Let's be clear: Matthew's 'rehab' wasn't just for the professionals. While his occupational, physical, and speech therapists handled the twice-weekly outpatient sessions, I was eager to kick it into high gear at home. Mike and I teamed up with them, collaborating on approaches and prioritizing what came first (my instinct was everything, but even I knew that wasn't feasible). Since we were living in the trenches, we were optimally positioned to integrate their efforts into real-life practical experiences, which in turn freed them up to drill down foundational essentials of biomechanics, strength, and coordination. However, there was no way I was hanging up my shingle or abandoning my post. That would have been entirely counter to my nature—and frankly, an impossibility. So, after a mere week of "leisure" for Matt to acclimate, it was time for Mom’s Boot Camp to get underway again. We started slow, sure, but soon we were going full throttle. My mission was simple: Matt needed every opportunity to thrive, and I was going to make sure he got it.

So much to juggle, balance, and prioritize.

Next, Matt shuffled his trusty walker into the kitchen. After parking it to the side, he firmly grasped the wood railing separating the kitchen and family room. Carefully guarding his balance, he then stepped sideways: four feet to his left, then to his right, repeating the motion five or six times. He followed this with toe raises, heel raises, marching in place, squats, and butt kicks. For his left leg, he performed strength training against a red, light-resistance TheraBand anchored to the newel post. His right leg worked without the band. By then, Matt was ready for a rest, timed perfectly to coincide with The Price is Right.

Fatigue is one of the most common (45-73%) and debilitating long-term symptoms after a TBI, significantly impacting daily life, social activities, and the ability to work. Gratefully, Matt shed his level of fatigue quickly, returned to waking and the crack of dawn, and let me work him long hours.

Before convening an afternoon session, we made lunch together. It was often a turkey sandwich—Matt preferred dry and without condiments, which I found quite bland! He'd also eat baby carrots, lots of them. I swear, at one point, his fingers acquired an orange hue from the sheer volume. Pretzels, iced tea, and possibly a cookie rounded out the meal. I'd shuttle everything to our front patio and position it on a small table for his easy access. Then, I'd escort Matt outside and down the steps, keeping a close eye on him, always wary of what stunts he might try. Once safely relaxed in a porch chair, we'd enjoy the fall sunshine and mild temperatures, replenishing our fuel supply for round two. I'd fill the air with idle chatter about anything that came to mind, strategically drawing out as many responses as I could.

We spent the next few hours engaging in hand activities that demanded dexterity, coordination, and manipulation. These tasks could be tedious and repetitive, but I made an effort to incorporate fun. Matt matched picture dominoes, built towers or houses with his childhood blocks, or we played memory with a partial deck of cards spread face down on the table. Aunt Debbie had created flashcards with images of our extensive Watkins family, and painstakingly, we prompted Matt to relearn everyone’s name. This, along with naming objects, letters, and numbers, proved to be significant stumbling blocks, so we included traditional flashcards for these as well.

Whenever I drove Matt to therapy, I used the ten-minute drive as an opportunity to ask him to repeat family names from my side of the family, and later recite them without prompting. This was no small task, and often a frustrating undertaking. If I pushed too hard or didn't perceive the onset of mental fatigue, a blank look descended like fog. We practiced, for ages, well, okay, many months, just like my daughter now teaches our names to her two-year-old son, Kai. If it were a competition, Kai would easily win; he is so adorable and singsongs each name enthusiastically. Sorry Matt.

We wove speech and ognitive strategies into every aspect of Matt's other therapies, daily chores, and even his supposed downtime. During these moments, we'd inconspicuously coax him to answer questions and initiate conversations. Generally, though, he still depended on us to engage him first. Daily, we strengthened his vocal cords by having him project a loud, operatically sustained "ah" that was meant to be heard clear to the moon—or at least across the room. Sometimes, Matt and I sang simple songs like "Row, Row, Row Your Boat," "Twinkle, Twinkle Little Star," "Old MacDonald Had a Farm," and church hymns. He could verbalize and project his voice much better when singing than when talking. As November crept into view, the speech therapist arranged for Matt to use the Constant Therapy App at home, with "games" assigned to address sound recognition and his ability to follow verbal and written instructions. This provided a nice change of pace and a bit of independence.

Megan unpacked and encouraged Matt to help set up his computer. We had hoped that this task might come more easily to our Computer Engineer and college professor, but it didn't. There was no light bulb moment. Kindly, she talked him through each step, and when that failed, she called her boyfriend, Ben, for help. Matt sat by as we arranged his desk paraphernalia and Megan gave the computer a whirl. Soon, he was practicing his math skills using a children’s computer app. Related tasks included developing writing skills and improving reading. Aloud, we practiced Green Eggs and Ham together, not quite in sync, as he listened carefully for me to initiate each word.

New possibilities opened as Matt's progress grew incrementally with each passing week. To keep track, ensure we covered all our bases, and switch things up, I created a two-week flowsheet, exactly like what I'd used for years as a physical therapist. It included a table of twenty potential actions, such as exercises (with weights, resistance bands, core stabilization, or isometric), balance (one-legged or on a half-foam roll), kneeling, walking, typing, piano, ballroom dance steps (Fox Trot, Waltz, and Swing), reading, writing, and, in time, Math and English workbooks. I logged specific details and updated task progress as Matt made strides. There was never a shortage of opportunities.

One day, I got extra daring. I helped Matt sit gingerly on a big, red, wobbly therapy ball. His eyes grew huge, and he resonated a one-word warning, "Dangerous!" Despite his misgivings, he did well rocking back and forth and raising his arms overhead and out to the side.

Every two weeks, I'd grab a fresh flowsheet, mixing and matching to keep things interesting. A few activities, like walking, were essential and always had a reserved spot. The weeks I went to work, Mike did his own thing, adding his unique flair, must-haves, and pet projects. This variety kept Matt engaged and covered a broad spectrum for maximum impact.

People have often misinterpreted my ability to give 110% and keep going without breaks as meaning I am okay with that, didn’t need help, or didn't need to rest and relax. That couldn't have been further from the truth. But in my mind, at this juncture, I felt I had no choice. Matt was depending on me.

© 2025, Sarah Watkins