does what he's told,... (LAUGHS) doesn't overdo things and just lies back and has a nice relaxing weekend. Worst case would be that he tries to do too much and yeah, tries to paint the house or something like that. Uh, but I think he'll be... he'll be good. Do you want me to carry that or are you all right? Nah, I'm OK. Thank you. How long have I been married to Andrea? Um, probably... Shit, probably 30 years. 26th of May 1974 ` there you go ` we got married. There you go. I remember. (LAUGHS) Those are good innings, eh? Yeah. < Did you just remember that? Yep. < Good one. Feels good. Feels great. First thing we'll do, we're gonna hop in the car and go home. Yep. (CHUCKLES) When you get home, what's the first thing you're gonna do? Um, well, I dunno. I think I might just go for a little walk around the place and have a look. CAR ENGINE STARTS GENTLE MUSIC In our next episode, TK is home, but his therapy continues. Terry is keen to put his brain injury behind him. And Jarrod makes an emotional return to where he had his heart attack. Captions by June Yeow and Faith Hamblyn. www.able.co.nz Captions were made possible with funding from NZ On Air. Copyright Able 2016.