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.
"These numbers are higher than we would have expected," Cifu says, adding that prior efforts showed a rate "significantly less" than where it is now.
"So much has changed since 2006," says physician Shane Mcnamee, VA director of the polytrauma center in Richmond. "The level of knowledge and approach that you need [to help brain-damaged patients awaken] is not something that you can just unpack out of box."
They say two key factors helped. Because of the funding emphasis Congress has placed on treating traumatic brain injury during the wars in Iraq and Afghanistan, the VA has more money to spend.
The VA spent $34 million in emerging-consciousness treatment for 104 patients since January 2007, according to department statistics. Total staffing at the four polytrauma centers has expanded from 78 specialists such as doctors and therapists in 2004 to 255 today. And in-patients are allowed more time to wake up.
Private-sector programs rarely pay for special efforts to stir someone out of a coma, often pushing those patients into nursing homes, Giacino says. Those that do fund emerging-consciousness treatment do so for only about 30 days, and only if the patient shows steady improvement, Cifu says.
The VA usually gives these patients up to 90 days to emerge from a vegetative state. Family homes or nursing homes outside the VA are commonly the alternative for those who do not emerge.
The department also makes it easier for relatives to help their loved ones, assisting with moving the patient out of bed, or massaging and stretching limbs, all things vital to recovery. Social workers arrange free travel to and from the VA hospital through charitable donations. Free long-term housing and child care is available.
Cifu cautions that emergence is only a start. Years of painful rehabilitation and the prospect of severe disability lie ahead.
"Some return to relative normalcy in terms of walking and talking," he says. "Most continue to have some difficulty with normal day-to-day functioning, but have improved to the point where they could return to the community [and], for the most part, to their homes."
"I want to be independent," Staff Sgt. Remsburg slowly types on a bedside keyboard in an interview.
Remsburg was on his 10th deployment to war when he was wounded. Special operations soldiers such as Remsburg go to war more often than traditional troops but for shorter periods.
He had led a Ranger squad into combat that night of Oct. 1 on the outskirts of Kandahar, killing nine insurgents. Afterward, as the soldiers walked to where a helicopter would meet them, a roadside bomb detonated, says Col. Brian Mennes, Remsburg's former battalion commander.
Sgt. Roberto Sanchez, 24, was killed. A second Ranger's left leg was severed below the knee, Mennes says.