Defining Moment A Different Kind of Commencement For a determined young man, "graduation exercise" takes on new meaning. By Travis Stoner, PT, DPT, COMT | April 2016 Listen to 'Defining Moment' In the summer of 2012 the Haller family was vacationing in Ocean City, Maryland, enjoying the beach like many families do. No one knew that this trip would change their lives forever—and allow me to be a part of the most awe-inspiring stories of dedication I ever could imagine. On July 27, 16-year-old Parker Haller did what a lot of teenagers do and dove headfirst into a wave. Unfortunately, there was a sandbar directly behind that wave. Parker hit head-first into it, resulting in vertebral fractures and an incomplete spinal cord injury at C4-5. He immediately felt his entire body go limp and had to be rescued out of the water. He was airlifted to a shock trauma center in Baltimore, where he spent several weeks in the intensive care unit. Within the first week he had surgery to repair his vertebrae and was given a 4% chance of ever walking again. He then had a second surgery that increased his chances of walking to 35%. Parker next spent 2 months at the Shepherd Center in Atlanta, Georgia—a rehabilitation hospital for patients with spinal cord and brain injury—before coming home to the Washington, DC, suburbs to continue outpatient rehab at Inova Mount Vernon Hospital in Alexandria, Virginia. Parker first came to our practice, Fusion Physical Therapy, in Woodbridge, Virginia, 2 years ago. At that time, he was in a motorized power assist wheelchair. Still, his arms were so weak that he was unable to propel the chair for a prolonged time or distance. He could walk very short distances with forearm crutches. We sensed immediately, upon his initial evaluation, that this was a young man who could defy the odds. With spinal cord injury that severe, walking is extremely difficult. Patients' arms and legs are weak. Their sitting balance is poor and their endurance is minimal. From the start, however, Parker showed a strength of spirit and determination to succeed. We saw him 4 times a week. He worked tirelessly on an FES (functional electrical stimulation) bike and did everything we asked of him at home. Together, we worked on Parker's balance, trunk control, and overall strengthening. Within a year he was traveling extended distances in the power assist chair and could stand up unaided for at least 2 minutes. Next, Parker began walking—first with crutches, then with a cane. A year ago, he surprised his mother by walking a couple of steps with human support but without any assistive device. As his strength and coordination further improved, we continued to challenge him. Parker's family was our ally in this. Upon arrival for therapy, for example, his father would make Parker use his crutches, then later his cane, to get to our clinic, which is located on the second floor of a professional building. At around the 1-year mark after the accident, we—Parker, his family, his rehab team—made a goal: Parker would walk across the stage at his high school graduation. We then coordinated with venue staff to determine the stage setup and length. We learned that Parker would need to walk 32 feet to traverse the stage and at least another 50 feet to get down a ramp back to his chair. Two days a week he worked with Ashley Rolley, PT, DPT, on his standing and kneeling balance to strengthen his core muscles and improve his standing balance. They also worked on stairs each session to prepare Parker for the walk up and down the ramp to the stage. During Parker's other 2 weekly sessions we worked continuously on walking. Each ensuing week we added something else to help him progress—from taking bigger steps, to increasing his walking speed, to decreasing the sway in his upper body, to increasing his foot clearance from the floor. Six months before the graduation ceremony, Parker was able to walk independently, with no one holding onto him, but for only 3 or 4 steps. We knew we literally had to step things up if Parker was to achieve his goal. Suffice it to say, he—as always—was up to the challenge. When graduation day finally came, we knew Parker was ready, but few of his classmates had an inkling of his full capabilities. Although he'd made tremendous progress, there was no way he could do things like get to class on time without using his power assist chair, so that was still the way most people thought of him, although they knew he could walk a few steps at a time. Other than Parker's family and those of us on his therapy team, only a few teachers who helped him with his wheelchair knew what was planned for graduation day. Finally the big day came. Fusion staff sat in the rear of George Mason University's Patriot Center—perfect seats from which to see everything unfold before us. One of his teachers wheeled Parker up the stage with all his classmates. Finally, Parker's name was called. We were all so nervous! He had been sitting in his chair for almost 2 hours at that point. His legs were going to be very stiff. It took him a couple of tries, but he stood up. Our eyes filled with tears of pride and joy. Two years of extremely hard work were about to culminate in an amazing and inspirational way. Parker was handed his cane and took a step. At that moment, the entire 2015 graduating class of CD Hylton High School rose to its feet. I have never seen such a standing ovation in my life! With each step, the claps and screams grew louder. In all of our therapy sessions, I had never seen Parker walk with such confidence. He walked across the entire 32 feet of that stage without so much as a stumble or slight trunk sway. Then, after shaking hands with the principal and getting his diploma, he walked down the ramp to the bottom of the stage and sat in his chair for the remainder of the ceremony. He stood back up for the recessional and walked through a hall lined with teachers applauding and encouraging him. I have many more years to practice and many more miracles to see. It's going to be hard to top what I saw on Saturday, June 6, 2015, however, when Parker Haller blew his classmates away by walking across that stage. Travis Stoner, PT, DPT, COMT, is director/operator of Fusion Physical Therapy in Woodbridge, Virginia. Video of the graduation ceremony described in this essay is available at www.fusionptcr.com. Click on "Videos" at the top of the page.