Andrew Graham had only met Heidi Nuckolls of Washington one time before she came to him in February as a personal training client at the Four Rivers Area YMCA.
At their first meeting in the winter of 2017-18, she had asked for his help in learning how to do a dead lift. He was on staff that day in the Y’s fitness center. He showed her the proper technique, explained it really well, and she picked it up easily.
But when she returned to him early this year for personal training, she not only looked different — she had lost a lot of weight and her hair was shorter — but she presented challenges that he didn’t initially realize.
In the time between their meetings, Nuckolls had sustained a chemical brain injury that resulted in what she describes as “brain paralysis.”
“It healed in a way that I didn’t remember things, and I’ve had to relearn things,” she said. “Things like how to drive, how to talk, how to read . . . ”
For some people, fitness might have been the least of their concerns. But for Nuckolls, who was a gymnast and swimmer when she was young and someone who had recently lost a considerable amount of weight, working out was vitally important to her.
The only problem was, her brain injury meant she couldn’t process information in the same way and she had trouble with balance on her left side (because her right brain had been injured).
She had already been working with therapists to relearn things like talking and driving. Working out with Graham was just another component of her recovery plan.
“I literally had no balance,” Nuckolls recalled. “I had been a gymnast and balance beam was my speciality. I was an athlete, so I knew that physical therapy for me was not going to be traditional. I needed something that worked with me.”
She wanted something that had a competitive edge to it, that pushed her and built up her confidence to make her feel strong.
“I felt very vulnerable,” said Nuckolls. “There are times I still feel very vulnerable. It’s hard to put my body into that position and follow it. I feel very vulnerable and weak.”
Graham said he was shocked to see the change in Nuckolls’ ability as a result of the brain injury.
“If I had told her to do a dead lift then, she wouldn’t even know where to begin,” he said. “We had to find those things, relearn those things.”
For him it meant learning a new way to present the exercises, to break down what he wanted her to do. In a way, he had to learn a new language.
“I had to find different ways to get her thinking about the kind of movements we want to do. I call them alternates,” said Graham.
It wasn’t breaking down the moves into smaller steps, because too many small steps would have been overwhelming for her.
“I tried to make it as simple as possible in the beginning, and as we mastered those simple steps, the next workout I would throw in another one, maybe two, and work our way back up,” he said.
One of the other things he tried to be cognizant of with Nuckolls was brain fatigue. Although their workouts weren’t always very physically strenuous, they did push her mental capacity.
For that reason, their training sessions varied in length, depending on where she was with her endurance.
Some of the exercises Graham gave Nuckolls did more than just build up her muscle and strength. They challenged her mentally too. One exercise he gave her to do was one that a coach had given him back in high school for weight training — holding a light weight and using it to spell out the letters of the alphabet.
“That works a lot of the muscles in the shoulder girdles,” said Graham. “I just thought it would be something that would transition very well for her. You can do it with letters, numbers, and I think one time I had her spell a word.”
Graham also did things like have Nuckolls count out loud as she completed her sets and add up the weight plates as she put them on the barbell.
“I remember doing the alphabet,” said Nuckolls, with a smile. “It was long. But he constantly did things like that and researched ways on his own to help me.”
Building Up Confidence
In addition to building Nuckoll’s physical and mental strength, Graham helped her rebuild her confidence to do things.
There were exercises that she had the muscle strength and muscle memory to do on her own, but she didn’t believe in herself, Graham explained. She needed to have that connection with her brain again.
“This was kind of a special situation for a personal trainer,” he said. “Normally we have a baseline, and we are trying to work our way up to something. She was already there. We were just trying to figure out a way to make it happen.
“She really made me grow as a motivator,” he remarked, recalling the time he helped her learn how to do a box jump, which is jumping from the ground up onto a platform.
The box was probably 24 inches, and each time Nuckolls attempted to jump, she would hesitate. But when she finally let go of that fear, she nailed it.
