At 36, Daniel B. Grossman was at the top of his game. He was an emergency medicine physician at Mayo Clinic in Rochester, MN, pulling nine-hour shifts in the emergency department, where he thrived on the pressure and helping people at their most vulnerable. His full-time gig was at Medtronics Lab, part of the Medtronics Corporation, a business venture he developed that designs medical products and services for patients in resource-constrained markets such as Africa, India, and Latin America.

"Daniel was a vibrant, worldly, and compassionate and caring individual," says his friend and colleague Annie T. Sadosty, MD, regional vice president of Mayo Clinic Health System (Southeast Minnesota) and professor of emergency medicine at Mayo Clinic.

Grossman also played hard and took pride in staying fit. He loved cycling the scenic Minnesota byways and had recently taken up mountain biking on rugged trails in northern Minnesota with his friend Ron Garber, a lawyer from Minneapolis who works for Medtronic.

Curveball

Last September, Grossman's life took a devastating turn when he fell off his bike on a trail in Cuyuna Mountain Bike Park and Campground. "We don't know how it happened," recalls Garber. "We were mountain biking on a relatively easy trail, I was riding in front of him. I just heard someone yell, 'Your buddy's down,' and I turned around. We believe he went over his handlebars going down a small decline and in a freak injury landed on his head."

Grossman himself remembers few details. After regaining consciousness, he recalls lying on a trail looking up at the concerned faces of other cyclists. He also remembers feeling no sensation below his midsection. From his years in the emergency department, Grossman suspected almost immediately that his chances of walking again were slim.

Acute Care

He was airlifted by helicopter to a trauma center in Minneapolis, where he underwent trauma protocol, including a CT scan, which confirmed his suspicions: In falling off his bike, Grossman had fractured his thoracic spine (the series of vertebrae that house a large, complex area of the nervous system between the neck and lower back), a spinal cord injury that would confine him to a wheelchair.

Once doctors ascertained the injury, Grossman underwent surgery. Neurosurgeons opened up the back of his spine and removed bone to free up the pinched-off spinal cord. Then they stabilized his spine with titanium rods and screws, Grossman says.

After surgery, Grossman rested a few days in intensive-care recovery before physical therapists began helping him move. "I learned to sit on the edge of the bed, how to get into and out of a wheelchair, onto a mat," he recalls. "Acute care is fairly simple, but not easy. My spine was in shock, which caused my blood pressure to go up and down erratically; just sitting up on the edge of the bed could cause a serious drop in blood pressure. When I practiced transferring to a wheelchair, I almost passed out several times."

New Ways to Move

After about a week at the trauma center, Grossman was transferred to the Inpatient Rehabilitation Unit at Mayo Clinic—the same hospital where he worked in the emergency department—to begin more than four months of physical and occupational therapy. "Because I was paralyzed from the waist down, I needed to strengthen my shoulder and core muscles. I also needed to learn how to activate my shoulders and upper back in a new way in order to transfer into my wheelchair," he says.

Inpatient rehabilitation involved learning new techniques and developing new muscle memory, he says. "I did lots of repetitive work on biomechanics such as how to sit up, how to get dressed, and how to roll over in bed in a safe and healthy way."

Setting Goals

The goal of acute care was to prepare Grossman to return to work and resume daily activities such as driving and doing household chores. "I never felt hopeless," says Grossman. "My goal was freedom and independence, and I knew that therapy was the way." Grossman, who lives alone, says his parents, who live in Illinois, were integral to his recovery. They flew back from a European trip to join him, living in hotel rooms or at his home for six months. "I can't overstate the value of my parents' support," Grossman says.

Radical Acceptance

From almost the moment of his accident, Grossman accepted his changed circumstances. "This is the way my body is now," Grossman recalls thinking. He still had the same desires and goals, he just had to figure out new ways to achieve them. "Attitude and actions followed that," he says. "I always asked for more rehab, more hours. When other patients canceled rehab, I grabbed their appointments."

Those who know Grossman aren't surprised. "It's just who he is," says Garber. "I told him, 'Thank God you're still here, and thank God you're still you.' He was a driven, hard-charging kind of guy and, thank goodness, he still has those same qualities. He sets goals quickly and stays focused on what's in front of him and what he can control."

Looking Ahead

A positive attitude can be a decisive factor in recovering from a neurologic challenge, says Kristin L. Garlanger, DO, senior associate consultant in the division of physical medicine and rehabilitation at Mayo Clinic, who worked with Grossman on his acute postinjury care. "Daniel was proactive and positive during both his acute rehabilitation phase and as he transitioned to home and outpatient and maintenance rehabilitation," Dr. Garlanger says.

