Troops With Traumatic Brain Injury Face Long Road to Recovery

Remsburg was found face down, submerged in a canal filled with water. Bomb fragments had penetrated the right side of his head. Resuscitated but comatose, he began a long recovery that included two surgeries to remove skull sections and allow his damaged brain to swell, according to Mennes and Cory Remsburg's father, Craig.

In November, Remsburg was transferred from a Navy hospital in Bethesda, Md., here to Tampa, where family members began taking turns at his bedside -- Craig switching off with his wife, Anne, or Remsburg's mother, Karen Petersen, and her husband, Ken. Other family members have filled in as well. A small army of clinicians and therapists, working with members of Remsburg's family, began the task of helping the young Ranger reach consciousness. Over time, about 20 VA health care workers would treat Remsburg.

Craig Remsburg tracked progress on an online journal — Cory moving his lips, giving a thumbs up, tossing a ball, listening to country music, eating his first full breakfast, writing his name or reaching out from a wheelchair in the parking lot to touch his gray Ford F-150 pickup.

The VA therapists and doctors begin a steady process of pushing and pulling at the physical and mental limits of the patients. Beyond the daily kneading, stretching and exercising of hands, wrists, ankles, legs and arms as the patient lies prone, therapists also move Remsburg in and out of bed. For a time, he was strapped to a tilt table and pulled upright to a position that mimics standing. He is regularly lifted into a wheelchair — sometimes by his father — and wheeled outside into the sun. Splints are applied to wrist and ankle joints to prevent gnarling for lack of use.

During the awakening process, therapists tested Remsburg's cognitive limits with daily instruction in tasks — asking him to show his teeth, stick out his tongue, blink or close his eyes, or raise his eyebrows. Stimulants such as Ritalin; bromocriptine, used for Parkinson's disease; or Modafnil, a treatment for narcolepsy, were administered to galvanize the brain.

With each flicker of response, demands ratcheted slightly higher. "They know when to push and when to kind of let up on Cory," says his mother. "It's a balance of the drugs, and waiting, and pushing, and waiting. It's just like: 'Do a little bit of this and try something different.' "

Analyzing the Findings

"For many years, there was little interest in studying this population because they were viewed as hopeless," says John Whyte, head of Moss Rehabilitation Research Institute in Philadelphia and a leading researcher in the field.

New advances in imaging of the brain, stimulation drugs and tools to assess meaningful changes have offered promise, he says. The VA results are also a record of how many patients can recover, Whyte and Giacino say. However, they caution, the results need to be analyzed more to learn fully what the VA has accomplished.

For example, they ask, how many of the patients arrived at the VA in a minimally conscious state — a kind of transition between vegetative and fully emerged? How long were patients unconscious before emerging? The longer, the more impressive the result. How many patients might have awakened without the intensive emerging-consciousness program?

The VA plans to publish an analysis of its findings, Cifu says.

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