The adage that you don’t appreciate what you’ve got until it’s gone is so true. Every day, we perform numerous tasks subconsciously and often take them for granted.

When our children were young, I sometimes felt exasperated when one of them didn’t catch on or gain proficiency doing x, y, and z as quickly as I thought reasonable—activities that should have been no-brainers.  As a small child, two particular activities did not come intuitively to Matt. The first was, “Matt, you need to raise your arms overhead so Mommy can help take your shirt off.” The second was, “If you want me to open the car door for you, you can’t stand in front of it.” Now, in comparison, faced with relearning every aspect of life, the process back then was easy-peasy and the learning curve relatively short. I longed for it to be that simple again!

Matthew has motor apraxia. Motor apraxia is a difficulty with motor planning, characterized by an inability to perform a requested task or movement, even when the individual understands the task and is willing to try. Matt wanted to, but his compromised short-term memory and comprehension further restricted his ability to comply. It didn’t matter how often we explained the steps to him; Matt struggled to integrate them. Until then, I had never considered the sequence of actions involved in the most basic activities, such as brushing one’s teeth or taking a shower, things we do automatically. All the while, as I offered words of encouragement, I felt like pulling my hair out in frustration because this slowness further delayed our ability to confront the next hurdle.

Activities of daily living, such as self-care, involve a finely tuned synchronization of large and small movements in the direction of the intended task, as well as those behind the scenes that provide counterpressure and stabilization. Much like in an orchestra, if the background accompaniment is behind the beat or flat, the slightest change in a movement sequence can alter its quality or cause it to fail altogether. Matt’s motor apraxia felt like a hidden prankster bent on foiling the best intentions.

Initially, taking a shower was an experience. He sat on a tub bench for the first two months before being deemed stable enough to stand. While standing outside the curtain, Mike and I did our best to reach inside and squirt liquid soap or shampoo into his palm. It wasn’t as simple as one might think. It was like chasing a moving target as his hand moved into or away from the squirt bottle, forcing us to hold his hand still with one hand while corralling his hand and squirting with the other. It was almost impossible to stay dry. Octopus arms would have helped to corral all the moving parts.

Just as with brushing teeth, there are many steps to showering. We broke the process into subgroups: undressing, starting the shower, bathing, drying off, getting dressed, and putting everything away. As he gained some proficiency in one sequence of steps, we moved on to the next set of tasks. The last step would be to wipe the shower down, then drape the shower mat over a rail and the terrycloth mat over the tub's edge.

Our morning ritual was time-consuming. My alarm went off at 6:15 a.m. I quickly changed into exercise clothes, then three times a week, I'd jog a 2¼-mile loop through our development, or twice a week, I'd cycle through the 7-Minute Workout three times. If lucky, I had enough time to finish my morning care without rushing before Matt stirred. Then it was his turn. It could still take over two hours before we moved to the kitchen and started making breakfast. Fortunately, Matt's shower time gradually decreased from an hour to 30 minutes and finally, in May 2019, to 20 minutes without help. I, for one, was glad to regain that chunk of time.

Unexpectedly, one morning, October 13, 2018, a loud voice startled Mike and me awake, exclaiming, "Help!" Matt wasn't saying much then, and certainly not very loudly, so this was a huge surprise. Lo and behold, Matt was awake and eager for help to get going—a remarkable, and amusing, milestone for us.

Unlike in normal childhood development, the strategies and abilities Matt learned in one situation did not transfer to the next task. Each task had to be learned from scratch. There was no sequential learning. Everything required verbal or physical cueing, practice, repetition, repetition, and more repetition.

For every achievement, there was no shortage of skills he struggled to do or couldn’t do. I always had to remember to keep a positive outlook and focus on each baby step along the road called conquest.

© 2025, Sarah Watkins