The Power of Care at Home: Maddie’s Story

Big brown eyes and a smile as wide as the pale pink bow in her long dark hair are what Julie Pickering sees each time she walks through the door.

Julie, a Home Health Care physical therapist with Forrest Health, visits five-year-old Madelyn “Maddie” Martinez each week. Maddie is always waiting, eager to see her friend, a modern-day Mary Poppins, arrive with a bag full of toys, especially the big orange bouncy ball tucked under her arm.

Pediatric home health providers are limited, particularly across the wide region Julie serves. For families like Maddie’s, having a therapist come to them isn’t just convenient, it’s essential. And it makes a world of difference.

Small for her age but overflowing with personality, Maddie has already accomplished a lot despite the obstacles she makes the best of. Much of her world moves with her in a small pink wheelchair.

“Her wheelchair has given her a lot of freedom,” Julie said. “She’s a quick learner and manages it really well.”

Though her arms are still too short to reach the spokes, Maddie propels herself by pushing on the rubber tires, which for now will work, and her independence is earned.

Maddie was born at 37 weeks with a rare genetic disorder. Julie has been part of Maddie’s journey since she was 11 months old and unable to roll over on her own. “She has come a long way since I first started seeing her,” Julie said. “We started with the very basics.”

Today, Maddie moves quickly and confidently around her home, turning corners and navigating spaces with ease. When therapy ends, she often rolls off to her room, sometimes to see what her young nephew is up to, other times to enjoy educational programs on her tablet. Whatever she’s doing, she’s smiling.

“I’ve really seen her progress over time,” Julie said. She visits twice a week, with sessions lasting 30 to 45 minutes depending on Maddie’s energy. “Some days she has more energy than others, just like us.”

During those sessions, what looks like play is actually purposeful, carefully designed work and exercise.

Julie and Maddie focus on building strength, improving balance, and practicing transfers - getting in and out of her chair or onto the couch. They also work on walking with two different walkers: a smaller U-shaped walker that encourages leg use, and a larger, faster one Maddie can power with her arms.

“It’s not as pretty, and she’s not as fast, but the goal is to get her to use her legs,” Julie explained. “With the bigger walker, she can really go.”

Therapy often begins with a choice – something as simple as a song.

Julie holds out her hands: Old McDonald on the left, Wheels on the Bus on the right.

Maddie chooses.

Soon, she’s seated on the bright orange ball, bouncing as Julie sings. In the background, her mother helps guide her hands through the motions. Maddie squeals with delight, working hard while having fun.

The wheels on the bus go round and round…

Laughter fills the room.

Other exercises follow. Maddie reaches into a bucket to pull out blocks, bending and stretching as Julie encourages her.

“I know it’s hard, but you can do it,” Julie says.

There’s clapping, encouragement, and quiet determination.

In another activity, Maddie reaches side to side to grab pieces of a toy cake, strengthening her balance and coordination. She favors her right side at first, then works to engage her left.

Every movement matters.

Maddie faces significant physical challenges. Hip dysplasia makes certain movements painful, and her spine and tailbone create additional discomfort. As a baby, she was born with severe club feet, and while progress has been made, continued therapy is essential to strengthen her muscles and improve mobility.

She is also non-verbal, but far from silent.

“She understands everything,” Julie said. “In English and Spanish.”

Maddie is bilingual, uses some sign language, and communicates clearly with those who know her. She can indicate when she needs something, when she’s tired, or when she’s ready to move on.

At home, she’s supported by her family, including her older sister, Genesis, who helps her learn and grow.

For Delmy Portillo, Madelyn’s mom, having therapy at home makes a meaningful difference.

“It’s much easier,” she said.

Maddie also receives occupational and speech therapy outside the home, but transportation and scheduling can be difficult, especially given her complex medical needs. She has a feeding tube, sleep apnea, requires oxygen, and has a weakened immune system that makes frequent outings risky.

“If she goes out a lot, she gets sick,” Julie explained.

Home health care helps bridge that gap. Home Health Care is life changing for many families who have children needing care, but would struggle to get to a doctor’s appointment or therapy with all the equipment that child may require. “There’s a lot to do to go to a doctor’s appointment or to therapy,” said Pickering. “For Madelyn to get therapy in the comfort of her own home, in a specialized setting she’s used to, and not have the burden to load up Madelyn, her wheelchair, oxygen, and any other equipment she may require makes all the difference for parents. Being in the home also allows the entire family to take part in the therapy sessions.

Through it all, Maddie remains what her mother describes simply as “a very happy girl.”

Even when therapy is hard, even when she’s tired, there’s still that smile.

And as she bounces on the orange ball, laughing at a familiar song, it’s clear that in this small living room, progress doesn’t always look like work.

Sometimes, it looks like joy.