Ken Beckett’s Remarkable Parkinson’s Rehabilitation Journey
When 82-year-old Kenneth Beckett was admitted to TIRR Memorial Hermann on August 2, 2016, he was, as his daughter Randi Carrabba, says, “on death’s door.” He was delirious, unable to stand or communicate, and his body was covered with bruises and lacerations from multiple falls. A year (and after a lot of hard work) later, Beckett was walking on his own, working out with a trainer and dancing with his daughter.
Progressive Deterioration from Parkinson’s Disease
In 1998, Beckett, then a resident of Orange, Texas, was diagnosed with Parkinson’s disease, an age-related progressive disorder of the nervous system that affects movement. For Beckett, the progression of the disease was relatively slow. After undergoing deep brain stimulation surgery in 2008, Beckett exhibited few of the physical symptoms, including the tremoring, typically associated with Parkinson’s. But in 2012, Beckett began exhibiting the cognitive symptoms of Parkinson’s-related dementia, including anxiety and anger, which, Carrabba says, “are not at all who he is.”
Beckett’s condition continued to deteriorate. He was falling, sometimes three or four times a day. A knee injury in February 2016 caused him to become immobile. In July 2016, he was admitted to a local acute care hospital for a severely broken toe, which became infected, requiring amputation. After eight days (“which felt like eight years," according to Carrabba) , she called Beckett’s neurologist, Mya C. Schiess, M.D. (“Dr. Schiess”), “in a panic.” (Dr. Schiess is the Clinical Director of the UT MOVE Movement Disorders and Neurodegenerative Diseases Program and a Professor of Neurology at McGovern Medical School at UTHealth.) Recalls Carrabba, “I called Dr. Schiess and told her, ‘We’ve got to get him out of here.’”
Transferred to TIRR Memorial Hermann
Dr. Schiess referred Beckett to TIRR Memorial Hermann in the Texas Medical Center for inpatient rehabilitation. “I was surprised that Dr. Schiess recommended TIRR,” says Carrabba. “I had always thought of TIRR as a hospital for people with traumatic brain injury – people involved in car wrecks.” But Carrabba trusted Dr. Schiess. “I can’t say enough positive things about her,” adds Carrabba.
“When he arrived,” says Dr. Schiess, “Mr. Beckett suffered from delirium from being hospitalized and treated with antibiotics and pain medicine for the fall and the fractures. Patients can suffer from dementia and still be oriented and retain a lot of their social interaction skills. But when they’re delirious, they’re disoriented and unable to focus or concentrate, making it very hard to rehabilitate them.”
A Different Approach to Managing Delirium
At TIRR Memorial Hermann, Beckett was placed under the care of physical medicine and rehabilitation specialist P. Jacob Joseph, M.D. (“Dr. Joseph”), who worked with Dr. Schiess to manage Beckett’s delirium. “Here, our approach to treating patients with delirium and other cognitive impairments is not to sedate them, which only makes them incapable of interacting with anyone,” says Dr. Joseph. “Instead, we work as a team, including with the neurologists at UTHealth, to balance out a patient’s medicines and to create an optimal medical regimen. That regimen includes minimizing a patient’s sources of anxiety or aggression by reinforcing day and night, and minimizing environmental distractions, such as noise, that can aggravate them. Additionally, in Mr. Beckett’s case, we used a new medication that had just been approved for Parkinson’s delirium, which helped.”
Inpatient Rehabilitation: A Promising Start
As an inpatient at TIRR Memorial Hermann, Beckett was cared for by a multidisciplinary team who provided rehabilitation nursing care, physical, occupational and speech therapy, the overriding goal of which was to help restore basic function.
From the start, his team of therapists and other care providers worked to get to know Beckett, including his background, lifestyle characteristics and his likes and dislikes. They knew from experience that the best way to enlist a patient’s cooperation is to appeal to the person, not the patient.
His occupational therapist, Anna Haertling, OTR/L, MOT (“Haertling”), says, “We wanted to get to know what was motivating for him. We learned that he was a pilot and liked planes. My boyfriend is a pilot and aircraft enthusiast, so I began to talk about planes with Ken, to build rapport. I brought in old airplane magazines, which served as a motivator. I would motivate him by saying ‘Let’s get through this session, Ken, so we can talk planes.’”
