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From Doctor to NRN Patient: “Be an active participant in your life.”

Stan Yoo advocates to be an active participant in your life.

In November of 2008, Stanley Yoo, now 33-years-old landed on his neck while warming up on a trampoline before an adult gymnastics class. A resident doctor in Temple University's Physical Medicine and Rehabilitation Program at the time, he knew all too well what had really happened. The fall resulted in Yoo living with a C6, C7 spinal cord injury.

We spoke to Yoo in late 2009/early 2010. At the time, he was continuously making small victories as part of the Reeve Foundation’s NeuroRecovery Networkconstantly striving for more. In a 2012 Q&A, Yoo tells the Reeve Foundation how his improvements are never ending.

When we last spoke you were regularly back at the gym, however only minimally, performing low impact exercises. What is your work out like now? Do you have any limitations?

Since we last talked I pretty much switched exclusively to doing CrossFit for fitness. We'll include several different types of movements into one workout, which changes every day. Some movements are loosely gymnastics related, while others include everything from Olympic and Powerlift elements to kettle bell work, rowing, running, and jumping rope.

The movements are definitely more dynamic and higher impact than what I was doing a couple of years ago. I still wouldn't consider myself fully recovered by a long shot. I still have strength and coordination deficits that make some of what we do in CrossFit more challenging that they would have been prior to my injury, but for the most part I can do all the exercises, am able to finish our workouts as they are written, and only scale down the weight or substitute one movement for another when I absolutely need to. Each class runs for about an hour and I try to go at least 4-5 times per week when work allows.

Has anything from the NRN still helped you years later?

I think it goes without saying that any sort of improvement - whether physical, mental or emotional - takes repetition. While locomotor training and other aspects of the NRN were just the beginning of my recovery, they were the building blocks on which all of my other progress was based. Having that much practice on the treadmill in front of experienced eyes and with experienced hands guiding you along the way definitely helped me get to where I am functionally today, and my suspicion is that it may have helped me in ways I don't realize, even now. I think the literature has shown the benefit of body-weight supported treadmill training like the locomotor training in the NRN in SCI patients, but literature aside, it just makes good sense that the more you practice at something, the better you'll get.

Aside from just treadmill training, what has carried over is the simple understanding that as an individual living with an SCI, I have to intellectualize movements a lot more now; movements which before my injury my body understood intuitively. This is something the therapists do very well, because they are trained to do so, but as I transitioned to exercising on my own and began pushing the envelope physically, I had to take on that some of that analytical role myself.

Thankfully, I found an activity where there is a strong emphasis on analyzing movement for the purposes of both efficiency and safety, so I have coaches to watch me with a critical eye as my therapists had beforehand. Nevertheless, being the only individual with SCI working out with a group of able-bodied individuals, I still have to be conscious of my deficits and how they might affect the movements that I’m performing. Going through all the therapies in NRN, you get a sense of what the PTs and OTs are looking out for, how they are analyzing your progress and how they are coaching you to improve. You learn how to coach yourself a little with the understanding that learning new motor tasks not only take more physical effort, but much more mental effort as well.

Yoo challenges himself with CrossFit fitness excercise.

Are you still doing gymnastics at all? Or any other recreational activities or sports?

I'm not currently doing any gymnastics. Because of continued relative core weakness, I have difficulty even hitting a simple handstand for a second, let alone tumbling... but it’s still a goal.

As far as other recreational activities, while CrossFit takes up a good deal of my free time, over the past few months I've been trying to broaden my horizons and either try new activities, or revisit some old ones that I did prior to my injury. I've tried rock climbing at a gym and surfing with mixed success and actually just returned from a ski trip in Vermont. I used to be a fairly good skier, but this was my first time on the mountain since my injury and my first time back on skis in about 10 years. While I was definitely rusty, I was pleasantly surprised by how much I could still do. Sports on my "to do" (or "re-do") list are tennis and Tae Kwon Do, and I'm always open to other suggestions.

Professionally, where are you in your career? Has the injury still further helped you to understand field?

I recently graduated my residency program in Physical Medicine and Rehabilitation this past June, and took a position managing mostly inpatient and outpatient amputees at Moss Rehab in the Philadelphia area, though I do occasionally cover patients on other services including SCI.

While no one would ever ask for a spinal cord injury, it definitely has given me empathy not only for those living with SCI, but anyone living with disability that affects their function and quality of life, and has helped me understand how much each little bit of recovery makes a difference. Being involved specifically with amputees, I do get more exposure to gait and walking deviations. It's a professional goal of mine to gain more understanding of gait, not only as it applies to patients with limb deficiency, but those with neurologic injury, such as SCI as well as musculoskeletal injury and neuromuscular deficits.

Do you have any advice for anyone in similar situations? Or for anyone who think they can't make it?

Two things:

One: As much as has been taken away by your injury, you still have the ability to be an active participant in your life. Draw on the strength and support of those around you, and realize that you have a big role in their lives as well. Since my injury, I have made an amount of functional recovery that is sometimes incredible even to me. But while I am extremely grateful for that recovery, what I am more grateful for is that I have support from those who would accept me and involve me in their lives no matter how much or how little physical recovery I made. Though there are clearly times I still struggle emotionally, I don’t think I would have gained the amount of acceptance I have for what has happened, nor been motivated to push for more out of my recovery if I didn’t have the support of my friends, family and those who have given me care through the years.

