Fifty-year old, R.K. had been described by friends as the "queen of multi-tasking," prior to her motor vehicle accident in July of 2003. Not only did she have a full-time job as a middle school teacher, but she also spent much of her time engage in painting, quilting and other craft activities.

On July 8, 2003, R.K. and her husband were traveling when their SUV blew a tire, causing their vehicle to roll several times. R.K. immediately lost consciousness and extrication from her vehicle was prolonged. She was transported to the emergency room via ambulance where she was diagnosed with a severe traumatic brain injury, as well as, multiple fractures in her thoracic spine. She was placed on a ventilator and subsequently a tracheotomy was performed. Additionally, a shunt was placed in her brain to drain off excess fluid. She was unable to eat, so nutrition was provided via G-tube. Confusion leading to agitation were noted and she was not able to follow verbal commands. R.K.'s life as she knew it had completely changed.

Approximately one month after her injury, R.K. was admitted into an acute rehabilitation center where she received treatment for 4 months before being transferred to a sub-acute care facility. Although, she was able to walk for 50-75 yards with a walker and assistance, she was not able to complete activities of daily living. She was incontinent of bowel and bladder, had sleep disturbances, and continued to have episodes of severe agitation in which she would bite, scratch and kick at staff. Medications were given for severe agitation and insomnia. However, these medications did not seem to be effective. Other difficulties that R.K. experienced were tangential speech, inappropriate responses, repeating what others said, confusion, lack of appetite, and difficulty remaining on task.

After five months of acute and sub-acute rehabilitation, R.K. was discharged home with her husband and daughter. She was not independently able to care for herself and required 24-hour supervision. Difficulty with balance and being easily distracted caused R.K. to fall occasionally and thus created a fear of falling when walking and transferring between standing and sitting positions. Although she engaged in outpatient physical, occupational, and speech therapy, progress was hindered by agitation and aggression. Approximately 10-20 behavioral outbursts were noted per session of therapy.

In March 2005, R.K. was admitted to Centre for Neuro Skills® (CNS) in Bakersfield, CA. She still had a G-tube because she refused to eat enough to receive adequate nutrition. She loved Cheerios and many times this was all that she would eat. Incontinence was still an issue and a bowel and bladder program was started to assist her in achieving continence. At the CNS, R.K. was engaged in five hours each day of intensive therapy addressing physical, occupational, speech, counseling and educational concerns. After daily therapy at the clinic, she returned to a residential program where she was challenged to cook, clean and engage in regular activities of daily living by the residential staff that assisted her.

Behavioral outbursts were an issue that had not been successfully dealt with in the acute or sub-acute care settings. However, at CNS, these issues were explored and a behavioral modification program was implemented. Crying, screaming, refusing to engage in therapy, grabbing at staff and being impulsive were target behaviors that required staff intervention.

R.K. worked hard in therapy and attended a structured, intense rehabilitation center that was able to meet her needs. She was a different person than when she first entered the program. Over the course of treatment, she progressed from using a wheelchair, to using a walker, to walking without any assistance. Continence of bowel and bladder was achieved. Her G-tube removed and she was able to eat a normal diet. After engaging in intense visual therapy, R.K. was able to begin painting again. Consistent and challenging cognitive treatment resulted in improved orientation, memory and attention. Perhaps the most remarkable improvement was with her behavior. Crying and screaming which used to occupy a large portion of her therapy sessions, were seldom observed. These behaviors were replaced with laughing, smiling and confidence.

After 6 months of intensive rehabilitation at CNS, R.K. was discharged home to live with her husband and daughter. Arts and crafts, an important hobby of hers prior to the injury, occupied her time, as well as, working in the library of the school where she once taught. R.K. began to resemble the person she was before the accident. In fact, she was able to be an active participant in her daughter's wedding without difficulty. To symbolize this new stage in her life, she renewed her wedding vows that day and danced with her husband.