Last year was a roller coaster for 23-year-old Kate Via and her husband, Joshua. The pair married in April 2024, announced they were expecting their first child in September, and in November, began navigating brain injury recovery as Kate was seriously injured in a car accident. Miraculously, her baby was not hurt. She was taken to CHI Health Bergan Mercy, where she spent four weeks in critical care. Her family was uncertain of what her future would hold.
“I remember taking the neurosurgeon out in the hallway and asking, ‘Will our daughter survive?’” Chryssi Zeleny, Kate’s mom, said. “She said, ‘Your daughter’s brain is very ill.’ We didn’t know what that meant.”
Kate was diagnosed with a diffuse axonal brain injury. She came to Madonna Rehabilitation Hospitals’ specialized brain injury program, weak, but determined, to recover in time for her baby’s March due date.
“She made a comment early on that it would have been easier to die,” Chryssi said. “But she said, ‘I’m fighting for my baby.’”
Rediscovering her voice
“When Kate came to us, she kind of had three big things that we noticed right off the bat,” Claire Dowling, MS, CCC-SLP, CBIS, Kate’s speech-language pathologist said. “First of all, she wasn’t really able to verbally communicate, so she communicated with us with head nods and gestures, but she wasn’t really able to make her wants and needs known. Because of that, it was a big question mark as to what her cognitive status was. Third, she wasn’t eating when she came here, so all of her nutrition was through a feeding tube.”
To keep her weight up and provide nutrients for her baby, Kate needed to be able to eat and drink by mouth. In daily speech therapy, Dowling had her do several swallow studies and Kate quickly progressed to a full diet.
From there, Kate was determined to find her voice. Using breathwork exercises, she built up the muscle strength and lung capacity needed to vocalize. Then, using specialized technology like the VisiPitch computer system, she gained vocal volume and her speech became clearer.
“When Kate first started talking, we were talking about all the great things she was going to be able to do again, talking to her family, but what really touched me was she said, ‘Well, now I’ll be able to sing to my baby,’” Dowling said. “That really brought a tear to my eye because it puts her goals in perspective.”
Incorporating life roles into therapy is key to successful community reintegration. As her cognitive skills took off, Kate practiced balancing a checkbook, planning out meals, and sequencing household tasks like laundry or changing a diaper in therapy sessions.
“Obviously, we think about what the patient was doing prior to the accident and how we’re going to get them back to those roles, but also we had to think forward a little and know that in a few months, she was going to be a new mom,” Dowling said. “She was going to have a big new role in her life and a lot of new responsibilities, so I worked in tandem with occupational therapy and physical therapy.”
Stepping into her new role
Having been in the hospital for more than a month, Kate was physically weak and deconditioned when she arrived at Madonna. In physical therapy, her first goals were to be able to get out of bed on her own and stand unassisted. But it didn’t take long to see Kate was determined to fight.
“It only took a few days to realize that Kate was responding extremely well to therapy,” Kailyn Wiseman, PT, DPT, Kate’s physical therapist said. “Each day she was accomplishing something new and I think it was just a testament to her work ethic and really trusting the process and just embracing each day. It was clear she was fighting for much more than just herself.”
For Kate’s family, watching her relearn how to walk was emotional.
“We were there when Kate took her first steps as a baby,” Chryssi said. “In the hospital, we were there because we were not going to watch her take her last breath. We were there to watch every milestone of this recovery. We didn’t want to miss one second of her story.”
Because she was progressing at such a rapid pace, Wiseman says they were able to be creative with incorporating some of Kate’s hobbies, like fishing, and motherhood tasks into therapy.
“We did a lot of activities with an 8-pound medicine ball to simulate the baby,” Wiseman said. “We had her pushing a stroller up and down the halls. Also with some of those anatomical changes that you see with pregnancy, we were working on core stability and mobility exercises to not only help manage some of her symptoms, but also prepare her for delivering the baby and then recovering after birth as well.”
Physical therapy also tapped into Kate’s muscle memory and natural instincts by including fishing into therapy. As an avid outdoorswoman, Kate has ‘Fishing With Kate’ Instagram and TikTok accounts boasting several thousand followers each. Even when she was still unable to sit on her own, she was able to move her arms in the familiar motions of casting and reeling. As she got stronger, therapy was able to lean into those favorite hobbies even more.
In occupational therapy, using the ArmeoSpring gravity-supported exoskeleton, Kate enhanced her range of motion and grip strength by playing a video game where the object was to shoot birds and skeleton pirates to earn points. Occupational therapist Aubrey Janousek, MOT, OTR/L, CBIS, brought Kate a real fishing pole to test out in Madonna’s Independence Square. The session ended up being educational for both patient and therapist, as Kate taught Aubrey different casting and reeling techniques for different fish and what makes a fishing pole right for each person.
Collaborative strategies for vision improvement
Janousek also worked with Kate in depth on her vision. When she arrived, Kate wasn’t able to open and close her right eye and was dealing with double vision.
“We intervened with spot patching to prevent her brain from beginning to ignore her right eye,” Janousek said. “Interventions were primarily focused on improving the range of motion in both her right and left eyes individually since they were not working together as a team.”
Collaborating with Madonna’s on-site neuro-optometrist, Dr. Tanner Gates, Janousek used specialized technology like the Bioness Integrated Therapy System (BITS) and Dynavision light board, to provide Kate mass repetitions in shifting her gaze in all directions while also challenging her cognitive skills.
During her 10-week stay at Madonna, Kate’s vision and depth perception improved. She could recognize her right eye’s limitations and how to maximize her independence. A huge part of that carryover is credited to her family.
