03/17/2026
Progress in neuro rehab isn’t always measured in steps or seconds.
Sometimes it’s measured in half points of courage.
I’m working with a woman who had a stroke last year. Physically she’s come a long way, but the biggest barrier right now isn’t strength. It’s fear of falling.
In the time I’ve known her, she’s had two minor falls without injury. But that fear has taken up a lot of space in her brain and in her body.
Today we worked on standing without holding onto anything. I’ve been trying to sharpen my motivational interviewing skills, so I asked her to rate her confidence with this activity on a scale from 0–10.
She immediately responded, “Zero.”
Not a 2.
Not a 1.
A big FAT ZERO.
I asked her to look straight ahead and stabilize her gaze on the picture on the wall. Then I asked her to shift her weight back and forth between her stronger leg and her weaker leg.
By the end of the session, she had increased her confidence to 0.5/10.
I jokingly told her, “Wow! You’re practically unstoppable now.”
But here’s the thing some clinicians, caregivers, and even patients sometimes miss: confidence can grow the same way strength does — slowly and incrementally.
Half a point matters.
Before I left, I wrote her a little summary and she listed tasks she had already completed that increased her confidence (DEPOSITS INTO THE CONFIDENCE BANK):
Closing the closet door while standing
Wiping dust from a table
That’s evidence her brain can’t argue with.
On the right side of the page, I left a column for withdrawals — events that shrink confidence. Our goal is to keep that column EMPTY.
I also asked her to reflect on the unsupported standing and identify strategies to increase her confidence to 1/10 in the next four days.
In physical therapy, we talk a lot about meeting people where they are.
Today she was at 0.5.
And honestly, that’s a pretty great place to start.
Progress in neuro rehab isn’t always measured in steps or seconds.
Sometimes it’s measured in half points of courage.
