A Positive Attitude Makes All the Difference in One Young Man's Stroke Recovery

He didn't know what had hit him.

On Feb. 21, 2022, Endicott College sophomore Jack Smiley was practicing on the ice with his hockey teammates. He had felt fine all day. But toward the end of practice, he got hit with what he described as "a wall of all the symptoms at once."

First, he felt disoriented and couldn't catch his breath. Thinking he just needed some rest, he skated over to the bench. On the way, he noticed his right foot wasn't doing what he wanted it to do. Soon he had lost all sense of coordination.

"My right arm started not working the right way," he said. "All of the neurological signals that I tried to send to my muscles weren't firing correctly. That's when I knew something was definitely wrong."

When his teammates couldn't make sense of what Jack was saying, they called the trainer over. Within minutes, Jack was rushed to a local hospital. After being diagnosed with a stroke, he was transferred to the Neuroscience Intensive Care Unit (NeuroICU) at Massachusetts General Hospital. 

Searching for what caused the stroke

David J. Lin, MD, a critical care neurologist and neurorehabilitation specialist, was part of Jack's care team at the NeuroICU. He said that Jack had suffered a stroke in the brainstem, an area that affects breathing, movement, and other critical functions. The cause of the stroke, however, was a mystery at first.

Jack's clinical team kept digging. During conversations with Jack's family, someone mentioned he had been hit in the back of the neck during a game several weeks earlier. That fact led Dr. Lin and his colleagues to revisit some imaging tests they had previously reviewed. This time, they detected on one of the images a tiny fracture in the bone that surrounds the left vertebral artery. 

"This is one of the major arteries that runs up the back of the brain and supplies the brainstem," Dr. Lin explained. "We concluded that he had a vertebral dissection, or tear, of the artery due to that initial hit. That led to a blood clot that formed in the artery and later went to the brainstem and caused the stroke."

At this point, his doctors weren't sure Jack would ever walk again. However, Dr. Lin noted, it is very hard to predict what recovery from stroke will look like for any given patient. And Jack had two key factors on his side: his age and his attitude.

"Being young, fit, and physically mobile at baseline certainly helps with long-term recovery of function," Dr. Lin said. "Jack was able to achieve acceptance of what had happened early on. And he was super motivated to play hockey again, a goal that played a major role in his recovery."

Wasting no time to initiate care

In the NeuroICU, Jack received care from neurologists; physical, occupational, and speech therapists; nurses; and pharmacists. Having a multidisciplinary team is a critical factor that can enhance stroke recovery. Another is acting in a timely manner.

"One unique thing about the Mass General NeuroICU is our recognition that recovery and comprehensive care must start the moment a stroke patient comes in," Dr. Lin said. "We mobilize patients as early as possible so we can understand what they're able or unable to do and get them pointed in the right direction."

About a week after his stroke, Jack was considered medically stable enough to leave the NeuroICU. Like most Mass General stroke patients, he was transferred to Spaulding Rehabilitation Hospital Boston for his rehabilitation.

Spaulding and Mass General are both part of the Mass General Brigham healthcare system, and communication between the two hospitals is seamless.

"Recovery that starts in the Mass General NeuroICU continues at Spaulding," Dr. Lin said. "From our occupational therapists exchanging documentation to the pass-off that happens between physicians, there's a transition plan in place to ensure continuity of care."

Therapy that aligned with his interests

Upon his arrival at Spaulding, Jack had no function on his right side and was unable to eat, speak, or get out of bed. He tackled his rehabilitation with vigor, completing six to seven therapy sessions each day.

With floor-to-ceiling windows and ample nature light, Spaulding's rehabilitation space was an appealing environment in which to work out. Jack's clinical team also took care to tailor his therapy to reflect who he is as an individual.

"They were always asking me what my goals were, what I wanted to achieve, where I wanted to be," Jack said. "They had my hockey stick brought in, which I used in therapy. And they worked in activities that would engage me as a person, like shooting a beanbag or a basketball."

Key members of Jack's Spaulding team included physical therapist William Santana, PT, DPT, and occupational therapist Nick Herring, OT.

"They found ways to adapt my recovery and incorporate tactics in the gym to my style," Jack said. "They made things competitive. They pushed me in ways that got a response out of me and made me want to get better. Finding someone who can do that is a challenge, and they did it very well for me." 

