. Captions by Antony Vlug. www.able.co.nz Captions were made with the support of NZ On Air. Copyright Able 2017 My goal is simply to be able to live an independent life. And I will never get there 100%. So I have to define independence differently now. I find that life has... lost its shine. This is Eltje just one year ago at the Tour de France. The last thing she remembers before her accident is cycling on a rural highway in New Zealand. It's likely she was the victim of a hit-and-run. Medics use the Glasgow Coma Scale to determine how severe a brain injury is. When Eltje was assessed, her score was the lowest possible survivable rate. OK, so just hold on before you do any steps. Doctors never expected that she would ever speak again. However, she's been lucky. Now she's anxious to progress faster. That early stage, that first six months particularly, is where we see` or tend to see the most change. And then gradually over time, it, sort of, plateaus out a bit. Eltje will be leaving soon. She wants a full recovery and is keen to learn how much improvement is possible. If you were to try riding a bike, it would carry significant risks for you. OK. Yeah. I want to ride my bike. (SOBS) I miss that. Having completed a full year of medical rehabilitation, Eltje is aware any future improvements will come from her own efforts. (ALARM SOUNDS) She's determined to progress beyond what doctors thought possible. It's been a year` over a year, actually, about 16 months, since my accident. And everything is different. I was in rehab at ABI Rehab first for half a year, and then got discharged into so-called slow stream rehab. I was there for seven months. And then I moved to Cambridge, to here. I sleep really well because I take a sleeping pill at night, and also an antidepressant, and those two together really give me a good sleep. Even if I've had a rough day, I settle to sleep within 20 minutes usually. It might not look like it, but that's actually a challenge to hit the cup and not the bench. Most things are challenging. And so with doing them, I get the brain to learn. And everything I do and something goes wrong, I do it again, and then hopefully get it right, and that's a learning for the brain. From the moment she wakes, she's focused on challenging herself both mentally and physically. The brain injury didn't shake her pure determination. It's safe to do it this way because all my knives are blunt. Eltje has insisted on maintaining her independence with minimal support from friends or carers. In the past month, Eltje has broken her wrist falling during an exercise routine, but that's not stopping her. That was a real setback because I was much more dependant after that. And I obviously strive for independence. But after a few days, I got over it and thought it was just another obstacle. Every morning I do a few exercises. That kinda wakes the body up. And a lot of it is core stuff. And hopefully it will also help with my walking. And then my physio gave me a few tummy exercises. Initially, I couldn't lift my abs off the ground at all, so I can do that now. And then I do a few gym ball things. With that, you try to do a controlled movement. And then a little bit more core stuff. Five more of those. I have a right-sided ataxia, so ataxia is when the nervous system sends your muscles wrong messages, so you can't just extend your leg like this, but it suddenly goes like that. And the same with the arm. And so it's more or less, erratic movement, and you obviously have to counterbalance on your so-called good side. Balance is one of her main issues ` complicated by an eye condition. That's double vision now. I see my main image here, but the other one I see rotated and dropped to the right side. Just the brain giving the eye the wrong information. They are going to do surgery on it, and hopefully the two images will be one on top of the other. Like it should be. Every morning I have to look at my schedule and also compare with my diary in order not to forget anything. So, today is first walking a little bit, then to the gym, and then we might go to the bike shop, and then later on in the afternoon, John's going to come. Routine is absolutely important, because otherwise I'd forget things, and if I have my routine, then it's easier to follow through with all the exercises that I have to do, with the appointments that I have, and I get flustered really easily if there's a change to that. Hi, Nikki. Come in. Hey, Eltje. How are you? I'm all right. So, today, Eltje, we're going to do our route to Countdown. Yeah. So we're going to do it the same way as we've done it last time. So we start with our grounding exercise for 30 seconds, and then we'll follow the same route as we did on