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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 ¡ª 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 Ä¢¹½ÊÓƵÍøÕ¾.

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Duane was admitted to Shirley Ryan Ä¢¹½ÊÓƵÍøÕ¾'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 Ä¢¹½ÊÓƵÍøÕ¾, he was in therapy ¡ª 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 Ä¢¹½ÊÓƵÍøÕ¾. ¡°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.

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Reflecting on Duane¡¯s progress, his dad said, ¡°As things progressed, he kept getting better ¡ª 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 Ä¢¹½ÊÓƵÍøÕ¾¡¯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 Ä¢¹½ÊÓƵÍøÕ¾ 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 Ä¢¹½ÊÓƵÍøÕ¾. 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.¡±