Following a month of inpatient therapy, Jack was able to walk out of Spaulding using only a cane. His next stop was a fully accessible apartment located across the street, where he lived with his mother while undergoing outpatient therapy at Spaulding.

The transition out of the hospital was difficult. From his hand and arm down to his calf and ankle, the right side of his body still wasn't working right. Struggles with his gait necessitated the continued use of a cane. Leaving an environment where he was surrounded 24/7 by others on similar recovery journeys was also tough. 

But Jack persevered. After two months of outpatient therapy, he was ready to return to his family's home in southeastern Pennsylvania. He said that Spaulding will always have a special place in his heart.

"I can't imagine a place being better at what they do than Spaulding is," he said. "The way they think about therapy, the cohesive ways they use their tools, who they hire as therapists: It's the perfect recipe for you to have the best recovery possible." 

While undergoing inpatient and outpatient therapy at Spaulding, Jack paid several visits to the Mass General NeuroRecovery Clinic, which Dr. Lin directs. The clinic focuses on long-term recovery and rehabilitation for patients with acute neurologic injuries including stroke.

A typical patient experiencing a stroke might need care at an acute care hospital like Mass General, a rehabilitation facility like Spaulding, and an outpatient center after they return home. Increasing continuity of care across these settings is a key priority for the NeuroRecovery Clinic.

So, too, is maintaining an interdisciplinary, collaborative care model. During a typical patient visit, a neurologist offers their perspective on the patient's recovery along with therapeutic options. Each patient is seen simultaneously by experts in neurology, occupational therapy, physical therapy, speech therapy, pharmacy, nutrition, psychology, and social work.

"One unique aspect of our clinic is having neurologists who are specifically trained to look at patterns of injury in the brain and think deeply through how patients perform functions," Dr. Lin said. "We then offer strategies, including approaches to therapy as well as medications and devices, to restore neurologic function and help patients recover better, faster, and more completely." 

With input from the NeuroRecovery Clinic, Jack and his family designed a customized, multi-year rehabilitation program. It incorporated different types of movement through activities like hockey, yoga, dance, and mixed martial arts training.

Upon returning to his parents' home, Jack began his custom-designed therapy program in earnest, including with the assistance of a local rehabilitation facility. He took off the 2022-23 school year to focus on his recovery. 

Adjusting to mental and physical deficits

In fall 2023, Jack went back to Endicott as a full-time student majoring in exercise science. His junior year was a grind, as he learned to deal with mental and physical deficits while trying to keep up with his physical therapy, course load, and social life. But being able to rejoin the hockey team—as the captain, no less—made it all worth it.

"I was a full-fledged part of the team and participated in everything right from the get-go—all the spring practices, captains' practices, and workouts," he said. "I never got a chance to play in a game but did everything else."

While realizing his hockey career may look different than what he had once envisioned, Jack looked forward to rejoining his college team for his senior year and fulfilling his dream of playing one more shift on the ice.

Jack still does physical therapy on his own in addition to seeing the team at the NeuroRecovery Clinic every six months. The progress he has made so far has amazed Dr. Lin.

"This is someone who had no movement at all in his arm in the first few weeks after the stroke. And now, he's not just moving his arm fluidly but also skipping down the hallway in the clinic, doing squats, and getting on the ice," Dr. Lin said. "The amount of recovery he has had is remarkable and a testament to the rehabilitation program that he created together with us."

Jack's recovery and determination have been so impressive that Dr. Lin offered him an internship at his Laboratory for Translational Neurorecovery for summer 2024. "We try as hard as we can to integrate patient perspectives into our research, so having someone like Jack who has lived through this is invaluable for our work," Dr. Lin said.

Soon after starting the internship, Jack was excited about the opportunity to work with Dr. Lin and perhaps even pursue a career in stroke rehabilitation. Jack is passionate about making the opportunities that allowed him to maximize his recovery available to other stroke survivors. And of course, he will continue to have a positive attitude in facing whatever challenges may lie ahead.

"It's all about focusing solely on what I can do today to make for a better tomorrow," he said. "I still have a life to live and things I want to do. I'm going to give my best to make the best recovery I can, whether that takes three weeks, 20 years, 40 years, or 70 years."