Step by Step
The Ottawa Citizen: Step by Step
On July 19, 2009, Robert Wein and four other cyclists were injured when a minivan slammed into their bicycles. Before the crash, Wein was in the best shape of his life. In the hours that followed, doctors feared the broken athlete might die. Now he's in rehab -- working his way back
BY ANDREW DUFFY, THE OTTAWA CITIZEN FEBRUARY 21, 2010 12:00 AM
Working with physiotherapist Joan Heard, Robert Wein is stronger and more flexible. He can stand on his own for four minutes, a vast improvement from the 16 seconds he managed on his first attempt.
Photograph by: Photos by Wayne Cuddington, the Ottawa Citizen, The Ottawa Citizen
For many mornings at The Ottawa Hospital Rehabilitation Centre, Robert Wein confused his right leg with his left.
His nurse would correct him patiently as she helped him transfer from his bed to his wheelchair. Today, four months after entering the rehab centre with a serious brain injury, Wein doesn't make that mistake anymore.
"She taught me things a three-year-old needs to learn," Wein says, grinning at the memory. "I'd call my right leg my left leg. I don't know why."
That confusion was one feature of the brain injury he suffered on the morning of July 19, 2009, when a minivan slammed into his bicycle from behind.
Four other cyclists, including Wein's girlfriend, Cathy Anderson, were injured in the hit-and-run. The accident defied reason: The riders were struck as they pedalled in a dedicated bike lane on a broad stretch of March Road in Kanata. They were about 20 minutes into a 100-kilometre round trip to Pakenham. Few other cars were on the road at the time.
Wein, who was cycling behind the lead rider, has no memory of the event. He has read about it on the Internet, but none of it sounds familiar.
In fact, for months, the 39-year-old triathlete and civil servant couldn't relate his physical state to the crash. He didn't understand why his legs wouldn't follow his commands. He feared it might be his fault.
Then one morning, late last year, he woke up "with the total understanding I was in an accident."
He often reminds people now that he was hit by a car. The word "minivan" escapes him yet.
Wein is firmly set on the hard road back. How far he's able to travel down that road will depend on his brain's ability to rewire itself, to find new ways to perform once automatic activities such as balancing, walking and remembering names.
"I got hit," he explains. "But I wasn't born this way and I'm not going to die this way."
Among the first things Wein remembers after the accident is sitting up in a hospital bed, having people congratulate him for the feat. "I was thinking, 'Yeah, big deal,'" he says. "I didn't know a month earlier I was unconscious."
Wein was in the best physical condition of his life before the accident; he had competed in a triathlon on his birthday the previous weekend.
After the crash, Wein underwent emergency surgery at The Ottawa Hospital's Civic campus for a serious abdominal injury. He had also suffered a collapsed lung, a broken rib and severe road rash to his lower legs and right arm.
His brain injury was life threatening. He had been wearing a bike helmet, but it had shattered in the crash.
Doctors warned Wein's parents, Patricia Buchanan and Marceli Wein, that their son might not regain consciousness. His score on the Glasgow Coma scale -- a medical test used to assess unconscious patients -- suggested he had a 50-per-cent chance of survival.
"The prognosis was guarded," remembers Buchanan.
Wein was kept in a sedative-induced coma for three weeks to limit swelling, which can reduce blood flow and damage healthy brain tissue.
He was allowed to emerge from sedation when the pressure inside his skull subsided. Wein spent the next five weeks in the hospital's trauma unit, where he learned to swallow and eat again. His feeding tube was removed.
His recovery continued at Elisabeth Bruyère Hospital until October when doctors decided he was ready for more intensive therapy at The Ottawa Hospital Rehabilitation Centre.
When he arrived, Wein needed help to turn in bed and to reach a sitting position. He was transferred to a wheelchair in a sling. He had strength enough to push his wheelchair about five metres on the ward he shared with other brain-injured patients. He couldn't stand up.
Those were the physical manifestations of his injuries. But his rehab would be complicated by what couldn't be seen: the damage done to his short-term memory and motor control.
Unlike strokes, which follow a common pattern -- a right-middle cerebral artery stroke typically will result in problems on the left side of the body -- a severe brain injury is unpredictable.
Wein's diffuse injury produced a weakened right leg and left arm.
The accident also left him with double vision, which he manages by wearing a black patch over one eye. While it often rights itself, the condition can be corrected with surgery if it persists for more than a year.
Wein likes the eyepatch. "That way at least it looks like I'm injured," he says, grinning again. "I want to fit in here."
"Keep yourself centred."
It's the second week of January and physiotherapist Joan Heard sits on a stool in front of Robert Wein. She holds his hips as he concentrates on standing between parallel bars without holding them.
"Keep your weight on both legs," Heard coaches.
Due to his brain injury, Wein tends to favour his right leg. The leg wasn't damaged in the crash, but messaging to the limb must be reprogrammed. Essentially, he's learning to walk based on a new set of rules for his brain.
In three months, Wein has made significant progress. He is stronger and more flexible thanks to daily stretching and weightlifting sessions. He can transfer to a wheelchair. He can stand on his own for four minutes, a vast improvement from the 16 seconds he managed on his first attempt two months ago.
His communication skills have improved so much that his physiotherapist sometimes has to remind him to concentrate on walking, not talking.
Heard asks him now to lift one arm, then the other, as he stands between the parallel bars. It's an exercise that tests his balance.
Wein's brow beads with concentration as he masters the new skill, pumping his arms up and down like a dance instructor. "I'm impressed," Heard says.
She places a small plastic step on the floor. Wein practises lifting both feet onto it, and stepping down. He turns and comes back over the step, again and again.
The repetition is key to "motor relearning," the process of re-engineering the neural pathways that control movement. The process takes advantage of the brain's remarkable ability to change itself.
