The Legend of I.A.

Brain injury rehabilitation is hard work and no one knows that more than the clients that enter our program and the therapists who rehabilitate them. Occasionally, a client enters the rehabilitation program at Centre for Neuro Skills® (CNS) that has been so severely injured that the therapists wonder how they will rehabilitate this person to be less of a burden to their family, more independent, and how they will be able to give back this person a little piece of who they were prior to their brain injury. On these rare occasions the staff is reminded of one special client, I.A., that no one can forget. I.A. is an example of what determination and a great sense of humor can do towards achieving amazing results.

I.A. was admitted to CNS in Irving, Texas on September 15, 2004. CNS is a post-acute, brain injury rehabilitation program that works with clients to regain independence in all areas of living following a brain injury. Physical, occupational education, speech, recreation and counseling therapies are addressed at our clinical setting, while activities of daily living such as meal preparation, hygiene, laundry, cleaning and community re-integration are focused on at the residential apartment setting where our clients reside while participating in the rehabilitation program.

Many therapists and staff at CNS remember the day that I.A. was admitted into the program. He did not arrive in a car or via airplane like most clients arrive at CNS. Due to the severity of his contractures and the duration of the transport, I.A. arrived via ambulance on a stretcher. He was confined to a wheelchair, severely contracted, drooling, confused, unable to speak other than to moan or cry, unable to eat independently or take care of himself in general. He required 24-hour care, 7 days a week at both the clinic and the residential settings.

It is hard to imagine a once independent 46 year old, man now being dependent on others for the most basic activities of daily living. Certainly I.A. never expected that on June 4, 2004 while working on a roof that he would fall 20 feet and land on the concrete below him. Paramedics and other medical personnel never expected him to survive, based on the multiple injuries that he suffered as a result of his fall. Multiple internal injuries, rib fractures, a T9 compression fracture, basilar skull fracture as well as, right temporal lobe and occipital lobe brain injuries, were some of the injuries immediately diagnosed following I.A.'s injury. Additionally, I.A. was unable to move his lower extremities and experienced respiratory failure immediately following his fall.

During the course of his hospital stay, an intracranial monitoring bolt was placed in his skull to assess pressure within the skull cavity. Eventually, a craniotomy (removal of a small portion of the skull) was performed to allow for swelling of the brain and to remove blood that was trapped inside the surface of the brain.

I.A. was so confused and agitated that he had to be confined within a Vail bed (a cage-like apparatus over the top of a hospital bed) to prevent him from trying to get out bed and injuring himself further. Although, I.A. was now able to move his lower extremities, he had bilateral swelling that prevented him from being able to ambulate independently. As is the case with many individuals who are bed-ridden while recovering from injuries, I.A. developed deep vein thrombosis, or blood clots, in his legs that required an inferior vena cava filter to be placed within his heart to prevent a blood clot from entering his heart. I.A. was unable to eat independently due to swallowing difficulties, so a feeding tube was required to receive adequate nutrition. Bowel and bladder incontinence was an issue and he required a ventilator to breathe. Several infections complicated I.A. stay in the hospital.

Progress from I.A.'s injuries was slow and after being medically stabilized. He was placed in a long-term care facility where he could be managed since his wife was unable to care for him without significant help. After several months in this facility, I.A. was admitted into the inpatient program at CNS in Irving, Texas to transition to a more intense rehabilitation setting for those that have suffered a brain injury. This is the day when many therapists and staff wondered if they could do enough to help this man and his wife get back part of their life.

The process of rehabilitation had begun. Over the course of the next two years, this man spent five days a week at the clinic setting engaged in rehabilitation for his slowed processing speed, decreased memory, inability to focus, decreased problem solving skills, visual deficits, range of motion issues, balance and motor problems, swallowing issues, inability to speak, low endurance, decreased ability to cope with his disabilities, frustration, irritability, etc. After an exhausting day at the clinic, the residential staff at CNS worked with I.A. to increase his ability to perform grooming and hygiene independently, meal preparation, laundry, grocery shopping, interacting with others, etc. No one gave up on him, not his wife, his therapists, and certainly not himself. In many ways, I.A. tried to ease the stress and strain of rehabilitation by his incredible sense of humor. He could find humor in almost every situation and would frequently tell the staff jokes and funny stories to make the time pass faster.

Over a long period of almost two years, I.A. walked out of our facility and into his new home with his wife. It should be noted that there were no home modifications necessary, because I.A. was able to care for himself independently. Gone were the feeding tube, wheelchair, therapists to assist him care for his basic activities of daily living. All that remained was a slight limp, right-sided hand weakness and a great big smile. The legend of I.A. lives on in each and every client that comes to CNS. I.A. taught everyone that with determination and a sense of humor, anything is possible.