by Andrew Waite
Before U.S. Senator Mark Kirk's fist bump with President Barack Obama at the State of the Union address, before the embrace with Vice President Joe Biden atop the steps of the U.S. Capitol, there was the hand and arm stretch by Amanda Bacheller, OTR.
On January 21, 2012, Kirk experienced dizziness and numbness in his left arm. He was having a stroke that would require two operations. On February 10, 2012, he was transferred to the Rehabilitation Institute of Chicago (RIC), where his recovery truly began.
From the get-go, Kirk's goal was to return to the Capitol—both physically and in his capacity as a senator representing Illinois.
"To get into the Senate chamber itself you have to go through the Senate door, where there are photographers and reporters, so there is no way you're not in public. Then I thought about how getting off the elevator and getting into the Senate chamber is about 50 feet and three stairs. If I could do that, that would be huge," Kirk says. "In my early days poststroke, there was no way I could have made it."
Bacheller, RIC day rehabilitation therapist, says her early occupational therapy treatment sessions with Kirk focused on functionality in his left hand. She used different types of stretching to help build tone and activity tolerance.
Kirk's occupational therapists always minded his return-to-work goal.
"A lot of times when I worked with him, I would try to go through his day-to-day routine and ask, 'What does it look like?' And then get him to come to conclusions about what it is he would need to be able to do," says Sarah Zera, OTR, RIC day rehabilitation therapist. "Like I found out that most senators eat a buffet-style lunch, so we needed to figure out how he would be able to get his food to the table and unwrap his silverware. Those sorts of things."
Kirk says he appreciates occupational therapy's focus on activities of daily living. For example, an occupational therapist taught him to brush his teeth by using his working hand to squeeze the toothpaste and his nonworking left hand to balance the toothbrush.
"It was a trick I wouldn't have thought of," Kirk said. "To me, OT meant re-learning important things of daily life so that I could be more independent."
Kirk's occupational therapists say the senator was most inspired by activities that would help him return to his job.
"Those were big motivators for him because that is what he was thinking about all the time," Bacheller says.
For instance, because the stroke compromised Kirk's left visual field, occupational therapists used an electoral map to improve his visual scanning by having him predict which states would go red and which would go blue.
Ed Hitchcock, OT/L, Technology Center expert at RIC, helped Kirk re-learn to use an iPad, including how to use voice-to-text technology so the senator could send e-mails and memos without needing to type.
"I think it was really the times that we were able to get down to a very concrete, functional task that he could clearly see was related to something that he was doing before the stroke when he understood the value of occupational therapy," Hitchcock says. "He was able to see when he started that technology was something he was going to have trouble with. He knew he wasn't going to able to use it the way he used to use it. So what could he do? And that's where as an OT, I was able to say, 'Well, here are some ways you can do it. You're not going to do it right away the way you used to do it, and you aren't going to do it right away efficiently, but this is the path that you can take and get to the point where you are able to complete that work-related task that you used to do really easily.'"
Kirk says he related to Hitchcock's practical focus.
"He helped me navigate the iPad system and was just very flexible," Kirk said of Hitchcock. "What I admired most about [Hitchcock] was he just wanted to get us to practical functionality with whatever technology is before us."
Occupational therapists also trained staff members in Kirk's Washington, D.C., and Chicago offices so they would know how to help the senator once he resumed his duties. The occupational therapists discussed the need for him to have the right kind of chair (not a rolling chair or a deep cushion chair) in his offices as well as a place to rest during the day because fatigue might still be an issue.
"And we talked a lot about energy conservation. Yes, he can put on his own jacket, but is it worth the struggle if a staff member is willing and able to put it on for him?" Zera said.
Occupational therapists advised setting up the offices so that important items were on the senator's right side, within his visual field, as well as the need to pick out chairs in conference rooms that are closest to the door.
All of these considerations were part of a recovery that allowed Kirk to ascend the Capitol's steps on Jan. 3, 2013. Kirk called the moment a "victory."
One that occupational therapy can share.
"Of course we are proud of ourselves as occupational therapists, who always think outside of the box and try to figure out ways to make things easier. Of course you want to facilitate return to function," Bacheller says. "But I think the big takeaway message is that, as hard as we work and as much effort that you put into Senator Kirk's rehab and everybody's rehab, it's not a one-man job. So in addition to working so closely with each other, we really rely on speech therapy, physical therapy, our vocational counselors, and most importantly our other patients to motivate one another."
Occupational therapy meant so much to Kirk that he mentioned his therapists by name in a press release about his attendance at the 2013 State of the Union.
"When I look at political people as opposed to rehab people, I like rehab people a lot more because inside every rehab person is a small angel working with the world," Kirk says. "Occupational therapists have unbelievable patience in the face of what can often look pretty grim."
Andrew Waite is the associate editor of OT Practice. He can be reached at firstname.lastname@example.org.