Moments when you are involved with others - even if it's simply laughing or crying in the company of loved ones - are just as invaluable as any physical gain could ever be. These moments are what define us as people more than any accolade ever could, and thankfully they are something nearly all of us are capable of, no matter the severity of the injury.

Yoo believes, "Moments when you are involved with others – even if it’s simply laughing or crying in the company of loved ones – are just as invaluable as any physical gain could ever be.

Two: As always, never give up. It used to be thought that recovery was limited to a certain period of time, usually about two years. A little more than three years out from my injury, though, I still feel as though I am making progress, even if that progress is a little harder to recognize day to day. While some improvements may not be clinically or functionally significant, what I’ve realized is that for the individual, any amount of progress has personal significance. I've quoted this poem before, but it's a favorite of mine and has become a mantra in days when I need motivation:

I will persist until I succeed.

In the Orient young bulls are tested for the fight arena in a certain manner. Each is brought to the ring and allowed to attack a picador who pricks them with a lance. The bravery of each bull is then rated with care according to the number of times he demonstrates his willingness to charge in spite of the sting of the blade. Henceforth will I recognize that each day I am tested by life in like manner. If I persist, if I continue to try, if I continue to charge forward, I will succeed.

I will persist until I succeed.

I was not delivered unto this world in defeat, nor does failure course in my veins. I am not a sheep waiting to be prodded by my shepherd. I am a lion and I refuse to talk, to walk, to sleep with the sheep. I will hear not those who weep and complain, for their disease is contagious. Let them join the sheep. The slaughterhouse of failure is not my destiny.

I will persist until I succeed.

The prizes of life are at the end of each journey, not near the beginning; and it is not given to me to know how many steps are necessary in order to reach my goal. Failure I may still encounter at the thousandth step, yet success hides behind the next bend in the road. Never will I know how close it lies unless I turn the corner.

Always will I take another step. If that is of no avail I will take another, and yet another. In truth, one step at a time is not too difficult.

I will persist until I succeed.

Henceforth, I will consider each day's effort as but one blow of my blade against a mighty oak. The first blow may cause not a tremor in the wood, nor the second, nor the third. Each blow, of itself, may be trifling and seem of no consequence. Yet from childish swipes the oak will eventually tumble. So it will be with my efforts of today.

I will be liken to the rain drop which washes away the mountain; the ant who devours a tiger; the star which brightens the earth; the slave who builds a pyramid. I will build my castle one brick at a time for I know that small attempts, repeated, will complete any undertaking.

I will persist until I succeed.

I will never consider defeat and I will remove from my vocabulary such words and phrases as quit, cannot, unable, impossible, out of the question, improbable, failure, unworkable, hopeless and retreat; for they are the words of fools. I will avoid despair but if this disease of the mind should infect me then I will work on in despair. I will toil and I will endure. I will ignore the obstacles at my feet and keep mine eyes on the goals above my head, for I know that where dry desert ends, green grass grows.

I will persist until I succeed.

I will remember the ancient law of averages and I will bend it to my good. I will persist with knowledge that each failure to sell will increase my chance for success at the next attempt. Each nay I hear will bring me closer to the sound of yea. Each frown I meet only prepares me for the smile to come. Each misfortune I encounter will carry in it the seed of tomorrow's good luck. I must have the night to appreciate the day. I must fail often to succeed only once.

I will persist until I succeed.

I will try, and try, and try again. Each obstacle I will consider as a mere detour to my goal and a challenge to my profession. I will persist and develop my skills as the mariner develops his, by learning to ride out the wrath of each storm.

I will persist until I succeed.

Yoo says, "What I’ve realized is that for the individual, any amount of progress has personal significance."

Henceforth, I will learn and apply another secret of those who excel in my work. When each day is ended, not regarding whether it has been a success or failure, I will attempt to achieve one more sale. When my thoughts beckon my tired body homeward I will resist the temptation to depart. I will try again. I will make one more attempt to close with victory, and if that fails I will make another. Never will I allow any day to end in failure. Thus will I plant the seed of tomorrow's success and gain an insurmountable advantage over those who cease their labor at a prescribed time. When others cease their struggle, then mine will begin, and my harvest will be full.

I will persist until I succeed.

Nor will I allow yesterday's success to lull me into today's complacency, for this is the great foundation of failure. I will forget the happenings of the day that is gone, whether they were good or bad, and greet the new sun with confidence that this will be the best day of my life.

So long as there is breath in me, that long will I persist. For now I know one of the greatest principles of success; if I persist long enough I will win.

I will persist.

I will win.

- Og Mandino "The Greatest Salesman in the world"

What's next for Stan Yoo?!


(EDITOR'S NOTE: The American Spinal Injury Association (ASIA) has a scale from "A" to "E" classifying traumatic spinal cord injury, "A" being the most serious and "E" being normal motor and sensory functions.)

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