Six-year-old Bryan Sadowski didn’t know what was happening to him in the pool one day. It was January 2015, and he was in the pool with his noodle during a swimming lesson at the local YMCA.

“My arm started drifting downwards. I couldn’t move it at all. I thought, ‘This is strange. Why do I feel nothing in my arm?’” he describes. After being helped out of the pool, he began to lose consciousness and the staff called 911.

A CT scan at a local hospital revealed bleeding in Bryan’s brain. He was airlifted to The Children’s Hospital of Philadelphia, where pediatric stroke experts from CHOP’s Division of Neurology and Division of Neurosurgery quickly assessed the situation.

Bryan had a ruptured arteriovenous malformation (AVM), an abnormal tangle of blood vessels in his brain that had weakened and burst, causing a hemorrhagic stroke.

The team explained to Bryan’s parents Melissa and Tony that they first needed to drain the blood that was damaging Bryan’s brain.

“We were quiet, scared and in shock,” says Tony when remembering that first surgery. “We just wanted him back.”

Bryan recovered from surgery in the ICU. He had lost the use of his left leg and arm and could not talk, though he was able to communicate through hand signals and written notes. Within a few days, he began speaking again. He immediately began working with physical, occupational and speech therapists, and continued to make slow but steady progress. The plan was to allow Bryan’s brain to heal for another month or so before performing corrective surgery on the abnormal blood vessels.

Two weeks (and an ICU Super Bowl party with family) later, Bryan began a two-month stay in the Seashore House at CHOP’s inpatient rehabilitation program. He was soon standing and walking again, with a gait belt and assistance. Six weeks into his rehab, he had the corrective surgery for his AVM.

Accustomed to the busy therapy schedule, Bryan was bored recovering from his second surgery in the ICU, and excited to get back to work. Recovery was quick, and he picked up right where he left off within days.

Finding his strengths

Back at Seashore House, Bryan continued to work hard on his physical, occupational, speech, and cognitive therapies. The goal was to prepare him to go home and return to school. Along with his weak left side, Bryan had aphasia, a condition resulting from damage to the brain that affects your ability to speak, write and understand. He struggled to recover some of his higher brain functions, including categorizing, comprehension and inferring.

To Bryan, those two months spent at Seashore House felt short. He misses his therapists at CHOP, who turned everything into a game and made sure it never got boring. Bryan’s team keyed into his personality in ways that spurred his progress, says Tony. They developed strategies to get the best results out of him — such as focusing speech therapy exercises on Pokémon, and letting him design his own obstacle courses.

Bryan enjoyed having some control over his therapy, and his parents absorbed lessons that would help them work with him, too, once they left the “protective bubble of CHOP.”

“CHOP really prepared Bryan, and the entire family, for the challenges ahead,” says Tony. “The team is great at teaching a child in ways that will empower him to continue to learn and improve later on. They prepared the whole family to manage the stresses of recovery better.”

A year of growth and adjustments

The year since his stroke hasn’t been easy, but Bryan has stayed positive as he continues to make progress. He does home exercises, uses an electric muscle stimulator on his left arm, and continues to work with outpatient physical and occupational therapists at CHOP.

He has celebrated major milestones since his return home, such as graduating from speech therapy and being accepted into the gifted math program at school. But small victories are just as important. Bryan can take a shower, use scissors while holding the paper with his left hand, and put socks on by himself — activities that were not possible when he left the hospital.

Sometimes things give him trouble, like logging on to a computer because he can’t get his left hand to do the fine motor work to help his right hand. But, as Bryan’s therapists recognized early on in his recovery, Bryan has an impressive capacity to adapt and find creative ways to overcome an obstacle. He soon figured out how to stretch his right hand to hit “Control, Alt, Delete” on the keyboard all at the same time.

“Bryan is good at coming up with ‘workarounds.’ Sometimes too good. We remind him he always needs to try with his left hand first. But we’re amazed at how he can re-direct and figure out a solution,” says Tony. Bryan is encouraged to use his left hand when gaming, making an OT task fun.

At recess, he’ll make suggestions to change the game a little if classmates are playing something he can’t quite play yet — like basketball.

“I ask my friends if they’ll let me throw a ‘dance bomb’ or an ‘owl bomb’ at them,” Bryan explains. “This means they have to stop for a second and dance or flap their arms like an owl so I can get the ball away from them. They’re cool with it.”

The former soccer player kicks his ball around for a fun workout, and recently started a hip-hop class. He has already gotten the hang of moves that are new for him. (Bonus: It helps with motor and sequencing skills.)

The Sadowski family has learned to adapt and cope with the stress and repetition of daily therapy, too. Sometimes that simply means taking a break.

“It’s stressful to fit everything in all the time,” says Tony. “We do our best, but it’s impossible to be perfect. Taking some down time, joking around, reading together, playing video games — that balances out the stress.”

When asked what he would tell himself if he could go back in time and give a message to the quiet boy in the wheelchair, Bryan says: “You do not have to worry about a thing. You’ll get there. You just have to practice and work hard.” 

Originally published May 2016