Vol. 20 • Issue 12
• Page 10
After bidding farewell to his friends at a local watering hole in Collingswood, NJ, Brian Hickey set out on foot to catch a train home to Philadelphia. It was the day after Thanksgiving and Hickey, 35, was wondering whether his wife would still be awake when he got home.
That's the last thing Hickey remembers.
Hickey was struck by a car reportedly traveling more than 15 miles per hour above the posted speed limit. The reckless driver never stopped, leaving Hickey for dead on a dark, cold street.
Within moments, a local resident called 911 when his dog began barking in response to the loud braking sound from the collision. An ambulance transported Hickey to the Trauma-ICU unit at Cooper University Hospital in Camden, NJ, where he remained in critical condition for more than three weeks after undergoing bilateral decompression to relieve the pressure on his brain.
Dealing with the after effects of an eight-day coma, he was discharged to Magee Rehabilitation Hospital in Philadelphia, PA. In addition to a traumatic brain injury/cerebral contusion, Hickey entered Magee with a subdural hematoma, subarachnoid hemorrhage, two broken vertebrae-T7 and T9-and a crushed shoulder cap.
As a result of the calamities of that dreadful evening, Hickey finds himself among an all-too-common demographic of young, healthy males who have incurred a traumatic brain injury. According to the Centers for Disease Control and Prevention, males are about 1.5 times as likely as females to sustain a TBI. The leading causes of TBI are: falls-28 percent; motor vehicle-traffic crashes-20 percent; struck by/against events-19 percent, and assaults-11 percent.
Patients with TBIs notoriously recover at different rates, and Hickey can be counted among the very fortunate. "Brian's speedy recovery could be from multiple things such as his young age, activity level prior to his injury, family support or his motivation," explained Susan Esposito, PT, DPT, of Jefferson Health System's Magee Rehab Hospital.
Pen to Paper
Soon after arriving at Magee on Dec. 18, 2008, Hickey-a prominent Philadelphia-based journalist-discovered that he had lost his ability to even write out the letter "B" with a pencil. "My biggest fear was not being able to write an article," he shared.
This would be a difficult pill for anyone to swallow. But Hickey isn't just anyone. A Mensa member, Hickey possesses a strong sense of humor and an even sharper wit. To say he has strong opinions would be an understatement.
Not being able to communicate his thoughts succinctly for Philadelphia and beyond would be a death comparable to the one Hickey had just narrowly avoided. He challenged himself to regain the ability to put a pen to paper so he could return to his craft-his profession.
Hickey worked closely with Amanda Gartland, OTR/L, to regain arm strength and movement until his writing became easier and more legible. "Considering that this was his vocation, it became a focus of ours and he continued to work on the task outside of therapy times," she shared.
The inpatient therapists were charged with the responsibility of returning Hickey home on a safe and independent level of function. Honoring his personal goals-such as writing-was on the agenda, but first they needed to get him up and moving.
Gartland and Joe Ferguson, PT, DPT, staff physical therapist, performed Hickey's evaluation on his first full day to identify his deficiencies. Gartland determined that Hickey was largely dependent for activities of daily living (ADLs) due to multiple injuries, spinal precautions and decreased cognitive abilities.
During his first few days at Magee, Hickey exhibited decreased arousal and could not engage in basic interactions. He was unable to sit up or get out of bed without maximal assistance and relied on facial expressions and hand movements to communicate.
Because he had left Cooper in a fragile state, Hickey needed constant reminders of where he was and how he came to be there. "I needed to be prompted about the date, day of week, time and other standard knowledge that comes easily to most people," he said.
His family's involvement became critical because they could follow through with suggestions made during treatment. "Brian's wife and father were there to help answer questions about how he had progressed at Cooper," Dr. Ferguson shared.
Hickey's wife, Angela Klem, is currently in nursing school. According to Dr. Ferguson, her training came in handy on more than one occasion. Brian's father, Dan Hickey, attended every therapy session, providing support and asking questions.
"Brian's family knew when to step in but also when to step back and let Brian do something himself," Dr. Ferguson explained.
Building Strength and Stamina
As an inpatient, Hickey received the requisite three hours a day of speech, occupational and physical therapy in group and individual sessions. The OT component focused on ADLs such as bathing, dressing, functional transfers and household mobility while PT mainly addressed balance, walking and car transfers.
The first time Dr. Ferguson worked with Hickey in the PT gym, a lift was used to transfer him to a mat to work on stretching his legs and sitting balance with support.
Hickey suffered a venous stroke during surgery that left him with a left head injury and limited mobility on his right side. Dr. Ferguson concentrated on teaching him how to engage his right side more.
Gartland focused on activities such as dressing that Hickey took for granted before his injuries.
"We addressed transfers to/from the toilet and shower, dressing with adaptive equipment-as was needed due to his spinal precautions-and increasing his range of motion and strength in his right upper extremity as he had a subluxation," Gartland explained.
