“The inpatient staff was incredible and extremely instrumental in Gabriel’s recovery."
16-year-old Gabriel Soares was complaining of a bad headache when all of a sudden, he lost feeling in his left side and fell unconscious. His mom, Carla, immediately called for help, and he was rushed to a local hospital. A CAT scan revealed a dark mass, meaning Gabriel had experienced a sudden brain bleed and needed emergency surgery to remove a third of his skull to reduce the swelling.
After surgery, Gabriel was airlifted to a children’s hospital to begin recovery. Three days into recovery, he suffered an ischemic bilateral stroke and needed another brain surgery, which required an eighth more of his skull to be removed. “His neurosurgeon originally thought this was caused by an arteriovenous malformation (AVM), but an MRA/MRI could not find any traces of such occurrence,” noted Gabriel’s dad, Rui. “They still cannot explain the cause of the brain bleed. Everything happened so unexpectedly and quickly.”
After a month in the children’s hospital, Gabriel was ready to be transferred to inpatient rehabilitation to regain basic functions and movements. He started inpatient rehabilitation at Children’s Specialized Hospital (CSH) in New Brunswick, New Jersey, on December 5, 2023.
Inpatient Rehabilitation
Gabriel began services in the inpatient brain injury program at CSH, where he received a customized rehabilitation plan that focused on his medical, physical, cognitive, and psychosocial needs. In inpatient rehabilitation, he began daily therapy, including occupational, speech and language, physical, and recreational therapy.
In occupational therapy, Gabriel worked closely with senior occupational therapist, Emily Lowry. “When he was admitted, he and his family had to adapt to a new normal and relearn how to do many of his valued occupations,” noted Emily. During his daily occupational therapy sessions, they focused on working on his activities of daily living (ADLs), promoting his participation in his daily routine, and use of his arms and hands, including participating in interventions to improve his fine motor coordination to enhance his ability to use his hands and fingers for ADLs and leisure activities, as well as using a communication device.
“Gabriel made improvements and increased in independence each day. He is one of the most hardworking individuals that I have ever met,” added Emily. “Gabriel was always motivated and willing to try his best each day.”
His primary inpatient physical therapist, Colleen Dow, added, “He progressed a lot during his stay here. When he first arrived, we were focusing on consistent responses to environmental stimuli. He could soon blink for yes or no and move his head. Then he progressed to working on head control, moving, strengthening his right leg and arm to help with rolling, sitting balance, and operating his power wheelchair using his right hand and head, which he did very well with.”
“The inpatient staff was incredible and extremely instrumental in Gabriel’s recovery,” highlighted Carla.
Outpatient Rehabilitation
After months in inpatient rehabilitation at CSH, Gabriel was discharged, and services transitioned to CSH’s outpatient center in Union, New Jersey. In outpatient therapy, Gabriel receives speech and language, physical, and occupational therapy.
Gabriel’s speech and language therapy sessions started with a focus on the trial of high-tech Augmentative and Alternative Communication (AAC) via TD Pilot with eye gaze. This type of program enables Gabriel to select icons to express wants/needs/ideas and engage in social routines through the use of his eye gaze alone. During these sessions, Gabriel receives a multimodal approach to communication as he works with speech-language pathologists Jill Michael, who specializes in the use of AAC, and Christina Ciavattoni, who specializes in oral motor skills.
“Gabriel’s use of eye gaze has been carried over to use without AAC as well, such as response to questions during spontaneous speech. He’s also writing sentences and using modified gestures to express wants and needs,” added Jill and Christina.
As a goal to increase verbal communication, Christina introduced the use of PROMPT (PROMPTS for Restructuring Oral Muscular Phonetic Targets) and Beckman Oral Motor Exercises to provide opportunities for verbal speech. “Gabriel is now producing emerging sounds in isolation (“ah,” “m”) and sound combination for approximations “ma,” “no,” “I am,” emphasized Christina. “Gabriel has been working very hard in sessions, and his parents and his nurse are nicely involved in the carryover of his home exercises program.”
In physical therapy, Gabriel works closely with physical therapists Daniel Idrovo and Steffanie DaCosta to improve strength, mobility, and seated balance. He also utilizes different modalities offered at CSH’s Union outpatient center, including serial casting, electric stimulation, and the bungee and pulley systems in the Universal Exercise Unit, also known as the “Spider Cage.” “Gabriel is excited and agreeable to try new and different treatment strategies, pieces of equipment, and modalities,” highlighted Daniel and Steffanie. “He has made tremendous progress towards his goals, and he continues to impress us with his effort and the potential we see in him.” Since starting physical therapy, Gabriel is now able to sit by himself for short periods, tolerate being upright in the stander, and able to help more with his transitions.
Gabriel has made much progress when it comes to occupational therapy. “He is now able to write sentences and play games with his hand, much to the credit of occupational therapist Laura Valente’s problem solving,” highlighted one of Gabriel’s occupational therapists, Kristen Tutzauer. “He is so motivated to participate in therapy, and we are always looking for new ways for Gabriel to access his environment and participate in meaningful occupations.”
“We’re so excited to keep working with Gabriel and to see how far he will go,” exclaimed Daniel and Steffanie. Kristen added, “He is one of the most inspiring and hardworking patients that I’ve had the pleasure of working with.”
“Gabriel’s willpower and flexibility to try all new types of therapies comes from his structured personality,” added Rui. “He’s a fighter and wants to get better and please all those who support him.”
Making Strides
“Gabriel has come a long way. From a brain perspective, he’s very intuitive and aware of his surroundings, and passing all his home school classes,” highlighted Rui. “Doctors said he was never going to walk, talk or move again. He now has motion on the right side and recently went for a haircut and stood up in the chair. We’re going back to some normalcy, and his body is starting to recover. He just needs more time to catch up on what he’s lost.”
“Gabriel feels like a superstar at Children’s Specialized Hospital. The whole experience has been positive, thanks to the support and everyone going above and beyond. We’ve even seen the CEO and President, Dr. Matthew McDonald, a few times, and he always remembers us and our love for soccer,” stated Rui.
Learn more about Children's Specialized Hospital Brain Injury Center of Excellence.