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Ashley's Rehabilitation Story

by UPMC Susquehanna

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By most accounts, Ashley Johns, 18, of Wellsboro, is a miracle. In February 2014, she lost control of her vehicle on a wintry road. The one-car, rollover crash left her unable to walk, talk, stand, eat or even sit up in bed. She suffered multiple facial and skull fractures, bleeding in the brain, fluid buildup in the brain, leaking spinal fluid and breathing difficulties requiring a tracheotomy. Today she is back attending school, cracking jokes and walking independently again—the same lively and talkative girl she was before that fateful night—thanks to top-notch surgical and rehabilitative care right in her own backyard.

EMERGENCY ACTION

The long road to recovery began with emergency care and several surgeries by neurosurgeon Dr. Rodwan Rajjoub, a brain and spinal specialist at Williamsport Regional Medical Center, to target immediate concerns with her brain. “Ashley was a very complex case due to the multiple, severe injuries to her brain,” explains Dr. Rajjoub. “I performed a craniotomy to release pressure around her brain as well as several procedures to address her facial and skull fractures and spinal fluid leaks.” “I love Dr. Rajjoub,” Ashley announces with a big smile. “He’s just awesome—he took care of me when I first went to Williamsport and always took time to explain everything he was doing. I still see him for follow-ups now.”

Ashley was comatose for roughly the first month following her surgery. She was transferred to the Children’s Hospital of Philadelphia to handle some additional concerns with spinal fluid leakage and muscle spasticity before being discharged to begin therapy back home.

 TAILORED THERAPY

“When Ashley came to us, she was wheelchairbound, just starting to speak and required the assistance of several therapists to sit up and support herself,” notes Tanya Geneski, one of Ashley’s primary physical therapists and supervisor at the Susquehanna Health Physical & Aquatic Therapy Center in Wellsboro.

Every patient is unique, so each treatment plan is tailored to the person’s specific needs. Due to the nature of her injury, Ashley needed an even more out-of-the-box, multi-faceted approach to rehabilitation, including physical, speech and occupational therapy to address both muscle strengthening and the mental retraining of those muscles.

As a certified vestibular therapist, Tanya is specially trained to treat patients with vertigo/dizziness, imbalance, coordination or concussion-related issues due to inner ear or brain and spinal cord injuries. “Ashley’s case required a lot of therapy designed to improve her balance and coordination as well as decrease the spasticity of her muscles—re-educating her muscles on how and when to move—to return her to more normalized mobility,” Tanya says.

Ashley’s team also used aquatic therapy. Water therapy allows patients struggling with weightbearing exercises, joint problems or trouble with balance to build strength, neuro-motor control and flexibility using the water’s buoyancy. This creates a less physically taxing environment and can help patients more smoothly transition to land-based exercises and tasks. “All the different angles of therapy combine to further each other during the healing process,” Tanya explains. “Speech was crucial to improving not only her communication but also her cognition and processing—which in turn played a vital role in her ability to rejoin school at the same grade level. Each milestone built on the next. Her greater energy, expression and enjoyment when getting back to feeling like herself gave her the motivation and dedication to push harder and get stronger.”

PERSISTENCE AND SUPPORT

 But make no mistake, therapy was tough. The injuries to Ashley’s brain meant her pain receptors would sometimes treat even the lightest touch as very painful, complicating therapy even further. At times, it felt too hard, but one such moment led to the biggest turning point in Ashley’s recovery. “I was feeling so fed up that I yelled ‘I quit’ and tried to storm off—that’s when I walked on my own for the first time since the accident,” Ashley laughs. “I suddenly realized how far I’d come and what I’d accomplished, and it made me want to work that much harder.” As she made progress with her physical and speech therapies, the team expanded to provide relaxation techniques to help Ashley cope with her brain’s heightened sense of pain as well as hand and occupational therapy focused on common daily tasks, social interactions and life skills. These aimed to ease any anxiety about returning to previous activities or navigating public places with a cane. “My team here is just the best—they make me laugh and smile,” Ashley adds. “They push me when I need it, and they always make time for me. Everyone is kind and chats with you; it’s very social, and it’s much more personal. They get to know you. They aren’t just being friendly—they are all really invested in your care.”

Facing so many new challenges and adjustments at once can create doubt, depression and stress, so her team also focused on the emotional aspect of recovery. To combat nerves, frustration or sadness, the team involved her incredibly supportive family in her care to create a dedicated support network, encouraging and motivating recovery both at home and at the center. Together they sought to make every trip to rehab upbeat and satisfying, making even the most challenging work feel worthwhile.

“It is wonderful to watch Ashley’s progress,” adds Dr. Rajjoub. “She was very determined to get better and was lucky to have such a supportive family and therapy team doing whatever it took to get her there.” All of which has led Ashley back to her normal routine: enjoying lunch out with family, planning for her career as a veterinarian and being back in school with friends. Her favorite subject is history—fitting for someone whose strength and motivation inspired what those around her call a history-making recovery.