Jacob: Preparing to Return to School and Music Following Brain Injury

Fifteen-year-old Jacob Velez loves all types of music, from jazz, to classical, to rap. He is a member of his high school marching band in Brownsville, Texas, where he plays the trombone. When he had a brain arteriovenous malformation (AVM) that ruptured, his TIRR Memorial Hermann team worked together to prepare him to return to school and the activities he enjoys.

On December 28, 2022, Jacob was at home for his Christmas break. His mom woke him up that morning to have breakfast.

“When he came to the breakfast table, Jacob said he didn’t feel good and that he thought he might vomit,” said his mom, Priscilla Chavira. “He also said that his hands and fingers felt numb.”

Priscilla was immediately concerned and called 911. Jacob was taken via ambulance to the closest hospital with a pediatric ICU to their home in Harlingen.

“There, they did surgery to address the bleeding in his brain,” Priscilla said. “They weren’t certain how extensive his brain injury was. That was the worst thing to hear and our entire family was praying for his recovery.”

The surgery went well, and Jacob stayed in the hospital for 22 days as he recovered from surgery. The AVM left him with extensive weakness on his left side, in addition to, moderate cognitive deficits, so he was transferred to TIRR Memorial Hermann in Houston to begin his rehabilitation.

“I knew that miracles happened at TIRR Memorial Hermann, and I am so glad he was able to go there for inpatient rehabilitation,” said Priscilla.

“Jacob presented to us with left-sided weakness as well as cognitive deficits,” said Simra Javaid, DO, FAAPMR, assistant professor of pediatric rehabilitation medicine in the Department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth Houston and attending physician in the Pediatric Rehabilitation Program at TIRR Memorial Hermann. “Despite the deficits he presented with, he has remained very positive and optimistic – always providing a big smile and kind words. He has shared that one of his main goals is to get back into competitive band and to be able to play the trombone again as well as attend school with his friends.”

Jacob and his speech pathologist, Sabrina Filoteo, MA, CCC-SLP, worked to get Jacob prepared to return to the classroom.

“Jacob had difficulty with processing information, recalling written/auditory material and problem solving,” said Filoteo. “While at TIRR Memorial Hermann, he demonstrated improvements in cognitive endurance and self-monitoring, which are important skills for a successful return to school. At the time of discharge, he was able to initiate and draft an email to a clinician, plan and organize a mock college class schedule, and research and present on his topic of choice, The Fastest Car in the World.”

Occupational therapists Chelsea Whatley, OTR, C/NDT, and Anthony Kennedy, OTR/L, MS, OT, focused on improving activation and use of Jacob’s left arm.

“A portion of his treatment has included learning piano during OT to improve coordination, sensation and motor activation with his left upper extremity. He was able to move from requiring hand-over-hand assist to Jacob being able to manipulate the foot pedal and play with left hand without assist,” said Whatley. “In addition to addressing upper extremity neuro reeducation, we have been heavily focused on improving mobility to eliminate use of his wheelchair in order to fully return to participation in leisure activities, such as marching band.”

At times, Jacob’s physical therapist and music therapist worked together to help him move toward his goal of rejoining his school’s marching band.

“In physical therapy, Jacob has participated in activities to encourage weightbearing through his left leg and electrical stimulation to encourage neurorecovery in his left leg,” said his physical therapist, Emily Klein, PT, DPT. “Due to Jacob’s interest in marching band and music, his walking has improved with rhythmic auditory stimulation during Music Therapy co-treatments and through use of a metronome. In this form of therapy, the external sound of the music or metronome, helps Jacob to take symmetrical steps and increase his speed while walking.”

Each day, Jacob progresses closer to his goals of returning to school and playing with his band. Now, he is also considering a future career in the medical field.

“He is optimistic that he will be able to pursue a career in health care in the future, and his entire TIRR Memorial Hermann pediatric team is rooting him on!” said Javaid.