Frazier Rehab Institute, part of KentuckyOne Health, is now among one of few facilities in the nation to provide specialized care to individuals with disorders of consciousness. The renowned, comprehensive rehabilitation center recently launched a new program called EMERGE to help individuals with a disorder of consciousness emerge and regain capabilities.
When a traumatic or non-traumatic injury to the brain causes a person to lose consciousness, as the person comes out of a coma, he or she may remain in a vegetative or minimally conscious state. This state is called a disorder of consciousness.
For many years, these individuals have been denied rehabilitation because it was felt they would never recover or emerge from this low level state.
“Historically, people in this state have often been thought not to justify rehabilitation care and have been sent to a nursing facility or home family care,” said Darryl Kaelin, MD, medical director, Frazier Rehab Institute. “Research has demonstrated that aggressive medical and rehabilitation care can improve both functional abilities and quality of life for these patients. At Frazier Rehab, we’re seeing examples of just that.”
The first patient admitted to the program at Frazier Rehab was Emily Holmes, 20, from Fort Campbell, Kentucky. Emily suffered a traumatic brain injury during a car accident in January 2013. After several weeks of care at University of Louisville Hospital, also part of KentuckyOne Health, Emily could not walk or speak.
She was transferred to Frazier Rehab to begin rehabilitation therapy in the EMERGE program. While being treated with medications to help her regain full consciousness, she began physical, occupational, and speech therapy.
Emily regained consciousness and while she continues to recover from severe brain injury, she has made tremendous improvements. Before going home to continue outpatient therapy, she was able to respond verbally with yes or no responses and demonstrate her sense of humor. Her memory and balance continue to improve, and she is more communicative. She can walk with assistance and is slowly regaining many of the skills she lost as a result of her injury.
Emily is a prime example of why programs like EMERGE are both necessary and successful.
The goals of the EMERGE program are to:
► Achieve medical stability
► Increase the patient’s level of responsiveness to allow greater participation in rehab
► Train families to provide the care needed for an eventual return home
Patients typically remain in the program four to six weeks. Once they emerge to a higher level of consciousness, they are transitioned to the facility’s acute brain injury program.
The EMERGE program utilizes the Coma Recovery Scale (CRS) as a tool to monitor improvements in patients with disorders of consciousness. The scale consists of 23 items addressing auditory, visual, motor, oromotor, communication and arousal functions that help physicians recognize even small changes in abilities.
One challenge is the ongoing education of payors about the benefits and success of programs like EMERGE. Since it is not common, many insurance companies are not familiar with this type program and may be hesitant to provide coverage.
Many times, through education and outreach, providers will allow patients to be admitted for a limited time and monitor results closely to determine if it will cover continued care. “If we feel very optimistic, we will negotiate for smaller amounts of time and hope to see improvements that convince the insurance company to let us keep patients longer,” Kaelin said. The program is cost effective for payors in that it improves the patient’s ability to function and decreases caregiver burden. In the long term, this reduces costs for care.
According to Kaelin, historically, programs such as EMERGE at Frazier Rehab have a success rate of 60 to 70 percent. “That says a lot about this level of rehabilitation for the patient and the families,” Kaelin said. “With the right rehabilitation, you can take someone who otherwise was given no hope and give them the life they had before.”