In the movies, when people wake from a coma, they typically come to, blink their eyes a few times, then carry on with their lives as if nothing had happened.


The reality is, unfortunately, harsher than that, says Janice White, rehabilitation service manager in the traumatic brain-injury unit at St. Lukes Rehabilitation Institute here.


White, who has a doctorate in communications, works with patients who have suffered brain injuries, which can cause them to lapse into a coma following their injuries.


Recovery from that state is made in stages, which can take many weeks or months to work through, she says. While some patients will recover fully, others will display subtle differences in their personalities for the rest of their lives, and still others will have an even greater degree of mental or physical impairment, she says.


Whats more, the notion of living happily ever after following a traumatic brain injury can be pure Hollywood: Being out of work for an extended period of time, not to mention being saddled with high medical costs, frequently is devastating financially to a patients family, she says. And while the patient likely wont remember much of his or her injury and rehabilitation, they can cause enormous stress within a family, resulting in a divorce rate of more than 80 percent in families of brain-injury patients, she says.


Accidents seasonal


Traumatic brain injuries happen for a variety of reasons, which are somewhat seasonal, White says. In the summer and early fall, outdoor activities frequently are the culprits, she says; in the winter, its often auto accidents.


Nationally, the majority of such accidents happen to 18-to-24-year-old males, who tend to engage in riskier behavior, White says.


A common injury is called an acceleration-deceleration injury; it happens when someone is moving in one direction and that motion suddenly stops. Such an injury can involve a sudden impact to the head, but doesnt have to, and in some cases, the injury wont be evident on imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT), she says.


Nevertheless, the impact causes the brain to hit against the skull and bruise, and at the cellular level, things are disrupted, White says.


Patients initially are treated at an acute-care hospital, and some recover quickly and are discharged from there.


Others take longer to work through an eight-stage recovery process called the Rancho Los Amigos cognitive scale, and those patients typically end up at St. Lukes or another facility.


The first stage, coma, means patients dont respond to pain, sound, or sight, White says. Slowly, theyll begin to respond to pain and then to other stimuli, until they reach stage 4, where theyre more awake and active, and frequently, more agitated and even aggressive.


The brain-injury unit at St. Lukes, which has 16 beds, is far better able to handle stage 4 patients than an acute-care hospital, White says. Rooms can be adjusted to relieve environmental stimuli, and the ratio of nurses to patients is six or seven to one.


Stage 5 brings confusion, but by stage 6, patients start to become more aware of their surroundings, White says. They tend to start asking questions such as, Why am I here? and talking about issues that are important to them, such as their families, she says.


You get to know a lot about them at their core being because of whats important to them, White says.


Until stage 6, patients usually have no memory of whats happened to them since their accident, she says. Not so with their families, who have lived through the anguish of whether their loved one would die in the hospital, only to be confronted with the exaggerated behaviors of their recovery, she says.


Theyve really been through the wringer, White says.


Yet, a familys support is one of the most important determinants in the success of a patients recovery, she says.


Patients typically are discharged from St. Lukes at stage 6 or 7, and nearly 90 percent are discharged to their homes rather than to another care facility, White says. The average length of stay in St. Lukes traumatic brain-injury unit is 19 or 20 days, and the facility treats about 175 patients there a year, she says.


Follow-up therapy is offered at whatever level is appropriate to the patient, ranging from occupational and physical therapy to recreational therapy, which can help a patient engage in activities they enjoyed before their injury.


White says part of her job is to follow brain-injury patients after theyve left St. Lukes, while the patients and their families try to rebuild the lives they had before their injuries.


It can be a long process, and while you can predict they will go through stages, you cant predict the time associated with it, she says. The most important thing is to structure the environment for success, she says.