Taking the Reins

Jockey recovers from a spinal cord injury with help of dedicated therapists.

The thundering hooves of race horses penetrated the air at Gulfstream Park in Hallandale Beach, FL, on the afternoon of Feb. 18, 2011. Thousands of spectators cheered wildly as the horses entered the final stretch. But moments after Omi's Vindication crossed the finish line in first place, a chilling hush came over the crowd. Finishing in second place, Precious Lady stumbled and tossed jockey Paco Lopez as she fell to the turf course. A split second later, third-place finisher Lady Chesterfield was unable to avoid the fallen horse and unseated jockey Eibar Coa.

"It was a scary situation," Coa recalled. "I stopped rolling and realized I had no sensation from my neck down. I was hoping that it was temporary and would go away in an hour or two."

Lopez suffered minor injuries but Coa fractured the C-4 vertebrae in his spine along with his right wrist, left shoulder and left collarbone. After being admitted to Memorial Regional Hospital in Hollywood, FL, Coa was diagnosed a complete quadriplegic and given little hope for ever walking again.

The native Venezuelan underwent two neurosurgeries during a two-week period at Memorial Regional Hospital before being released to The Rehabilitation Institute of South Florida at Memorial Regional Hospital South for extensive rehabilitation.

True to his word, the 40-year-old veteran rider walked through the front doors of Memorial Regional Hospital South six weeks later, without assistance.

Steely Determination

Coa made a recovery that was nothing short of miraculous, according to Greg Zorman, MD, chief of neurosurgery, Memorial Healthcare System.

Everything seemed to align in Coa's recovery: family support, clinical expertise and patient compliance. From day one of his stay, his determination was unmatched by any other patient. During his six-week stay at Memorial Regional Hospital South, Coa was often referred to as a model patient.

"When I train, I work hard every day to keep myself in shape," Coa told ADVANCE. "I focus on maintaining my weight and being active. But my training schedule pales in comparison to the work I did in therapy."

During Coa's first morning in the rehab facility, Deni Welch, OTR/L, performed an initial manual muscle test and mobile assessment. She educated Coa and his wife, Rebeca, about his injuries to prepare them for what was to come. He had been outfitted with a cervical collar and a wrist cast and was non-weight bearing in his dominant right upper extremity.

When Sherry A. Magcalas, PT, met Coa, he was just beginning to regain movement in his legs, but it was weak. Coa was unable to hold himself up on the edge of his bed due to a lack of trunk control. "I told him, 'let's start with sitting and then progress,'" said Magcalas. "I didn't want him to get frustrated because his goals were too big from the beginning." According to Magcalas, Coa cried the first time he sat by himself on the edge of the bed. "This is working," he had said.

From an OT standpoint, Welch felt that Coa needed to focus on learning to feed himself. "This was a tall order since he was wearing a neck brace, was unable to use his dominant right hand, and had weakness in left hand," she shared. By the end of his stay, Coa could take the brace off and feed himself with finger food.

Athletic Prowess

"As an athlete, Eibar's body is his business," Welch said. "Before a race, he visualizes racing on the track and how he will manage his horse. Similarly, he was an athlete before and during his therapy sessions."

"Because some of our physical therapists are marathon runners, they identified with Eibar as athletes and competitors," shared Denise Maillet, director of rehabilitation services at the Rehabilitation Institute of South Florida. "They were as determined as he was. Soon they were trying to keep up with him."

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Eibar Coa, a jockey with 4,080 career wins, was thrown from his horse in February 2011 and made a miraculous recovery from a complete C-4 injury.

Magcalas soon discovered that Coa continued his therapy in his room at night with visualization exercises. "He mentally prepared himself for his next session by identifying things he could do better," she said. "We feel that by visualizing himself succeeding, he was able to achieve his goals faster and more fully."

Within time, he began supplementing the three hours of rehab he received during the day with additional work in his room. Welch gave Coa UE exercises to do with resistance bands when he was tired.

A large piece of Coa's recovery was the support he received from many family members. His wife, in particular, was a tireless, ever-present source of love and encouragement.

According to Welch, Coa requested that the therapists teach Rebeca how to safely transfer him. She is taller than Coa and needed to learn where to put her hands and how to use the gait belt. "We called Rebeca our 'junior therapist,'" she stated. "When we weren't there, she guided his sessions and home exercise programs."