Monday. And I'll be guiding you, if you need the help. Yeah. We're doing the same route exactly the same way just so that you're able to recall it, so that you'll eventually do it independently. Hopefully, yeah. Definitely. There you go, Eltje. Thanks. Eltje was excited to get this walking bike, which allows her to get into the community and go longer distances. We provide total assistance ` full assistance initially so that we're really making sure that Eltje makes no mistakes. And then what we start doing next is actually meeting Eltje in different places so that she's doing some and all of the route on her own. So, going out to the gym or the supermarket, and then I have to find my way back. And that sounds easy, but it's not easy for me, because I go twice around a corner and already don't know how to get back. That's how bad it is. The other good thing about the Alinker is I can walk a few kilometres even without getting tired. She defines her own rehabilitation goals and objectives, so when we're working together, it's Eltje who's saying, you know, what we need to achieve and how we need to achieve it, which is great for my work. So, it's good it happened like this, so you don't underestimate it. Yeah. The brain is really good at setting down new neural pathways, and we call that neuroplasticity, and what happens is that when Eltje's learning a new route, we're making a new neural pathway, which then will help her to remember the route from then on in. My goal with the OT is in the long-run to be able to go on my own to the supermarket, gym, cafe or wherever I want to go and find my way back, obviously. We made it. Well done, Eltje. You did really well. Eltje's had a long career as a physiotherapist. I wait for my transport, and while I'm doing that, I just routinely do those exercises. Every spare moment is an opportunity for rehab. Stepping forward, backwards and sideways. Just for coordination of the legs. And it's... And also alternate weight-bearing. So I do that in this corner, so I can save myself hopefully. Then my transport lady is going to pick me up. (CAR APPROACHES) Morning, Connie. Morning. A perfect day for a walk, eh? Yeah. The ultimate goal would be to be able to walk without a walking aid. And I have that belt on in case I tumble. So they walk behind me and can, kind of, get me back into balance, but in the long-run, I would like to be able to walk without anybody behind me or... but that might never happen. Don't know. Thank you. My mum was quite strict. And so to me, it's kinda normal to follow through with all the things, all that, say, with my routine, and there's no exemptions to it. I simply have to learn to actually let go of that sometimes, I was told. (CHUCKLES) And not to be too hard on myself, but that's a learning process. In the pool, we are working a lot on walking, itself. Some balance exercises as well. OK, so we're gonna sit on the noodle. So we're gonna work on your sitting balance. It's gonna be a bit of fun. Just come into the middle of the pool and see if you can stay balanced on that noodle the whole time. That's it. The benefits of this Hydropool is that we're able to do a lot of balance stuff that we can't do around the home or in a gym ` that is we get to push the boundaries a bit more. Eltje does have some balance problems with weakness down one side, and due to her ataxia, or involuntary movements. And obviously, if we do lose our balance and slip or fall, you're just gonna get a bit wet, so it enables us to challenge the boundaries a bit more. Good? Yeah. Nice. I was a physio here in New Zealand for about 15 years, and before that in Germany for about eight years. And my physio, obviously, doesn't have that amount of experience; he's still young. But we can discuss things and talk about it and usually find a common answer to the problem. Knees nice and high. Eltje's actually awesome to work with. She's one of those clients that you don't actually have to do much pushing or motivating. She's extremely motivated and really hard working. And now flick your heels up the back. So I think most of our energy is more around shaping what exercises she does participate in and make sure that she's safe and, I guess, using that energy and motivation to keep progressing and keep challenging the right areas of her rehab. And see if you can hold that position. It's gonna take some work on those shoulders as well. Awesome. Yeah, I used to be quite passionate about my physio work. I obviously miss the good feedback that I used to get. How are you finding that? It's all right as long as I can stand like this. Yeah. But next thing would be 'put your feet together.' (LAUGHS) Exactly. So put your feet together. (CHUCKLES) I miss that kind of