After TBI, St. Luke’s Wood River patient builds strength, resilience — and birdhouses

Paul Ramm's life changed forever when he fell down a flight of stairs in August 2021.

Suffering a traumatic brain injury, Ramm was transferred to Boise from Wood River, needing emergent high-level care. A breathing tube, a feeding tube and a craniotomy due to blood clots and to reduce brain swelling was necessary before six weeks of inpatient therapy, which finally allowed him to return home.

By then, Ramm was using a wheelchair in the community needing help with self-care tasks, and had difficulty speaking due to aphasia.

Ramm and his wife, Lynn, own property in Bellevue south of Ketchum where they care for their animals and land. Before his TBI, he enjoyed working with horses, fixing things and managing their property. He was an expert tiler for his own home as well as many houses in the Wood River Valley, and most recently working in animal control for the sheriff's department. Ramm is a well-known member of the community - he also drove a school bus for Blaine County School District.

“He is skilled with building and using tools and our desire is to help him return to these tasks that are meaningful to him and Lynn,” said St. Luke's occupational therapist Jackie Einerson, who has worked with Ramm for the past year.

Einerson and speech language pathologist Kristin Reynolds brainstormed functional tasks that would be meaningful to Ramm and came up with an idea – building a birdhouse. They knew he wanted to use tools again, and this would require him to use both hands, even with limited coordination in his right hand. It would also allow him to communicate in a functional way, including reading directions and talking with the therapists.

Jesse Foster, senior manager of Rehab Services at St. Luke's Wood River who had worked previously with Ramm, said:

“I feel that this is pretty unique to be able to have speech and occupational therapy working together in real-life situations to help a patient get back into the community, doing what they loved to do before,” Foster said. “This is more than just being able to read – it is being able to follow instruction on how to build something and then using tools, and it is beyond doing curls and triceps exercises in the gym.”

And it proved to be successful.

“When the nails proved difficult to hammer in the wood, he jokingly said, ‘I would have used smaller nails,’” Reynolds said. “A short sentence like that may not seem like a big deal, but for Paul, who has worked hard to get even one word out, this was a huge success in functional and meaningful conversation with others.”

Said Einerson: “And that's the whole point of our therapy: to engage and encourage meaningful tasks both physically and via effective communication.”

“Paul and Lynn are the definition of resilience and a great team” Einerson added. “Lynn never misses a therapy session, and takes the skills practiced in therapy and applies them to his functional life outside the clinic. She recognizes and provides opportunities for him to use his right hand, whether its fixing fences or picking up pinecones around their property.

Reynolds added: “Lynn has also supported his communication along the way so that he can be as independent as possible when expressing his own thoughts and ideas, careful to never speak for him or over him.”

The Ramms live a life full of family, caring for their home, camping, vacations and fun outdoor recreation. They don't let his TBI define him or inhibit them from continuing to do the activities they love to do. Paul has already become much more independent in completing projects on their property, and the St. Luke's team is hopeful Paul can continue to regain even more skills, specifically regarding increased community engagement.

With the help of a dedicated care team and a focus on Paul’s improvement, they've come a long way and continue to preach one simple phrase: “let's keep going!”