Matt’s rescue mission included not only medical interventions but efforts to promote functional mobility. St. Luke’s Hospital embraced the philosophy that early mobilization begins in the ICU. After a stroke or TBI, the espoused benefits of this approach include increased arousal, cognition, and functional recovery; and reduced mortality and complications such as pneumonia, pressure sores, weakness, and cardiovascular problems. Matt was moved to a specialized bed that could safely position him sitting up or tilt him into a standing position. To promote weight bearing through his legs, over the course of several days, the staff slowly inclined the bed, more and more, until he was fully erect. This immediately grabbed Matt’s attention—his eyes would snap wide open, sometimes scan the room, or pause in the direction of a familiar voice—new signs of arousal.

Occupational and physical therapy services (OT and PT) were likewise part of this early mobilization protocol. The first day, they sat Matt straight up in bed and worked on his balance—this was literally and figuratively a stretch—simply because Matt’s hamstring muscles have always been too tight to sit this way. Yet, it was something, and it was a safe environment in which to assess his ability to participate—which he couldn’t. His head flopped around like a baby, but still, they persevered—knowing this was just the beginning. Unfazed, the OT subsequently tried to have Matt help brush his teeth and wash his face. I was thankful that neither therapist seemed intimidated to learn that I was a physical therapist, nor did they suggest that I stand down. They welcomed my input into his care and were receptive to the added assistance I could provide. As grateful as I was to lend a hand, these experiences were like an intense spotlight exposing the unfathomable investment of time and effort that would be required to regain even a glimmer of Matthew’s prior life.

Daily I exercised Matt’s arms and legs, incorporating stretches and techniques to facilitate and encourage his muscles to contract. For example, as I instructed him to try and bend or straighten his elbow, I simultaneously tapped the biceps or triceps muscles—providing a tactile stimulus that said, “Hey you, wake up and get to work.” A different strategy was to raise his arm, hand, or finger and tell Matt that when I let go, he needed to keep it from falling. I wanted to shout it from the rooftops, when finally, after three weeks he did!

Another time, sitting next to Matt’s bed and working with his left hand, I commented that we need to get his piano fingers moving. To my surprise, after I lift his two fingers, he lowered them down rather than letting them flop limply on the bed. Then when I happened to notice his left thumb moving involuntarily, I demonstrated how to lift it, and he was able to do that as well.

While the left arm was showing signs of life, only ever so briefly, was he able to hold his right arm up before slowly lowering it down. Throughout these activities, I sensed Matt concentrating very hard, as if willing his arms to work. It was so encouraging to know that he could understand my requests and respond. Within three days, Matt was able to consistently move his left fingers, hand, and elbow a small amount, wiggle his left toes, and occasionally flex the right elbow. It was so encouraging to observe voluntary movement in BOTH arms—but so extremely frustrating, when suddenly he lost that ability to move his right arm altogether. To compound my angst, I knew full well there was no guarantee that this motion would ever come back. It would be a long six weeks before we could joyously celebrate his ability to open and close his right hand.