When Welch worked with Coa on activities of daily living, he would say, "I'm not here to do dressing and bathing. I'm here to get back to work. "

According to Magcalas, Coa thought, "my wife is always here and can help me with toileting and bathing." He wanted to focus on exercise. The therapists had to make sure he understood that accomplishing those goals was part of the therapy.

On to Outpatient

When Coa was discharged from inpatient therapy, he was beginning to gain more functional use of his left hand, according to Welch. He could hold on to a toothbrush but couldn't apply resistance, so he would end up dropping it if he tried to brush his teeth.

His right LE was still weak, and sometimes the right knee would tire and buckle. Magcalas focused on functional tasks to prepare him for challenges outside the unit, such as navigating the 15 stairs in his two-story house. The therapists often used the facility's Determination Drive, an area equipped with various terrains, a simulated grocery store and a car to practice transfers.

When Coa reached the outpatient center, frustration and minor depression-mainly due to his limitations-were among his greatest obstacles. "One of his concerns was 'am I going to be able to return to sport?'" shared Evelyn Mora, PT. "He asked me that every day. I suggested he focus on the progress he had already made and not on things he couldn't do. For example, he shouldn't have been walking, but he was."

Mora performed his initial PT evaluation and discovered weakness, spasticity and poor balance and core control. Coa also had medical limitations, such as hypertension, that needed to be monitored throughout therapy.

Coa's main issues, according to Lucie Robitaille, OTR/L, CHT, were decreased strength, ROM and coordination in both upper extremities as well as pain, hypersensitivity and spasms limiting functional independence in all activities of daily living. Coa did not have the strength to move his arms overhead to put on a shirt or the grip strength to pull up his pants.

Besides working toward long-term goals, Robitaille introduced assistive devices for feeding and grooming to promote independence as early as possible.

His treatment and home exercise program included the use of dynamic orthoses and electrical stimulation for wrists and digits, core and upper-extremity strengthening exercises to promote stability and coordination activities for distal function.

As an athlete, Coa was able to recover faster than the average patient, according to Mora. Initially, his home program was focused on functional tasks such as bed mobility and lower-extremity stretching. He progressed to weight bearing activities including single leg exercises, squatting and functional training with emphasis on dynamic multi-planar activities.

The OT home exercise program Robitaille prescribed focused mainly on coordination and strength activities, such as practicing prone on elbows and gradually becoming weight bearing on all fours after his wrist cast was removed on May 6, 2011.

Coa returned to visit the inpatient team shortly after his cast came off. "He had regained his ROM and his grip had improved," Welch relayed. "He bounced a basketball with both hands and climbed stairs like it was a piece of cake. He could hold his balance on one leg."

"He was a different person when he came back," Magcalas recalled. "We were so happy for him."

Coa's therapy included a transition into the wellness program at the fitness center, located within the same facility. During his final weeks of outpatient, Mora took Coa to the fitness center to build strength in his quadriceps, gluteus maximus and hamstrings. "He needed to learn how to squat in proper position because he tended to favor his stronger leg," she shared. "Squats are an important exercise for riding horses."

"We provide guided exercises throughout the program and supervise their progress," Robitaille explained. "Eibar still comes to the facility to work out and can ask questions if he needs to."

Upon arrival in outpatient, Coa had rated himself a 4 out of 80 on the Upper Extremity Functional Scale. When he discharged, he rated himself a 22 out of 80. During his last evaluation on August 9, 2011, Coa performed self-care activities at a modified independent level. He was able to take a more active role in his daily activities because his pain, spasms and hypersensitivity had significantly decreased.

Keys to Recovery

"I was mentally strong and I worked hard, but I needed key people to help me achieve my goals," Coa explained. "The therapists from Memorial Regional South pushed me."

According to Mora, the interdisciplinary approach in both settings contributed to Coa's progress. "The collaboration of PT and OT helped his progress," she said. "We have great coordination and communication in the department."

With 4,080 career wins, Coa has not given up hope for a return to his sport. He continues to battle limitations in arm strength and weakness in his right leg. He remains committed to his home exercise program and working through the pain and frustration.

"I want to recover 100 percent, but my doctors say I may have another year of recovery ahead of me. If I work hard and don't give up, I will continue to achieve my goals," he told ADVANCE

Rebecca Mayer is regional editor of ADVANCE and can be reached at rmayer@advanceweb.com


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