Physical Therapy Journey

Image description: Robert—a male dwarf wearing jeans, T-shirt, hospital socks and arm band—sits in his scooter with crutches in the holder behind him as he rings the bell with sparkling eyes signaling the end of inpatient therapy.

Image description: Robert’s therapist stands—hands on hips—directing leg strengthening exercises in the pool; his walker is in the foreground and crutches lie on the patio next to the pool railing.

His physical therapist was determined to transition Robert from crutches to a walker to save his shoulders and arms from permanent nerve damage and stop him crashing to the ground when his crutches slid out from under him. However, after 60 plus years using crutches, Robert’s resistance was resolute! He only used the walker when the therapist was present and only did his homework exercises when he succumbed to spousal pressure. Consequently, it was no surprise when Robert was dismissed from PT services due to lack of progress.

When a nerve conduction test in Robert’s legs showed chronically irritated nerves in his lower back, we knew PT would help him. But given his low motivation for doing exercises between visits and disdain for the walker, I didn’t support Robert’s return to PT. Eventually Robert took matters into his own hands and restarted at-home PT while I was visiting family in Australia! Despite his assurances that this time would be different, I was skeptical.

“We can make our plans, but the Lord determines our steps.”
Proverbs 16:9 (New Living Translation)

After only a couple of months, Robert’s PT services were interrupted by a week-long hospitalization for high blood pressure, infections, pneumonia, and Chronic Kidney Disease. Although he did manage to get in a few walks—using his crutches—with hospital PTs.

Image description: Robert walking with a hospital PT wheeling an oxygen tank and discreetly closing the backside of his hospital gown.

When Robert was being discharged from the hospital, a referral to an acute rehabilitation facility for intensive PT was suggested. He chose to continue PT at home with Natasha, the therapist with whom he had developed an excellent working relationship. She was very good at distinguishing between excuses for cutting therapy sessions short and his actual need for a break. His complaints that it hurts fell on deaf ears and she was unimpressed by Robert’s resistance to using the walker. Instead of caving when he said with plaintive eyes and a winning smile, “You should see what I can do with crutches,” she burst out laughing.

Image description: Robert using his custom walker at home with PT Natasha

But five months later, unwelcome differences in Robert’s therapy transpired when he was admitted to the hospital for ten days, diagnosed with End-Stage Kidney Disease (ESKD), and prescribed dialysis three times a week. This was a major setback. Robert was now so weak he couldn’t independently pull up to a sitting position or support his trunk, and two or three people were needed to transfer him in and out of bed. Walking goals were remote.

Image description: Robert with physical therapist and aide helping him into bed.

I wondered whether Robert was even a candidate for the intensive three hours therapy per day at Encompass, an acute rehabilitation hospital. But the Medical Director—who was also Robert’s personal physician—made an exception for him saying, “after all he is exceptional.”

But God was still directing our steps, just as he did when we first met. In his second week at Encompass, I kept our tradition of giving him a Saint Patrick’s Day card:

“Forty-three years ago today my life changed forever
when I met you at the New Zealand Embassy.
So much has happened since then,
for better and worse,
but God has been with us through it all.
Now as we enter the next phase in our health journey,
I look forward with hope and love for you and our Heavenly Father
who guides our steps and gives us strength for every situation.”

Robert participated in the intensive therapy regimen to the best of his ability with therapists who were both caring and committed to his progress. He rarely complained and displayed good humor when I picked up an orange “thing” on his bedsheet to see what it was. When I told him it was salmon he quipped, “was it swimming?” Not so funny was the day his bed was stripped down to the mattress looking for his lost hearing aid. The search ended when a therapist walked in and spotted the aid in his ear!

In his three weeks at Encompass, Robert advanced from being barely able to sit up and feed himself to sitting up, eating independently, and transferring with one helper to and from the bed to his scooter. He discharged to PT at home where for six months he continued to work on building his strength. Sadly, he was never able to walk independently with either the crutches or the walker. He switched to using his scooter both indoors and out.

To my surprise, Robert never lost his powers of observation. One day he told me, “you have beautiful green eyes.” I was happy to know he still noticed and admired this feature. However, I was stunned another day when he blurted, “your teeth are falling out.” He correctly observed wider gaps between my teeth, but wrongly concluded that I was missing some teeth. I excused his lack of tact to his cognitive decline. And it wasn’t long before I missed his observations whether positive or negative.

Sepsis—secondary to a urinary tract infection—spreading through Robert’s body changed everything. After being hospitalized for another week, he lost so much strength he now needed two people to transfer him to his scooter and lots of pillows to prop him up while seated. Although Encompass accepted Robert back for more intensive therapy, physical therapists reported slow progress impeded by sleepiness and inability to follow PT instructions.

The only positive thing about being an Encompass alumnae was that he was warmly received by staff who remembered his willing participation six months earlier. It also helped that his brother Mickey was a patient at the same time. Although Mickey visited Robert every day, there was little conversation—Robert had become a man of few words and Mickey’s speech was impaired by a third stroke.

Image description: Robert reclining in the bed watches his brother seated next to him in his wheelchair.

This time Robert’s discharge from Encompass did not involve any talk of him coming home. He was transferred to Solaris for subacute rehabilitation services with only one hour therapy per day. There was little opportunity for progress given the limited time available for PT and two more hospitalizations for respiratory issues related to his ESKD and COVID. Inevitably Robert’s critically ill status led to his discharge from all rehabilitation services and ended his physical therapy journey.

My flesh and my heart may fail,
But God is the strength of my heart and my portion forever.
Psalm 73:26 (New American Standard Bible)

For more blog posts by Angela Muir Van Etten, go to:

• Caregiving with Help. September 3, 2025. https://angelamuirvanetten.com/caregiving-with-help/
• Caregiving at Home with Love and Faith. August 6, 2025. https://angelamuirvanetten.com/caregiving-at-home-with-love-and-faith/
• Dialysis Prayer Walk. July 2, 2025. https://angelamuirvanetten.com/dialysis-prayer-walk/
• Institutional Care. June 4, 2025. https://angelamuirvanetten.com/institutional-care/
• Hearing Aids: Lost and Found. May 29, 2023. https://angelamuirvanetten.com/hearing-aids-lost-and-found/
• PHYSICAL THERAPY: Move and Improve. September 18, 2023. https://angelamuirvanetten.com/physical-therapy-move-and-improve/

For further discussion on Robert’s physical therapy experiences, you may also want to read Chapter 15, For Shorter or Taller, Closer or Farther in the second book in Angela’s memoir trilogy—“PASS ME YOUR SHOES: A Couple with Dwarfism Navigates Life’s Detours with Love and Faith,” https://angelamuirvanetten.com/pass-me-your-shoes/.