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Julie Dancing group
They will rock you. The Toronto Rehab dance team (clockwise, from top L): physiotherapist Nina Hovanec, rehab therapist Jennifer Shaw, occupational and physiotherapy assistant Mia Cowan, registered nurse Pema Zela, speech-language pathologist Ruth Levin, choreographer Julie Tomaino and occupational therapist Cindy Ho. (Photo: UHN)

Julie Tomaino can recall the exact moment she realized what she was meant to do with her life.

Waiting in the wings of New York's Radio City Music Hall as a member of the renowned precision dance team The Rockettes, Julie was about to take her place on stage, when it hit her.

"I thought to myself, I love this work, but I don't want to perform on stage anymore," Julie, 39, who now calls Toronto home, recalls of the moment back in 2010. "I know I'm meant to be working creatively, as a choreographer, instead."

And so she began immersing herself in the craft. First, by assisting other choreographers, and then by saying 'yes' to every job that came along.

As Julie's reputation as a choreographer grew legs, so did her accolades. Work took her across Canada and the United States, with highlights including a stage production of Crazy For You in Vancouver, for which she earned a 2015 Jessie Award for outstanding choreography, and the 2017 television remake of Beaches, starring Idina Menzel.

Nothing could stop this star from rising – except the unthinkable: a series of strokes that left her unable to speak or move, and threatened to end the career she loved.

'I had no other option but to fight'

Life, as she knew it, may have pressed pause on Julie, but she was prepared to fight for her future.

"I remember laying in the hospital, before I could even talk again, knowing that I had no other option but to fight – and that everything was going to be fine," she says.  

After three weeks in acute care, where Julie slowly regained the ability to speak, and finally stand, she was transferred to the Stroke Rehab Inpatient Service at Toronto Rehab. There, she met the team that would ultimately help her get her groove back.

"Our primary goal is to help patients transition back into the community, and return, as much as possible, to what they were previously doing," says Karl Wong, Manager of Program Services for Stroke Rehab.

For Julie, that meant two things: re-learning the skills it takes to choreograph, and gaining the confidence to get back to her craft. That's a longer-term goal that would typically be set in outpatient therapy, once basic benchmarks – such as talking, walking, and eating – are met, and therapy is no longer confined to an inpatient setting.

"Julie wanted to demonstrate dance moves, like pirouettes, jumps and leaps - components of dance that are so much more dynamic than getting in and out of bed," says physiotherapist Nina Hovanec. 

Julie dancing
Julie Tomaino, pictured here during her previous work as an award-winning choreographer, is set to resume her career later this summer after working with clinicians at UHN, including the Stroke Rehab Inpatient Service at Toronto Rehab. (Photo: Courtesy Julie Tomaino)

Driven by the desire to create a treatment plan that was motivating and meaningful for their patient, Julie's team couldn't resist stepping out of their comfort zone and into the spotlight.

Over the next six weeks, led by Julie, they planned and rehearsed a dance to the 1980s hit "We Will Rock You" by the band Queen and performed it for a live audience on the unit.

"It's a great example of stars aligning," says occupational therapist, Cindy Ho. "Not only were we all open to a creative adventure, but from each professional discipline, we all had something we could add to the effort."

'I was in my element'

Julie spent the first few weeks working one-on-one with her team members, with a focus on speech, physiotherapy and occupational therapy. She re-learned how to give verbal instructions, plan roles, schedule rehearsals via email, draw stage maps and practice dance moves.

Around the third week, when the group started meeting for rehearsals, three times per week in a cafeteria, Julie started combining her therapy disciplines and her abilities started to soar.

"I was in my element, in the creative zone, and that was therapeutic for me," she says.

Speech-language pathologist Ruth Levin says: "I wish we could have time-lapsed the process."

"At the first rehearsal, Julie was sitting in a chair, giving verbal instruction and subtle demonstration. By the next day, she was standing, and from there she took off."

And that's what made it so motivating for the team, agrees Rehab Therapist Jennifer Shaw.

"She took us out of our comfort zone a little, but it was exciting to see her changing every day."

Julie Tomaino
For Julie Tomaino, re-learning the skills it takes to choreograph and gaining the confidence to get back to her craft after her stroke were key parts of the therapy work she did at Toronto Rehab. (Photo: Courtesy Julie Tomaino)

'They made me feel safe'

But rehab wasn't without its challenges.

Julie's team was used to meeting with patients one-on-one, and weren't in a habit of synching their schedules amid busy caseloads. Through constant communication and collaboration, they were able to be flexible and adapt their daily clinical practice. By nailing down the rehearsal schedule early, everyone had enough time to plan other work activities around it.

"Sometimes it was tricky to juggle competing job demands," acknowledges Cindy.  "It was helpful that we were all on board and believed in the benefit of this project, and important that we had the support of our manager and other staff on the floor."

On a personal level, Julie was facing her own fears. 

"There were jumps in the choreography, but I was too afraid to fall," she admits. "I thought, 'How am I going to demonstrate this, if I can only lift my heels?"

By introducing a harness, Nina took that fear away. By the next day, Julie's muscle memory kicked in, and she was jumping on her own again.

"It was so cool ­– I cried and cried," Julie recalls. "I didn't know it would be possible to get that back so quickly, but they made me feel safe."

'I gained confidence again'

When the big day arrived, the excitement was palpable as Julie's friends, family, and other patients filled the 9th floor dining room at Toronto Rehab's University Centre.

When asked to compare the anticipation she felt on that day, with how she feels before a performance in the real world, Julie is philosophical.

"The pressure is still on, because I take every job seriously," she says. "But in this case, the process is more significant for me than the final product will be because I gained confidence as a choreographer again."

'Pieces of creativity can find their way into rehab'

In the end, the show was a hit. The dancers were flawless. The audience roared.

And, the impact was felt far beyond their makeshift stage.

Julie's creative process gave the gift of hope to other stroke survivors on the unit. One long-term patient, who usually keeps to herself, was encouraged to leave her room and join the audience. Others saw how far she had come, and pushed themselves to stand a little taller, walk a little further, try a little harder.

Julie is now in Toronto Rehab's high intensity Fast Track Outpatient Service. By summer's end, she'll be back to work, heading to Thunder Bay to, coincidentally, choreograph the hit Queen Musical, We Will Rock You, and resume the life she loves.

"Learning to choreograph again was something I really wanted, and didn't think the team could facilitate," says Julie. "But they supported me fully, and were gung-ho the whole time.

"They did such a great job – I'd use them again," she laughs.

As for the team, would they step outside their comfort zone again?

"If a person like Julie came to us with the same goals, ambition and drive, we'd be more likely to go for it," says Nina. "Is this appropriate for everyone? No. But pieces of creativity can find their way into rehab."

And that's the gift that Julie gave her team, says Ruth.

"She showed us that, in an inpatient setting, this can be possible. I'll think of that always, going forward." ​

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