by Kate Vander Wiede

After being diagnosed with a rare neurological disorder, Keith Begnoche turned to physical therapy to help him get back on his feet again

When Keith Begnoche first came to the Smithfield clinic in 2016, he was hoping to get treatment for his knee – which he’d injured at his job, working for a school system with students with disabilities.

But from near the start of treatment, Dr. Tyler Foster thought something else might be going on. When doing his first screening with Keith, Dr. Foster noticed some abnormal back and neurology-related pain that worried him.

“I started having other things pop up,” Keith said, “like back pain and numbness from the waist down.”

Dr. Foster soon suggested that Keith go to the emergency room, where an MRI led to a diagnosis of multiple sclerosis. A short time later, after treatments seemed not to be working, the diagnosis was changed: Keith had Neuromyelitis Optica (NMO), a rare condition that can cause, among a vast array of symptoms, weakness and numbness in the lower body.

Keith was in the hospital for several months after his NMO diagnosis, and upon release, he was in a wheelchair and only able to put some weight on his legs, as they and his feet were numb. After doing home therapy for a few weeks, he needed a change.

“I just thought, that’s not going to work,” he said of home therapy. “I need to get up and out and do things at a facility.” Knowing that Dr. Foster had helped him before, Keith headed back to the Smithfield office in early 2017.

Dr. Foster quickly saw that Keith’s strength wasn’t an issue, since he started gaining muscle back quickly – maybe due to his time as a college athlete. (“I played baseball and football in college. I might be a bigger guy, but I was mobile for a bigger person,” Keith said, laughing.) It was sensation that was Keith’s biggest obstacle.

The plan of care, then, was to maximize Keith’s balance so he could better tolerate walking, stairs, and transfers to and out his wheelchair. The goal was to help Keith feel more comfortable navigating his home. As Keith gained strength over their months together, Dr. Foster turned their attention to balance exercises, walking with a walker and cane, and using stairs – all designed to help Keith be able to walk inside and outside his home, even without sensation in his legs and feet. Keith spent a lot of time balance training on non-flat surfaces: on foam pads, on a balance beam, on a rocker board, with his eyes. To help Keith’s body move even more easily, Dr. Foster used stretches and mobilizations of the hips and quads muscles throughout Keith’s treatment, helping to improve their mobility so they didn’t restrict movement.

Dr. Tyler Foster helps guide Keith Begnoche through a balance exercise at our Smithfield clinic.


After a year of working together, Keith is now able to navigate his home without a cane or wheelchair, and he only takes his cane when he’s going out, just in case he ends up needing it. And just a few weeks ago, Dr. Foster set up some cone sprints for Keith, and he was able to do them – a huge improvement from where he started. He hopes he’s able to progress to where he can throw the football around with his younger son in the backyard, something he hasn’t been able to do since his diagnosis.

“I’m not where I want to be yet,” Keith said, before adding that Dr. Foster sometimes chastises him for not giving himself enough credit.  “I am doing things now that I couldn’t do six months ago.” He recalls when he couldn’t even get out of bed by himself. Now, he’s driving.

Keith said he’s enjoyed going to physical therapy, where he is not only able to progress physically, but where he is able to talk about sports with Dr. Foster and other staff in the office. All the camaraderie, Keith said, has made working with Dr. Foster feel fun and easy, like they are brothers having good time while also happening to exercise and make progress. His success, Dr. Foster said, is all because of how much Keith has persevered. “He is a very hard worker,” Dr. Foster said, “and he is so self-motivated.” In light of all of Keith’s success, Dr. Foster is thinking of graduating Keith from physical therapy in May.

Over the last year, Keith rolled with the many punches his diagnosis has thrown at him. He moved to a new home where everything is on one floor, he regularly sees a neurologist to manage his diagnosis, and he has worked to come to terms with the fact that he might not get back to where he was before, physically.

In sharing his story, Keith hoped that he might help or give hope to someone else out there struggling with NMO. “If someone else gets NMO, they can see, ‘Oh, here’s this guy who had intense physical therapy and had a lot of success with it,’” Keith said, “’and maybe I can have it too.’”