“I literally looked at him and said, ‘Can I do this?’ He said, ‘Absolutely.’ And then I did it,” said Nuckolls.
Other exercises that caused her great frustration were things like wall ball, where she throws a weighted ball at a point above her on the wall and then catches it as it rebounds back to her, and various step combinations with an agility ladder.
Nuckolls said she used to cry, literally, when Graham asked her to do wall ball. She used to flat out say she wasn’t going to do it.
“I’m better about it now,” she said. “I get more mad when there’s something I feel I can’t do. I hate it . . . because I feel vulnerable. And he knows it. It’s happened a couple of times, where I yell. Doing the (agility) ladder. That was a really bad day.”
Graham said it’s not uncommon for clients to show anger toward their personal trainer, but usually it’s more playful, like wearing a T-shirt showing a personal trainer with devil horns.
“But this was different,” he said. “She has a right side brain injury, so she was having trouble with her left side. We really focused on that. I pointed that out, and she got a little mad at me. It was to the point where she even walked way.
“It was up to me as a trainer to know she needed her space and not to push her, but be ready when she was ready.”
Nuckolls said as hard as it was to relearn the exercises, it was critically important to her to challenge herself.
“I wanted it,” she stressed. “So much was taken away, and so much gets taken away from someone with a brain injury, and I just wanted to get something back, even if it meant relearning all of it. I needed to get something back.
“Like swimming. I’ve been a swimmer all my life. I could do a mile of laps. But when I tried to swim again for the first time, I literally almost drowned,” said Nuckolls. “I couldn’t get the rhythm, I couldn’t get the breath, and that’s one area where I still haven’t been able to get it back.”
She Taught Him Lessons Too
Graham has a bachelor’s degree in exercise science and is certified by the American College of Sports Medicine as a personal trainer. He is quick to point out that he is not a physical therapist.
He has been trained to work with people who have special needs, like Down Syndrome, but he had never worked with someone like Nuckolls, who was physically strong enough to do just about everything he could have given her to do, but had so much trouble with balance as a result of the brain injury.
“In school, they teach you a little about working with frail elders and people who are a fall risk, but I had never had someone who was this capable who also was a fall risk,” said Graham, explaining that Nuckolls was a fall risk because she had a right side brain injury, and the right side of the brain controls the left side of the body.
“That meant her left side had a lot more catching up to do than her right side,” he said. “So she was a little off balance. If she was getting up off the ground, she might stumble into the wall a little bit. It was just small things that I would notice, but it was important to see that, because that made me kind of hover closer to her, to make sure if anything happened, I was there.”
Looking back, Graham said having Nuckolls as a client helped him learn new things every bit as much as it helped her.
“Whenever I first took her on as a client, I had the viewpoint that she is a good worker, I have seen her, she can do dead lifts, this is going to be fun,” he said. “But then everything got flip-turned upside down, and I said, ‘Oh, this is totally different.’
“Now when I look at the situation, not everyone has this severe of a difference in who they used to be and who they are now, but I look at it as everybody has the possibility for this to happen . . . I could never have learned this anywhere else but working with her.”
Nuckolls is hopeful that other people like herself who may have a moderate brain injury or other condition that they feel prevents them from working out will realize that going to the gym can be an option for them.
“There are people at the Y to help,” she said. “Yes, personal training costs extra, but so does physical therapy. There are a lot of able-bodied people who are probably in my same situation.”
Even as strong as she is now, Nuckolls doesn’t feel like she is ready to workout at the Y without a trainer. Graham recently moved to Kansas City, so she has to find a new personal trainer.
“It’s about knowing what to do,” she said. “There is no way I could come in here alone, because sometimes I could really not know how to do something that I’ve done 50 times before. It might take someone telling me, ‘Your hands need to be here, neck up, chest out.’ That is lingering from the brain injury.”
“We find new stuff almost every other session that are vulnerable parts, those things that she has to master again,” said Graham.