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Background: The current body of evidence suggests that expectations, both positive and negative, may exert a critical and meaningful influence on treatment outcomes for patients with a variety of conditions. What is less clear is the magnitude to which expectations affect therapeutic outcomes as well as how outcomes may be influenced by changing patient expectations throughout an episode of care. Therefore, the purpose of this report is to highlight the value and malleability of patient expectations in the physical therapy management of an individual in a cardiovascular intensive care unit. Case Description: The patient was a 55 year old male who was admitted to the cardiovascular intensive care unit following aortic arch reconstruction with an elephant graft. During his initial evaluation, the patient demonstrated significant frustration, irritation, and resistance to physical therapy intervention. This initial negative mindset towards physical therapy was associated with potentially dangerous behaviors including self-removing his supplemental oxygen and impulsively moving prior to instruction. Outcome: Throughout his five physical therapy sessions, the patient exhibited a significant shift in his attitude and expectations regarding physical therapy. By the time of his discharge, the patient expressed a positive mindset regarding his recovery and reported how physical therapy was a bright spot in his day because he could see the functional improvements being made. Discussion: This case study suggests two potential lessons that can be applied. (1) Patient expectations may be malleable, particularly with proper patient education and continued encouragement (2) physical therapists should not let poor patient expectations deter or discourage them because patients can experience the benefits of physical therapy intervention, even in the presence of negative patient expectations.