“Kate’s family was extremely helpful in integrating my recommendations outside of therapy sessions,” Janousek said. “They provided feedback on how her vision impacted her in functional tasks, and they observed Kate completing outside-of-therapy sessions in the evenings and weekends. This was so helpful to allow me to problem solve with them accommodations or activities to address these skills.”
Bonding over motherhood
Occupational therapy focuses on getting people back to their life roles and using hobbies and responsibilities as part of therapy. Janousek started working with Kate right away on adaptive ways to hold or feed a baby, with tips and tricks she learned as a new mom herself.
“It was so amazing for me to know everything that I had just gone through as a first-time mom and how big that transition was and then thinking, ‘How could I take what I’ve learned and what I was doing every evening to care for my little one and adapt that and practice that with Kate?’ Janousek said. “She is very much a natural in how she cares for even the pretend babies, so I know without a doubt she’ll step into that role seamlessly. However it is a little bit different when you’re not able to walk and move and hold something as you once were, so it did take a lot of practice.”
There are ups and downs in recovery, and Chryssi remembers one day when her daughter got upset that her body wouldn’t move the way she wanted.
“She had one kind of meltdown moment where she said, ‘I don’t want to drop the baby,’ and Aubrey said, ‘That’s why we’re practicing. You’re not going to drop the baby,’” Chryssi said. “She’s got such a strong support system around her that we know that’s not going to be an issue.”
Kate’s dad says her experience as an aunt helps her stay ahead of the game in terms of baby prep.
“Even though she’s practicing all these things, a lot of it is already natural for her,” Steve Zeleny, Kate’s dad, said. “Even though this is her first baby, she’s been a great babysitter for her nieces and nephews, so that helped, and then Madonna piggybacked off that just to reinforce the safe habits of what she’s got to accomplish.”
Leaning on friends and family, Janousek says, is going to be important for Kate as she navigates motherhood.
“It’s not going to be perfect, but you know your family is going to be here to support you and that they’re going to allow you those opportunities to hold your baby and build that connection,” Janousek said. “As a first-time mom, it’s so huge after you have that little one to build that connection with them, and a lot of that bond is built through physical touch, so we talked through ways that she could continue to hold the baby even when her arms were potentially a little weak still. We did a lot of practice with baby-wearing and a lot of supported sitting techniques so she could still really create that bond with her baby.”
Janousek brought in her own baby items, like bottles, swaddles and wraps to practice. Using Madonna’s Independence Square, they practiced loading a car seat into a vehicle and changing a diaper. For Kate, these sessions also offered a chance to ask for advice.
“This is my first kid, so I’m like, ‘Tell me everything,’ because I don’t know what to do,” Kate said. “It was really helpful.”
Joshua says it’s been a joy to watch his wife’s maternal instincts start to shine.
“It’s been cool to see her learn and see that motherly nature come out of her,” he said.
Faith and family
Throughout her entire recovery, Kate’s family has been by her side every single day, cheering her on. Playing off her channel name, ‘Fishing with Kate,’ they wear matching shirts that say, ‘Fighting with Kate,’ because “her fight is our fight,” Chryssi says. On the back of the shirt reads, ‘Living proof of a loving God.’
“Kate loves God and that’s the biggest part that got her through this,” Steve said.
Combined with her unwavering faith and prayers from friends and strangers alike, Kate’s family support propelled her forward in therapy.
“I think a lot of someone’s progress has to do with the people around them, and Kate’s family and friends were right by her side through this whole thing,” Wiseman said. “They weren’t going to let her do it alone.”
Madonna encourages families to take an active role in their loved one’s recovery. Kate’s family attended therapy sessions, mastered extensive caregiver training, and accompanied Kate on community outings. They even held a special gender reveal party in Madonna’s cafeteria.
“Kate always said that she wanted a lot of kids and she wanted to be pregnant around the same time as her siblings, so we have three of the sisters pregnant together,” Chryssi said. “That was an exciting moment for all of us. We never thought we would have to be at Madonna to do a three-sister gender reveal but to watch that as parents is amazing and a miracle in itself.”
For Kate’s physician-led care team, family involvement meant greater carryover between therapy sessions.
“We know without a shadow of a doubt that patients are more comfortable with having their family provide care with very personal parts of their routine,” Janousek said. “We also knew when Kate was going back to her room, she was getting extra practice and extra repetitions. So much so that the next time I would come back and say, ‘Ok, let’s do this again,’ they would say, ‘Oh no, we already got it. We figured it out.’ Then we could just move on to the next thing.”
A new chapter
Exceeding every expectation she set for herself, Kate walked out of Madonna on her own. She is continuing her therapy on an outpatient basis through Madonna’s Rehabilitation Day Program as she prepares for her baby to come at the end of March.
“Proud is not a strong enough word,” Steve said. “From where she started in this journey to where she’s at now, [being] proud doesn’t even touch it. It’s a miracle, and she makes us proud each and every second through this journey.”
A miracle, but also a testament to her tenacity.
“Kate had a lot of really great factors in her favor, her age, her previous level of function, the fact that she did start to respond pretty quickly after her brain injury,” Janousek said. “Those are all ‘factors’ that we look for to help predict recovery. However, nothing can surpass her work ethic. She never complained. She was always willing to try the next hardest thing.”
Kate says she had no other choice but to push herself.
“I know it would’ve been easier to die, but then I would’ve left Joshua and our baby behind, and that was not happening at all,” she said. “I’m thankful for everyone, family helping me out and caring for us.”
Now, the pair anxiously await their baby’s arrival.
“I don’t know what to expect yet,” Joshua said, reflecting on when he will finally hold that baby in his arms. “But I know they’ll be so precious. A gift from God.”