Our battle to reclaim Matt’s autonomy and re-ignite his inner drive is a deeply collaborative endeavor. Outwardly, a list of Matt’s daily routines might lead people to believe that his effort, and ours, were targeting one deficit at a time. But in truth, as you have seen already, the focus on specific protocols rarely occurs in isolation, which can be a double-edged sword. While addressing balance, coordination, or fine motor dexterity, the central nervous system must provide sequencing instructions and corrections in tandem with biofeedback from our innate sensory network to facilitate performance. It gets messy or fails when any component is absent, executes poorly, or injects faulty signals. System-wide, Matt experienced a hodgepodge of inconsistent integration. It's like playing 'Pin the Tail on the Donkey,' with no one telling you which way to go or, worse, misleading you in jest.

Did we purposely include all these variables in our home programs? Not usually, but if asked, we could provide a reasonable physiological reason. Part of this knowledge was deeply rooted in us as physical therapists. It also came from years of raising children and learning from trial and error. Generally, most people have an instinctive sense of the natural order of development stages; they just don’t always think about it that way.

The essential set of cerebral processes—executive functions—is aptly called the mind's "air traffic control." The person waving the flag directs, guides, and coordinates resource management to achieve a desired goal—safe arrival at the gate or take-off down the runway. Matt’s air and ground controllers were understaffed and operating at a deficit, which affected his mental processing, self-awareness, and short-term memory. Consequently, re-establishing each action requires constant prompting, hints, gestures, demonstrations, prodding, and endless repetition.

Rather than a test score, a meaningful milestone was a glimpse of self-awareness when Matt started to recognize that his output (what he said or did) did not always align with his intent. This insight was humbling for us but pivotal for him because it enabled Matt to begin correcting his own errors.

Our experiences as physical therapists reinforced this philosophy: the injured mind benefits immensely from the repetitive signals of functional activities and patterns, even if those movements must be guided with "hand-over-hand" reinforcement. My boss, Peggy, an occupational therapist, witnessed how strictly we adhered to this principle: "When Matt needed assistance with basic personal care, Mike and Sarah made Matt do things, and would not be tempted to do something for Matt just to get it done in a timely manner. If it took thirty minutes to put on a sock, then so be it." That external observation was a powerful reminder that our agonizingly slow pace was not only necessary but professionally sound.

Peggy further validated our regiment's extreme demands. "Pushing Matt to participate, initiate, or continue tasks was an exhausting process." Despite having treated many people with neurological injuries, she had never seen—or suggested—the kind of intense daily pace we maintained at home. She recalled advising families to perform prescribed movements once a day, perceiving that was enough. In retrospect, she sees that her clinical mindset hadn't grasped the importance of practicing multiple times a day, six to seven days a week. Although our persistent approach was draining, our family embraced it to help Matt regain proficiency in all life competencies.

With Matt’s first-year anniversary behind us, we started the second year with straightforward yet ambitious goals. My journal entry outlined my wishlist: the ability to handle his AM care (shower, shave, brush his hair, and pick up after himself), prepare breakfast with minimal intervention, go outside whenever he wants, improve simple problem-solving, and learn to take initiative in identifying actions he can get better at.

© 2026, Sarah Watkins