▲Hayden has regained his vitality after undergoing brain surgery and intensive physiotherapy.

10-year-old Hayden is a budding fencer who has won some district competitions. While preparing for a territory-wide competition, he suddenly lost mobility on his left side. He was found to have brain hemorrhage due to arteriovenous malformation. After brain surgery and months of physiotherapy, Hayden is eventually able to pick up his foil again and ready to shine.

A member of the school team, Hayden has been practising fencing since five.

One Saturday after cycling, Hayden said he was too weak to walk. His parents thought he was just exhausted and would recover after a good rest, but on the next day, he was unable to move his left side. X-ray taken at the A&E confirmed brain haemorrhage which damaged his nerves, and he was sent to the Paediatric Intensive Care Unit. His mother recounted, "Dr. Ho who is in charge of neurosurgery of the Hong Kong Children's Hospital had a video call with us that night. He explained Hayden's condition and told us about the need for surgery." Hayden was transferred to HKCH at 10:00 the next morning, and underwent a MRI scan at 3:00 p.m. to identify the location and size of the vascular malformation.

Hayden's mother said, "I remember the next day was Ching Ming Festival. Dr. Ho met us at the hospital to go through the surgery's procedures and risks. His explanation was very detailed and clear. We trusted the whole team and decided to go ahead. Everything at HKCH was so efficient, which left us no time to worry. Examinations were arranged upon admission, and the surgery was done the day after we met the doctor."

Minor arteriovenous malformations can usually be treated with minimally invasive surgery or radiation to shrink and embolise the affected area. However, Hayden had a significant lesion near the brain surface with hemorrhage, so surgical excision was required. The surgery lasted from 8:00 a.m. to 5:00 p.m. and his parents were anxious, "We kept an eye on the staff coming in and out of the operating theatre. Whenever we saw someone bringing in packs of blood, we would wonder if they were for our son's transfusion. We had a lot of racing thoughts."

The surgery was successful and Hayden was observed in the Paediatric Intensive Care Unit. When he regained consciousness, he was so curious about the devices around him. He even learnt how to monitor his own vitals, and notified the staff when he spotted anything unusual. His mother appreciated the compassionate visiting arrangement, "The doctors were very kind and allowed me to stay with Hayden all day long, which was a great relief."

Post-operation swelling in Hayden's brain had not subsided, and mobility on his left side was still limited. A combination of acupuncture and transcutaneous electrical nerve stimulation was applied to his muscles, and various exercises were arranged. His mother said, "Although the doctor had told us that the first three months post-surgery was the golden period of recovery and we were already prepared to arrange intensive physiotherapy for him, we didn't expect to see the physiotherapists so soon. Right after the surgery, they came to the ward twice a day for treatment, even during holidays. I was also impressed by how seamlessly the allied health teams coordinated their services. For example, when the physiotherapist assessed in the morning that Hayden's ankle was not strong enough and needed support, a prosthetist-orthotist came that afternoon to take measurements for making a foot brace for him."

▲Physiotherapist using transcutaneous electrical nerve stimulation to promote Hayden's recovery after the surgery.

▲Hayden started practising standing and walking using assistive devices after surgery, then switched to crutches.

Physiotherapists arranged progressive training based on Hayden's condition, starting with walking aids and then switching to crutches. His mother found the resilient side of her son, "He was told to walk three laps along the corridor before bed, but he added it to ten. Although he was getting slower due to tiredness, he did not grumble at all and insisted on completing all ten laps before returning to his room."

After discharge, Hayden returned to the hospital for physiotherapy every day and made satisfactory progress. The physiotherapist paid a visit to his school to ensure the campus was safe enough for his return. His father remarked that the whole process was beyond his expectations, "The therapist checked everywhere, from the school bus drop-off point to the classrooms, seats, lockers, stairs, corridors, sports field, hall and toilets. He also suggested the school to let Hayden use the elevator and sit close to the door." As for Hayden, he was delighted to be back at school and revealed that all his classmates wanted to take a look of his surgical scar.

▲The physiotherapist checking everything on Hayden's campus to ensure he could go back to school safely.

As Hayden's leg gradually got stronger, the therapists tailored different strength and core building exercises to prepare for his return to the fencing strip.

▲Hayden is recovering well and can take on more difficult challenges, such as this flashing light stepping exercise to enhance instantaneous response.

▲Making reference to fencing skills, the physiotherapist tailor-makes special training to strengthen Hayden's hand-eye coordination and balance.

The family was thrilled when the doctor finally gave Hayden a green light to play sports on his follow-up day three months after surgery, as MRI scan showed normal brain blood vessels and his wound had healed. His mobility had almost recovered as well. That means his hard work had paid off, and he could put on his fencing gear again. Hayden said, "I want to thank the doctors, physiotherapists and my parents. After going through this journey, I am not afraid of any difficulties and I can endure all kinds of tough training!"

▲The neurosurgeon asking Hayden to perform different actions to evaluate his recovery.

▲The family is grateful to the medical team for their care and Hayden finally gets a green light to practise fencing again.