challenge as well, but hopefully it can get back to some sort of work. It might not be physical physio, but it might be some consulting type of thing. Right, that's us for today, Eltje. So, in the meantime, I want you to keep doing your home exercise programme that we've practising. I do. Yeah. Cool. And then we'll see you at the gym and go over your lower limb strength exercises. On Tuesday? On Tuesday. At what time? 8.30. Yeah, cool. Cool. I don't feel hunger any more, or appetite or anything, so I have to remind myself to eat. I have to look at the watch. When it's lunchtime. And it has happened the odd time that I've forgotten to eat. Maybe that feeling will come back. But I just don't have it now. I'm fine with breakfast, because it's what I do in the morning, but everything else is more for` kinda a nuisance almost. Everything seems to be awkward. I kinda get used to it. (CHUCKLES) Quite often I don't buy food because it's too difficult to handle. And I just buy food that's easier to handle. So I just have toast and salmon. I could have something else, but I don't... Like I said, I don't bother. For example, I like to eat avocados. But I find it too difficult to eat them properly, so I don't buy them. To be honest, my body is letting me down a lot. So I don't really think I should feed it, but, anyway, I feed it because I have to, but that's all it is; it's a chore. And the first six weeks were just all over the place. I had thousands of assessments and people talking to me and stuff. And that was just too much for me. Whereas now, it's kinda settled everything. So now a certain routine seems to be established, so that's good. The fatigue hasn't improved much. I think I can handle mental fatigue easier than physical fatigue. I can't delay a break, and so I learned that the hard way. Everything breaks down if I don't have my rest. During the day, there's actually still lots of obstacles, so I am quite appreciative of the help that I have now. I'm Caroline. I'm Eltje's support worker. And I help Eltje with lots of different things ` taking down the laundry, dishes, cleaning. Caroline does do my housework, more or less. A lot of those things I couldn't do at all. Some of them I can do partially, but she's definitely a big help, also in respect of my energy. She` The things that she does, if I would have to do them, I would be completely stuffed. Cycling buddy John is a loyal friend and advocate and visits almost daily. Hi there. Hi. How are you? I'm good. But buggered. It was a long day for me. Yeah, yeah. A year and a half ago, I was obviously was not able to make any decisions for myself, so it was completely up to him to make sure that things are happening, therapies are happening and stuff. But he now needs to step back from that and more live his own life more. So, which Indian place did you go to? The one where you were last time? Yes, it's Hello Indian, next to the Stables Cafe. Oh yeah. And that's more than medium. That's actually hot. Oh. Now you have the Alinker, you're physically capable of getting into town and the cafe or the gym or the shop. Yeah, it still needs a few repetitions to go. Yeah, but it's` I can't do it on my own. It's pretty exciting, though. Yeah, it's a great sign. Hmm. I think it's definitely` You're definitely... gaining. Since Eltje was discharged from Laura Fergusson, there was an initial period where I was very involved in her support. But in the last few months, she's got more a handle on being able to live independently with support, and so I am not involved with her day-to-day life. Well, that was good. And I'll be back tomorrow at 8 o'clock, so you need your bike clothes on. That's it. Okey-doke. OK, I'll see you tomorrow morning. Good night! Good night. Have a good sleep. Eltje's injuries were so extreme, many believed she'd never ride a bike again. She started with a trike. But now there's a new goal ` competing at the Paralympics. I am OK now with a trike. Initially, I thought that's not what I want. But I'm OK now because it's enables to go out there and feel the wind and enjoy being active. In the end, you've gotta be able to lead an independent, happy life. And part of that for a happy life would be for me to go for rides like today, so if that leads to a certain level where I can compete against others, I'm happy with that. She's courageous. It takes a lot of guts to hang in there, and she never wavers. Giving up just isn't in her vocabulary. On the bicycle, you have a good pace of moving. I just enjoy that. If I go for rides, so even if I found it hard, at the end, when I'm back home, I feel just relieved and happy. Captions by Antony Vlug. www.able.co.nz Captions were made with the support of NZ On Air. Copyright Able 2017