Haertling also quickly learned that Beckett suffered from sundowning, a symptom of dementia that causes confusion and agitation in the late afternoon and evening. So, she changed her schedule so that she could work with him in the mornings, focusing on basic tasks, such as dressing, brushing his teeth and eating breakfast.
Beckett’s physical therapist, Alyce To, PT, DPT (“To”), tailored his physical therapy sessions to his interests as well. “Everything had to be very functional, very important to him,” she says. “Appealing to the hands-on, pilot side of him, we engaged him in activities involving twisting, turning and screwing on, like building a pipe tree.” They also worked on posture (“Parkinson’s patients tend to exhibit a flexed forward posture,” To says.), standing, walking and building endurance.
“Within three weeks,” recalls Carrabba, “Dad was walking 100 feet and shooting hoops. He had not walked on his own for six or seven months prior to coming to TIRR.”
According to Dr. Joseph, “When Mr. Beckett was admitted to TIRR, he required 100 percent assistance to stand and walk. When he was discharged five weeks later, he could walk 75 percent of the time without assistance.” He was ready to begin the next leg of his rehabilitation journey, outpatient therapy.
A Multidisciplinary Approach
As a neurologist specializing in patients with neurodegenerative diseases, Dr. Schiess understands the value of a multifaceted, coordinated rehabilitative regimen. “Along the entire spectrum of neurodegenerative diseases, especially Parkinson's, all of this is so beneficial to patients, to keep them as high functioning as possible,” she says. “The benefits of exercise in neurodegenerative diseases across the board is so very, very powerful, as is the connection between physical and occupational therapies.”
Outpatient Rehabilitation: Continued Progress
After being discharged from TIRR, Beckett moved into an apartment (with 24-hour, in-home care) close to Carrabba’s home and began twice weekly outpatient physical therapy sessions with physical therapist Tracie Jackson, PT, DPT (“Jackson”), at TIRR Memorial Hermann Outpatient Rehabilitation on the campus of Memorial Hermann Memorial City.
Their sessions, which initially focused on basic, functional movement, such as rolling out of bed, were challenging, but Jackson tried to make it fun. “His daughter, Randi, said he liked music, especially the song, “Take Me Home, Country Roads,” by John Denver, who was also a pilot. So, I made a special playlist for our sessions. Three of the five songs on the playlist were that song,” she recalls with a smile. “I’d say, ‘OK, Ken, let’s stand up and sit down for John Denver,’ or, ‘We’re going to walk through this entire song.’ And we did.”
When Beckett’s knee pain (from his earlier knee injury) became limiting, Jackson moved him from “land” therapy to aquatic therapy. “Putting him in the pool,” she says, “was probably the best thing for him. There was no pain to focus on.”
Aquatic Therapy at TIRR’s Strength Unlimited
Today, Beckett participates in TIRR’s Strength Unlimited Program, working out once a week in the pool with fitness specialist Jared Mathews (“Mathews”). Mathews says the communications issues posed by Beckett’s dementia can be challenging, but seeing Beckett’s progress is extremely rewarding. “Some days, he’s extremely communicative; other days, he mumbles. We have a structured physical therapy plan, but on those days, we just go with the flow, modifying his exercise plan for the day to suit his mental state.”
Mathews credits much of Beckett’s progress to the support he receives from family, especially Carrabba. “Family is such a big motivator for Ken. In the pool, if he’s not getting a movement I’m trying to show him, Randi will stand at the side of the pool and mimic the movement, and he gets it.” Haertling concurs, saying, “Strong family support (or lack of it) can make or break a patient’s recovery. He’s lucky to have her.”
“No. 1 in My Book.”
Carrabba says her father’s admission to TIRR Memorial Hermann was a turning point in his Parkinson’s journey. “TIRR is number 1 in my book. Everyone there is a cut above. There’s a whole different mindset there. Some hospitals might mark a patient’s chart with, ‘Patient refused to participate in therapy,’ and that would be it. But not TIRR. They never took ‘no’ for an answer. They push everyone to be their best. Everyone involved in my dad’s care was completely dedicated to helping him get better. You can feel it when you first walk in the door. It’s a place of miracles.”
Dr. Schiess is also pleased with the progress Beckett has made. “I saw him in clinic a couple weeks ago. He's outstanding. it's a real joy. He still has Parkinson's disease, but he is doing extremely well. He has a degree of independence that he didn't have before.”
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