Troops With Traumatic Brain Injury Face Long Road to Recovery

July 31, 2010 -- Army Ranger Cory Remsburg was thrown like a rag doll into an Afghanistan canal Oct. 1 by the blast from a 500-pound roadside bomb, the right side of his head caved in by shrapnel.

After a medical evacuation and six surgeries at military hospitals in Afghanistan, Germany and Bethesda, Md., Remsburg arrived at the James A. Haley Veterans Hospital here in November in a vegetative state.

Doctors, therapists, family and friends rallied to help with Remsburg's therapy. They massaged joints, stretched limbs and exercised muscles. They stimulated him with drugs, aromas and episodes of the TV comedy Scrubs. They questioned, commanded and cajoled — anything to jump-start his brain.

Progress came by inches, his family rejoicing over every success: "Those baby blues are looking very good," they wrote in an online journal about his open and alert eyes.

More than three months after being pulled from the water of the canal, Remsburg, 27, had emerged into consciousness. On Jan. 13, doctors said he was officially awake. Remsburg's reawakening is one of several unexpected developments being documented at four special Department of Veterans Affairs "emerging consciousness" programs here and across the nation. Brain-damaged patients reduced to vegetative states by illness, accidents or wounds are waking up.

This is not the stuff of Hollywood movies, where a stricken soldier suddenly sits upright in bed and begins chatting with his family. For Remsburg and dozens like him, the emergence into consciousness takes place over painful, frustrating weeks and months.

Yet the VA reports nearly a 70 percent success rate at seeing once-comatose patients return to consciousness at the centers — here and in Minneapolis, Richmond, Va., and Palo Alto, Calif.

Of 97 troops or veterans admitted to these centers between January 2007, when the Emerging Consciousness program became fully operational, and the end of 2009, 67 have awakened, says David Cifu, VA national director, Physical Medicine and Rehabilitation. Two of those were soldiers brought in from overseas battlefields — Remsburg and Sgt. Tony Senecal.

For decades, doctors have considered patients in a coma or a vegetative state to be among the most confounding medical challenges because science provided no proven treatments for helping them regain consciousness. Even more frustrating, a recent study has uncovered brain activity behind the veil of listlessness. But the question remained — how to tease it out?

War offered an answer. A massive infusion of medical research money bankrolled VA plans to concentrate more medical staffers, more time and more cutting-edge therapies on troops with these severe brain injuries. The awakenings have infused this narrow field of medicine with hope, says Joseph Giacino, director of rehabilitation neuropsychology at Spaulding Rehabilitation Hospital, Harvard Medical School.

"They [the VA] are in an excellent position to further advance the science," Giacino says. He and others believe this will focus additional research on more effective ways of nursing damaged patients back to consciousness, with payoffs beyond the military.

The nearly 70 percent VA success rate "certainly is above the national norm in the private sector," says Jonathan Fellus, director of brain injury rehabilitation at Kessler Institute for Rehabilitation in New Jersey.

A review of 11 studies in the private sector showed the highest recovery rate for comatose patients was 54 percent; in five of those, recovery rates were lower than 10 percent. Cifu and VA colleagues say they need time to understand the reasons behind their success, and the role of their concentrated focus on physical and communication therapies, drug stimulants and intense monitoring.