Another of Hickey's personal goals-being able to throw the tennis ball to his 12-year-old Labrador retriever mix, Charlie Dawg-involved a combination of PT and OT. He needed to master standing and balance while throwing the ball with his weakened right side.
A Man of Motivation
As much as he came to respect and personally like the Magee staff, Hickey was motivated to return home. He attributes meeting this goal to the therapists' ability to push him and his willingness to succeed. But he had to dig deep to muster that drive. When he first arrived at Magee, he was completely uncooperative.
"I didn't want to do anything but lay in my hospital bed," he explained. "Once I walked for the first time, it registered that I could do it. I was determined from that point forward to listen to what they told me. I respected what the therapists knew and the training they'd had and I respected the facility's reputation."
Hickey had also progressed cognitively and emotionally-a tall order considering what he had been through. His PT and OT sessions were intense and frequently painful. All the while, his thoughts were becoming clearer and naturally he had a lot of questions about the accident.
Hickey forced himself to shut out the injustice that had happened to him and focus on the tasks at hand. "There were times I became agitated but I tried not to pout and let it interfere," he said.
Once he made up his mind, Hickey fully bought into therapy. "He followed the rules to a 'T' even though I have been told that he generally possesses a bit of stubborn streak," Dr. Ferguson explained.
Before he could be discharged, Hickey had to participate in a community outing so he could demonstrate his functional capacity and his ability to be independent. Hickey knew immediately where he wanted to go: to 7-Eleven to get a Mountain Dew Slurpee.
He figured out which direction to head in, navigated crosswalks and intersections, poured his own Slurpee and managed the money. He passed with flying colors. Hickey was headed home.
But first, the therapists talked with his family about the set up of his home-where he lives with his wife, dog and two cats-and the challenges it presents. He spent time mastering stairs because once home, he would face six steps to his front door and 12 steps to the second level of his home.
Hickey was discharged on Jan. 16, 2009, two weeks shy of the discharge plan outlined during his admission evaluation. "I was released more quickly than anyone predicted," Hickey shared. "My first week there was rough but beyond that, I discovered what I was capable of with each step I took."
Hickey was discharged on a "supervision" level for basic mobility activities, such as walking and navigating stairs, but was on a functional level cognitively. He was encouraged to do PT and OT exercises several times a day with hands-on help.
"Inpatient and outpatient TBI treatments look closely into cognitive and physical impairments and then tie them together to gain optimal functional independence," Dr. Esposito explained.
Dr. Esposito was Hickey's initial inpatient PT, and by coincidence, transitioned to the hospital's outpatient facility during his stay. Because Hickey had had a positive experience at Magee, he chose to continue his care-delayed a bit by insurance-at Magee Riverfront.
Dr. Esposito assessed Brian's current functional status and helped him return to the activities and function level he had prior to his accident. "I built a relationship with Sue during inpatient," Hickey relayed. "I respected her because she could get me to do things without objecting too much."
Hickey had six PT/OT/SLP sessions during a two-week period at Magee Riverfront. The PT mainly focused on strength and endurance activities, such as stretching and lunges, while including time logged on the treadmill and elliptical trainer. They worked on high level balance exercises, cardiovascular endurance, outdoor mobility and community reintegration.
When his outpatient therapy was complete, Hickey was sent home with an exercise program to maintain strength, flexibility and balance.
A Look at Today
In April, Hickey underwent surgery to replace the pieces of his skull that had been removed during the bilateral frontal craniectomy he had at Cooper for decompression of the brain from the accident. His neurosurgeon predicted a full recovery and his scars are healing nicely.
Brian progressed significantly in a short period of time and though he has made leaps and bounds since then, he is continuing to progress to this day.
"Joe thinks I recovered as quickly as I did because I'm young, relatively healthy and have no chronic health issues," Hickey shared. "But they err on the side of caution. Everyone with my injury recovers differently-you don't get better this fast without great, talented people taking care of you."
According to Gartland, the recovery process of any patient with a brain injury does not stop at acute care rehab, outpatient or home care therapies-rather, it is a continuing and ongoing process for many weeks, months or even years after the injury.
"Pieces of their "old self" and habits begin to emerge and though they may make a full physical recovery, the cognitive and emotional trauma wounds may still be very much present," Gartland relayed.
Hickey is in a routine now that includes regular writing and time set aside for exercise. Admittedly, he is hooked on Wii Fit and is not sure why it was not a part of his life until now. He is fascinated with the feature that estimates his age based on ability.
"The other day it told me I was 20 years old," he relayed while grinning ear to ear, perched on the balance board. "Today it said I was 35. I have my work cut out for me."
To date, the individual who struck Hickey has not come forward or been identified.
Rebecca Mayer is senior regional editor of ADVANCE and can be reached at firstname.lastname@example.org