A willingness to put in the hard work necessary to recover makes a big difference, says James Spendley, DO, medical director of the Spinal Cord Injury Program at the Courage Kenny Rehabilitation Institute, Allina Health, who now oversees Grossman's outpatient rehab and home exercise program: "Patients who actively participate in therapies and home exercise programs ultimately have a better functional prognosis."

Rigorous Rehabilitation

Knowing that aggressive therapy was the key to recovery, Grossman studied online videos of paralyzed people performing restorative therapies, including the use of cycling machines that deploy functional electrical stimulation to keep paralyzed muscles activated, "locomotor" therapies that combine a treadmill with a harness and weight training, and exoskeletons that allow people with paralyzed legs to stand and walk. He showed the videos to his rehab team and insisted on trying some of the therapies. "I also watched videos of paralyzed people doing transfers from floor to chair, putting their wheelchairs in their cars," says Grossman. "At first, it took me 45 minutes to transfer from wheelchair to car. Now I can do it in three minutes; getting dressed also took 45 minutes. Now it's just a few minutes."

Grossman's outpatient therapy continues to this day and includes lifting weights to build abdominal strength and learning how to deal with falls. "I inevitably fall when transferring in and out of my wheelchair," he says. Grossman also does locomotor therapy to strengthen his core and back muscles, which involves standing in a harness or standing frame and tucking his abdomen toward his spine, engaging his core, and tilting his hips. "It helps improve positioning and balance," he explains.

Back at Work

Grossman currently works four nine-hour shifts a month in Mayo Clinic's emergency department. He also teaches emergency medicine at Mayo Clinic and is medical director at Bright Health, an insurance company based in Minneapolis. He credits his return to work within months of his injury to activity-based restorative therapies, such as cycling and rowing machines and a standing frame that allows him to stand with help several times each week, and to functional electrical neuromuscular stimulation. Both help him rebuild muscle mass and promote neuroplasticity, the ability of the nervous system to repair itself by making new neural connections to the brain and spinal cord.

Robotics-assisted therapy helps keep his paralyzed legs active. When he uses the Xcite stationary bike, for example, electrodes attached to his leg muscles aid him in performing the cycling motion. "The cycling motion also keeps my muscles and nerves from atrophying," Grossman says. "Even though my expectation is not that I will ever walk again, I am continuing to develop muscle strength. I want my body to be ready if technological advances come along that could restore my legs."

He also needs to keep his muscles flexible to manage spasms in his legs and prevent cramps, says Dr. Spendley. "Using a standing frame to bear weight through his joints and bones promotes bone health."

Home Modifications

Grossman invited his therapists to visit him at home to assess his needs, leading to helpful adjustments. "We cut out under my kitchen and bathroom sinks so I can roll my wheelchair under them," Grossman says. "We moved plates and glasses from high shelves to lower ones, and remodeled the bathroom shower so I can roll right in. Of course, not everyone has the resources to do those things, but I want to live as seamlessly as possible, and these modifications allow me to do that. Upstairs in my condo is inaccessible to me at the moment, so instead of installing a lift, I reorganized my downstairs so it has more closet space, and I moved my printer downstairs."

An Inspiration

Grossman's self-advocacy and medical experience were a perfect combination, says Dr. Garlanger. "Daniel's background in medicine gave him a critical eye on the current literature of these newer therapies. He also reached out to colleagues or acquaintances across the country in the spinal cord injury and technology fields to know of his options, which kept him well-informed and up-to-date."

Grossman also reached out to other physicians in wheelchairs for advice and videos on how to get back to work. "It was important for me to remember that I am not unique," he says. "There are other paralyzed doctors."

Motivating Others

Grossman enhances his recovery by mentoring other patients with similar injuries, says Dr. Garlanger. "[He helps them see] that they can find a new normal. They can return to work, life, and leisure in different or creative ways, as Daniel has."

Grossman resists being labeled a hero or an inspiration, says his friend Garber, who encourages him to experience the full range of emotions an injury like his can trigger. "I think it's okay for Daniel to say, 'Oh, poor me' sometimes," says Garber. "There's pressure to look on the bright side all the time. And I try to make space for him to be really honest, to give him that emotional space."

A Better Doctor

Grossman believes his injury and recovery have made him a better physician, with more empathy. "I understand what trauma protocol feels like, and I think patients find me more 'believable,' for want of a better word," he says. "They trust me more when I talk to them about their own illnesses. They know I've experienced the ups and downs they are facing. Patients are surprised when I enter the room in a wheelchair. It's probably disconcerting at first, but then I see their surprise turn to relief."

A Bright Future

Today, life is different for Grossman but no less rich. He's even returning, in a new way, to an activity he loves—cycling. He uses a hand cycle, a reclining three-wheeler powered by arm instead of leg pedaling, which strengthens his heart and core and improves endurance.

"I still have lots of things I want to do for society, such as transforming the way health care is delivered around the world. To meet those goals, I have to be as independent as I possibly can," Grossman says.