"Neuroplasticity allows you to teach your brain how to do it another way," explains Dr. Shawn Marshall, medical director of acquired brain injury rehabilitation.
Repetition offers the brain the stimulation it needs to forge new connections between neurons. When enough of those connections are established, the brain can effectively transfer tasks from damaged areas to healthy ones.
The new brain networks, however, are not as efficient -- or experienced -- as the old ones. It means Wein may not move as smoothly as he did before the accident.
Wein's mother is thankful for what he's recovered.
"I almost don't think of the 'before': I just think of how well he's progressing now. He's got his personality back."
No one is sure how far Wein will progress. Brain injuries are dynamic, making the level of recovery for each patient difficult to predict.
A severe brain injury can take up to two years to heal, says Dr. Marshall, meaning Wein may not know the full extent of his recovery until next year.
Wein himself says he doesn't expect to be able to do everything he did before the accident, but he's encouraged by his growing independence and his ability to make himself understood. When he first came to the rehab centre, Wein was frustrated by his brain's inability to keep up with the speed of conversations.
That isn't a problem now, but his memory remains flawed.
"I accept the fact that pieces are missing," he says. "I don't get upset, I don't get mad. I don't get mad at myself, I don't get mad at anybody. That's just the way it is."
For as long as he can remember, Wein has loved the escape that is cycling. "The sounds and solitude," he says, describing its pleasures. "I can concentrate and think about things on a bike."
Always enamoured with cycling, Wein became serious about the sport five years ago after joining Soldiers of Fitness, a conditioning program offered by former Canadian soldiers. Wein embraced its physical challenges and enjoyed the camaraderie of his fellow recruits.
The fitness group became the focus of his social life. Two-and-a-half years ago, he began to date Cathy Anderson, a fellow recruit and triathlete. They became part of a tightly knit cycling group that took advantage of summer weekends to make epic bike trips to such places as Brockville and Kingston.
For Wein, cycling was the easiest of the triathlon's three disciplines: swimming, cycling and running. "I could go far and fast and long, and so I was drawn to it," says Wein, who grew up in Ottawa's Beacon Hill North neighbourhood.
His mother, Patricia, is a professional editor, his father, Marceli, is a scientist. Not surprisingly, Robert had eclectic interests as a boy. He was adept with books, computers, cameras and woodworking tools. He once built his mother an
armoire; he produced his own newspaper for family and friends
"He's always been at heart an entrepreneur," says Patricia.
Wein studied commerce at Brock University, then returned to Ottawa to take a job at Nortel. He migrated to the civil service about five years ago.
He kept a hectic schedule. He was involved in the lives of his two children, Geris, 12, and Connor, 10, from a previous marriage, and also managed an apartment building in Pembroke and a web-hosting business. He took scuba lessons so that he could travel with Anderson on dive trips to Cuba.
The day before their fateful cycling trip, Anderson and Wein drove the route to make sure the roads were in good repair. "We weren't concerned about the roads in Ottawa," Anderson says, "because we always stay in the bike lanes."
Anderson, 45, a business development executive, regularly assumed responsibility for planning and safety on the trips. She insisted the cyclists ride single file and not stray.
Anderson was at the rear of the line of cyclists as they pedalled down March Road. She remembers being struck from behind on her left arm. She remembers the sound of bones smashing and the screams of pain and the sight of bodies scattered on the road.
Her pelvis was fractured in three places and her left elbow splintered. No one at the scene would tell her what had happened to Wein. "Everybody's breathing," she was told.
Anderson, who spent 35 days in hospital and faces more surgery on her elbow, has watched Wein's rehabilitation with a sense of awe.
"It has been amazing," she says. "I've told him ever since he opened his eyes, 'I believe in you. You can do it.'"
Wein stays with Anderson every weekend; they plan to move in together when he's completed his rehab.
"We were together all the time before the accident. We were best friends. We did everything together," she says. "That hasn't necessarily changed that much, it's just that what we do is different. It's a lot slower. Everything has slowed down quite a bit."
Wein doesn't think much about the driver who put his life on hold.
Sommit Luangpakham, 45, has been charged with dangerous driving causing bodily harm and leaving the scene of an accident.
Wein doesn't plan to attend his trial. He wants to instead concentrate on adapting to what he calls his "new situation.
"Right now, I set my goal at integration back into the world. I'm not going to paint pictures. I don't want to be prime minister. I don't want what's impossible yet."
Back in the gymnasium, Wein crosses the floor with the help of a metal walker, weighted down to make it more stable. Joan Heard is teaching him to place his right foot flat on the ground -- it tends to curl on its side -- and not to take too big a stride.
Wein makes three crossings of the gym, then slumps into his wheelchair with a towel, soaked in sweat. It's as far as he's walked in six months.
Wein records such milestones in his journal to ensure he remembers how far he's travelled on his road back.
For months, he didn't always remember from one day to the next what Heard taught him in physiotherapy. Increasingly though, Wein says, he hears her voice in his head, telling him to plant his foot, shift his weight, bend his knee.
Wein must plot every step. It's as if, he says, he has to impose his brain's will on a foot that doesn't want to behave.
"I have to think: 'I'm going to put my foot flat. My right foot is going to be on the right side of my left foot. They're not going to be too close together ... '"
It's an exhausting enterprise because Wein, like other brain-injured patients, must expend enormous amounts of energy to process information. He'll usually take a nap in the late afternoon.
Wein promises himself every morning that he'll work hard in physiotherapy.
He's expected to be in the rehab centre for another month, then move to the Robin Easey Centre to improve his daily living skills.
"I don't get disappointed," Wein says. "I just try and if I succeed, I'm happy, and if I fail, I'll try again later."