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When a motorcycle accident left Duane D., a young mechanic, comatose with a severe traumatic brain injury (TBI), his future became uncertain.
“He got into some gravel, went off the road, and tumbled about 250 feet,” said Duane Sr., his father. “He had no other internal injury — not even a cracked fingernail. The brain took the entire impact.”
After doctors told Duane’s parents of his critical condition and offered little hope, Duane Sr. pushed for his son to go to Shirley Ryan AbilityLab.
Treating the Most Severe Brain Injury Cases
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Duane was admitted to Shirley Ryan AbilityLab's Amicous® Program, which treats disorders of consciousness (DoC). It is one of the few programs in the country designed to support patients with brain injury who are in a minimally conscious or “persistent vegetative/unresponsive wakefulness” state.
“From day one at Shirley Ryan AbilityLab, he was in therapy — Saturdays, Sundays, seven days a week. But there were no guarantees; everyone’s brain injury is different,” said Duane Sr.
A traditional rehabilitation program requires patients to be able to actively participate in three hours of therapy a day and follow commands consistently. However, such engagement is not often possible for patients with disorders of consciousness who have trouble following commands.
“With this understanding, we engage these patients in different ways,” said Sangeeta Driver, MD, MPH, chief of brain injury medicine at Shirley Ryan AbilityLab. “We leverage a combination of physical medicine and rehabilitation, sensory stimulation, and neuromodulation to help them progress.”
To determine patients’ level of consciousness, Dr. Driver also leads interdisciplinary clinical teams in comprehensive evaluations. Physicians conduct neurologic evaluations while physical, occupational and speech therapists conduct functional assessments.
“We conduct these evaluations multiple times a day over the course of multiple days because we know that patients with brain injury are going to fluctuate in their presentation day to day and even minute to minute,” said Dr. Driver.
Additional goals of the program include advising on medical stability for continued care; optimizing a patient’s medication regimen; and educating patient families and caregivers about their loved ones’ conditions and ongoing care, including their medical equipment needs.
Eyes on Emergence
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Reflecting on Duane’s progress, his dad said, “As things progressed, he kept getting better — taking his first step, speaking. He had none of those functions when he arrived. It gives you sense there’s light at the end of the tunnel.”
Patients who progress and emerge from a disorder of consciousness can transition into Shirley Ryan AbilityLab’s traditional inpatient rehabilitation program, which entails therapies focused on higher-level tasks.
Duane was able to pursue this path. He completed the inpatient program at Shirley Ryan AbilityLab before transitioning to the hospital’s DayRehab program. In the process, he was able to regain independence with physical functioning and reestablish meaningful relationships.
“It only takes a second to change your life forever,” Duane Sr. said. “It’s incumbent upon us as parents to give our kids every opportunity for a full recovery, and that’s why we fought to get Duane to Shirley Ryan AbilityLab. Dedicated, loyal therapists, PCTs, nurses and doctors must have seen something in him and they didn’t give up. Because of that, he’s where he is today.”
Duane’s story is not an outlier.
“I have seen patients who, based on their imaging and diagnosis, were told they weren’t going to progress,” said Dr. Driver. “Yet, after intensive rehabilitation, they’re able to go on and live very meaningful and fulfilling lives. My intent is always to instill hope and to give every patient the best chance for recovery.”
