For Chris Mason-Hale, healing comes in very small stages, sometimes so small he can't even see them.
Since suffering a paralyzing spinal cord injury in a Western Tech football game 14 months ago, he has come a long way. But progress is excruciatingly slow for a former star linebacker who cannot walk.
The 17-year-old steadily improved in the months just after the accident - a routine tackle that snapped his neck back, breaking the C-5 vertebra and bruising his spinal cord. He kept improving during inpatient rehabilitation at Kennedy Krieger Institute from January to March.
But by summer, he felt his progress had stalled.
Severe muscle spasms in his legs made it hard to work out. They didn't hurt, but he likened them to a child flailing into a tantrum on the floor, just "without the screaming." He had surgery to insert a device that would deliver medicine directly to his spinal column, but that didn't help, so he had another operation to remove the device. Healing kept him out of rehab until late summer.
When he did try to work out on an elliptical exercise machine, strapped in to hold him upright, a swing in blood pressure brought on nausea and dizziness, something Dr. Daniel Becker, who cares for Mason-Hale at the International Center for Spinal Cord Injury at Kennedy Krieger, said is common in patients with injuries such as his.
With all of that, Mason-Hale worked out less and less, and the usually upbeat teenager started feeling down.
"Every day was boring," he said. "I needed something to do. Distractions. TV. Computer. Definitely video games. Anything to keep my mind off of myself. Anything to keep me from thinking too much. Most of my [positive] moments were in the movie theater when I was focusing on somebody else's life, and then after the movie, I was like, 'OK, yeah. Back to my life.' "
Compounding his frustration, he watched his friends preparing to go away to college - something he had expected for himself just a year earlier. He had wanted to play college football.
"He's kind of a mellowed-out guy," said Matt Quayle, a Western Tech assistant football coach, "but the friends he does have, a lot of them went away to college, plus a couple of them were getting in football shape, too. It was just tough for him."
When Mason-Hale returned to Kennedy Krieger in late August for outpatient therapy, he was surprised to discover that he had made small but significant improvements.
"I saw stuff that I really hadn't noticed," he said, "because for me, it's always hard to see improvement where I am, as opposed to other people looking in."
Both arms had gotten stronger. The fingers on his right hand could move closer to making a fist, and he could spread that pinkie away from the other fingers. He also had a little more movement in his right leg.
"He has plenty of positives because he has recovered that nicely even without having a true home therapy program since March," Becker said.
"This is something his body did under the least-optimal conditions. I told him, 'You don't even know how much potential you have until you actually start using it.' I think by deploying the whole activity-based program in his home, he could be so much better."
Mason-Hale said he is more motivated to work at home now that his latest stint at Kennedy Krieger has ended.
"Physically, I'm definitely stronger, and I'm more independent than I was before. I can do more for myself, and I don't have to rely on others as much. Just not feeling as needy helps me feel a lot better," said Mason-Hale, who has an easier time transferring from his wheelchair to the car or his bed.
His mother, Aliecia Mason-Hale, said getting back to work at Kennedy Krieger helped her son physically and psychologically.
"He's much perkier," she said. "What I love is they're definitely encouraging him to be much more independent and even in some cases to take charge of some of his well-being, which I appreciate because I'm overwhelmed sometimes."
Keeping up his workouts should be easier this time, too. His parents encouraged him to keep up with the workouts during the summer, but it was difficult. In addition to struggling with the muscle spasms, he could not have all the equipment he needed at home.
The family's 1930s-era house in Windsor Mill needed renovation, not just so Mason-Hale could get into the bathroom and the kitchen in his wheelchair, but also to upgrade the electrical wiring to handle additional therapeutic machines. Mason-Hale also has hope for new medication to ease the muscle spasms. The exercise he has been doing at Kennedy Krieger has cured the nausea and alleviated the dizziness, which Becker said were exacerbated by inactivity.
"It's a kind of vicious cycle that you get into," Becker said. "He's had problems getting upright because of his involuntary nervous system not working correctly, and then what people do, they abandon that type of activity ... but if you don't challenge that system, it will get worse - to the point that he couldn't do it at all."
As part of his therapy at Kennedy Kreiger, Mason-Hale has been swimming and pedaling a Functional Electrical Stimulation (FES) Bike, which electrically stimulates the nerves in his legs. He hopes to get one to use at home now that his outpatient therapy has ended for the year.
"The electrical stimulation helps my legs push through the cycling motion," Mason-Hale said. "It's motion, but I can't exactly do it on my own. Before, the bike would only push me because I didn't have anything, but now I can help push more. I can't start it myself, but once I get started then I can do it."
Mason-Hale, who graduated from Western Tech with his Class of 2009, keeps in touch with his former teammates via unlimited text messages. He also gets regular visits from the Wolverines coaches, including Quayle and head coach Alan Lagon.
Last spring, the coaches, along with others in the Western Tech community, held a fundraising bull roast and raffle that brought in about $15,000 for the Mason-Hale family, which has medical insurance but will have to absorb some of the cost for Chris' care as well as for renovating the house.
Quayle said another fundraiser likely will be held next spring - perhaps a golf outing.
In the meantime, Mason-Hale is feeling better about his future. He went to the Wolverines' homecoming game Friday night at CCBC-Catonsville, where he has begun the process to enroll in classes for next semester. He also said he wants to volunteer to work with children at Kennedy Krieger.
"Every time I go over and see him, he's smiling and he's upbeat," Quayle said. "It inspires you to see someone who was hurt like that be able to bounce back the way he did and not dwell on it."
For Mason-Hale, the hard work continues, and the prognosis is good. Becker said he expects further improvement in his hands and more control over moving his trunk forward and backward. He also said there is hope that he could walk again.
"In the future, it's possible to get motor function back in his lower extremities, and if that occurs, we could get him into a walking program at least with braces. Overall, nothing is impossible."
He added that just because improvements don't come quickly doesn't mean they never will.
"The recovery from spinal cord injuries is a lifelong process," Becker said. "It never stops, and that's something that's really important to explain to our patients, because there's this theory in the community that certain thresholds are set: If you haven't recovered in X amount of months or years, that's all you're going to get, and this concept doesn't apply. The nervous system constantly repairs."