Occupational therapy included the 3 R’s: reading, writing, and arithmetic. She highlighted that Matt could do simple problem-solving or mental addition. Although he couldn’t vocalize his answer, he could hold up the appropriate number of fingers if the correct answer was ten or less. Matt had difficulty reading and writing, partly because his eyes didn’t converge enough to focus on individual words or small print. A friend at Sunnyview performed a brief test to screen Matt for a visual deficit—not an easy assessment without Matt's verbal feedback—but Matt seemed to squint less with 0.5 reading glasses, suggesting reduced eye strain. In time, he would need a thorough evaluation by an optometrist.

As his ability to participate improved, the occupational therapist raised the stakes. She navigated Matt’s WC through a labyrinth of smaller spaces in their clinic, each targeting specific activities or functional tasks, such as a mock car for transfers, virtual games, and various arm equipment, until she arrived at the Upper Extremity Ergometer, a.k.a. arm bike. His chair was locked an arm's distance away. Electrodes were adhered to both arms' biceps, triceps, scapula, and shoulder muscles, and his hands were securely ace-wrapped to the handle grips. The electrical stimulation augmented muscle contractions in sync with the cycling sequence. The ergometer was programmed to go at a slow rate and offered just enough assistance to help Matt complete each revolution. Although instructed to keep pedaling, Matt was lackluster and pulled free 15 minutes later, adamantly dodging further attempts to have his hand strapped in again. The therapist was undeterred. Instead, not to be outdone, she scheduled 30-minute time slots twice weekly. She was convinced, or at least hoped, that using a pseudo-piece of gym equipment that incorporated muscle stimulation and worked multiple arm muscles in a synchronized and repetitive movement would challenge and motivate Matt.

The occupational therapist creatively designed activities to involve both extremities, trunk rotation, and balance control during each task. Sitting on a mat table, she asked Matt to pick up a bean bag with his right hand and reach across his body to drop it on the floor to be picked up by his left hand. On other days, he was asked to pick up small objects from the table, deposit them in a basket overhead, or roll a ball around on a table surface. Sometimes, they stood to work on weight shifting side-to-side, turning to look to the far left or right to find a landmark or to use both hands to place large pegs into an incline board alternately. Unfortunately, as with the piano, spasticity complicated the quality of his right arm movement and function.

For the last month of his stay, Matt was scheduled, once to twice weekly, to play an interactive computer game designed to engage his mind further and develop right arm control. In the adjourning room beyond the bicycle ergometer, Matt sat before a monitor with his forearm secured to a rolling platform with a vertical handgrip. Like all basic video games, the goal was to navigate, point accurately, and hit as many targets as possible in a designated amount of time. It required concentration, coordination, and speed. Having grown up playing Super Mario Brothers, Donkey Kong, and Tetris, among others, this activity appealed to Matt more than the Upper Extremity Ergometer, to which he was unaccustomed.