Helping traumatic brain injury patients reconnect to the world

Severe brain injury can lead to what’s known as a disorder of consciousness, which is when a patient is not awake or aware enough to physically interact with their environment. As a result, many of these patients are simply sent to a long-term acute care hospital, skilled nursing facility or nursing home after they are stabilized or considered out of immediate physical danger following their initial injury. This leaves families with little hope and patients with a reduced chance of full recovery.

Yet there’s a better way.

Through the Ohio State Disorders of Consciousness Program, 70% of our traumatic brain injury patients since 2017 have emerged to consciousness following our treatment and rehabilitation. Our program is successful because we work with patients who have been injured within the last year, and our team of skilled therapists, nurses and doctors are trained to provide early treatment for patients with numerous resources and unique therapies.

Understanding different disorders of consciousness

Following brain injury, a person may be in a reduced level of consciousness lasting days to years.

In a coma, eyes remain closed, and there is no apparent activity or clear difference between being awake or being asleep. A slightly improved level of consciousness is when a person wakes, opens their eyes and may have some unintentional movement, but is still not able to focus on anything or deliberately interact with their environment. This is known as a persistent vegetative state or persistent unresponsive wakefulness. There are also some patients who show signs of awareness and respond to verbal commands but cannot communicate. These individuals are considered to be minimally conscious.

Regardless of the consciousness level, there are ways to support improvement.

Emerging consciousness

Already recognized for comprehensive rehabilitation and specialized services — ranked No. 1 in Columbus and No. 31 in the nation by U.S. News & World Report — The Ohio State University Wexner Medical Center’s Department of Physical Medicine and Rehabilitation, along with founding director Sheital Bavishi, DO, introduced the Disorders of Consciousness Program in 2017 to provide life-changing care to patients from across Ohio and beyond.

The earlier we see a patient, the better. We accept patients suffering loss of consciousness from one month up to one year following their initial brain injury, and we’ve had patients transfer to our Dodd Rehabilitation Hospital from other hospitals, long-term care facilities, nursing homes or even their own family home.

We’ve found that our early, specialized rehabilitation may help people emerge and regain at least some degree of independence. The key is our personalized approach, coordinated treatment between each member of a patient’s care team and consistent daily therapy.

First things first: Confirming the right diagnosis

While it may seem that a disorder of consciousness and its cause should be easy to identify, the American Congress of Rehabilitation Medicine reports that up to 40% of patients in an unresponsive, vegetative or minimal state of consciousness are actually misdiagnosed.

There can be other causes of lost consciousness besides brain injury, so the medical experts at the Ohio State Wexner Medical Center will complete a full neurological exam to assess current response to stimulation, ability to follow commands and levels of attention and communication. We’ll also rule out any other conditions that could be responsible for the patient’s state. Some of the conditions that may be reversible or can be treated to minimize symptoms include hydrocephalus or buildup of fluid in the brain, ongoing seizures or even hearing or vision problems that impact how a person interacts with the world.

In addition, we’ll explore the side effects of any medications the patient may be on, including opioids for pain or others that may reduce alertness. We can then wean the patient off these medications or change to one with fewer complications.

Finding the path back for each patient

After we know the cause and degree of consciousness lost, we’ll develop a personalized treatment plan to support a return to consciousness and physical recovery.

While at Dodd Rehabilitation Hospital — named the No. 1 rehabilitation hospital in Ohio by Newsweek — each patient is placed on a structured schedule to help them develop a consistent routine. We’ll continue with preventive care to maintain muscle strength and healthy skin, bowels and bladder, and reduce complications, such as blood clots, pneumonia or spasticity. We’ll also work with other specialists at the medical center to treat any other medical conditions beyond the brain trauma and loss of consciousness.

Each patient has their own private room and quiet periods of rest, as well as different types of active rehabilitation to help them re-establish and maintain a stronger connection between their body and their brain. An assessment is performed every day to track progress, so we can adjust treatment as needed.

Physical therapists use state-of-the-art technology and the latest methods to help the body recognize familiar movements. Occupational therapists and speech therapists stimulate different senses, such as vision, hearing, touch and oral sensations, to help individuals connect and engage with their environment.

Every step forward is a step toward real improvement.

Empowering the caregivers

We take care of patient families and loved ones too, because we understand the stress they face. Each patient is assigned a case manager to help their caregivers navigate health care issues, coordinate any additional appointments and find appropriate services or medical equipment as needed, such as wheelchairs or communication technology. A social worker can direct family members to helpful community and government resources, and a psychologist familiar with the challenges of caregiving following a traumatic brain injury is available for ongoing mental health support.

Throughout the patient’s rehabilitation time at the hospital, we’ll also provide hands-on caregiver training, whether that involves use of a tracheotomy or feeding tube, safe transfer to and from a bed, additional rehabilitation or any other aspect of daily patient support.

Our goal is to get the patient home

People thrive when they're home with their families in a familiar setting and they have the love and one-on-one care needed to help them recover even further.

While each patient dealing with loss of consciousness faces a different path forward, there is every reason to believe the proven therapies available at Ohio State can help a patient return home. As already mentioned, 70% of our patients have regained consciousness. Let’s work together to see what’s possible for your loved one.

If you have questions or would like to confirm eligibility for the Disorders of Consciousness Program at Ohio State Wexner Medical Center, call 614-293-5275.