Photo of patient, Ian.

Ian is twenty–four years old and is an Acquired Brain Injury (ABI) patient at The Salvation Army Toronto Grace Health Centre (TGHC).

Ian was on his way home late at night on September 7, 2016, when, after exiting a bus, he was hit by a car while crossing the road. Ian sustained a traumatic head injury as a result of being thrown twenty-five feet.

The next morning the police were able to contact Ian’s mother, Bernice, who was already aware of the accident after coincidentally seeing it reported on the news.

When Bernice arrived at Sunnybrook Health Sciences Centre (SHSC), where Ian had been admitted, the medical team told her that her son had sustained extensive injuries. She was also told that Ian had already been in surgery for an emergency right frontal temporoparietal craniotomy (a piece of the skull – a bone flap is removed) for the evacuation of a subdural hematoma (a procedure to drain blood that has accumulated over the surface of the brain). Subsequently, Ian would also require a decompressive craniectomy where part of the skull is removed to relieve pressure and allow the brain room to expand without being squeezed. This neurological procedure also included the removal of a bone flap, which was not returned to its location after the procedure because it was far too damaged.

Ian was then placed in an induced coma for two and half weeks. This was done to allow his brain to rest and reduce swelling. Ian was in SHSC for almost eight months recuperating. There, as well as having to deal with the injuries he already sustained, he would face many medical conditions that would develop because of the severity of his acquired brain injury.

A month after he had been at SHSC, Ian was moved to the neurological unit in the hospital. While visiting him there, Bernice noticed that Ian kept leaning to his left side and was unable to move that side of his body. She also noticed that Ian was developing a bulge on the right side of his head. The neurologist told Bernice the bulge was hydrocephalus — the buildup of too much cerebrospinal fluid in the brain. Normally, this fluid cushions your brain and provides basic mechanical and immunological protection. However, if there is too much, it puts harmful pressure on the brain. Ian would need to have the cerebrospinal fluid drained twice, the second time he developed meningitis.

For the duration of his stay at SHSC, Ian needed to have a tracheostomy tube (ventilator) to help him breathe and, because he was unable to eat food, he also required a gastrostomy-tube (feeding tube) to help nourish him. He was prone to infections with both tubes, and while he remained at SHSC, he developed pneumonia three times.

Despite all of the challenges that Ian faced during his stay in SHSC, Bernice believes the care the hospital provided was excellent, recognizing Ian’s recovery was protracted because his immune system’s ability to fight infections was compromised due to his acquired brain injury.

By the end of his stay at SHSC, Ian no longer required the level of critical care provided in an acute care setting. His neurologist as well as his social worker identified that Ian now required rehabilitation, and Bernice was given a list of rehabilitation health care facilities to visit. After her evaluation of these health care facilities, she chose to have Ian admitted to the TGHC.

Bernice said, “I chose the TGHC because the staff were friendly and understanding, and I could see immediately the quality of care and compassion Ian was going to receive.” She also said, “Jake the executive director of programs took the time to explain the ABI program and how Ian would benefit.”

ABI patients, including those with only moderate impairment, normally do not perform well physically, functionally or cognitively in the first year after their injury. During this period ABI patients are considered non-functional and may receive minimal rehabilitation. TGHC has developed a rehabilitation program for those ABI patients who no longer require acute care. Since the program began five years ago, the TGHC’s health care team has gained experience and proficiency in providing optimal care for ABI patients whose physical and cognitive level of disability requires a slower-paced rehabilitation approach.

Ian was admitted to the TGHC on April 18, 2017. Shortly after his arrival, Ian’s trach-tube (ventilator) was removed and Ian began breathing on his own. At this time, the rehabilitation health care team is working with Ian on his core muscles and the strengthening of his left side. As well, the team is also working with Ian on his fine motor skills, so he can become more functional and manage the activities of daily living such as bathing, washing and using the toilet. Lisa, Ian’s speech-language pathologist, is working with him on speech and communication, as well as eating, to help him transition from his feeding tube to oral intake.

The team’s goal is to continue to work with Ian to improve his overall physical functioning so that he can qualify for more aggressive rehabilitation. The TGHC’s program has had steady success in transitioning ABI patients from a slower stream rehabilitation to a high tolerance, low duration rehabilitation centre, where ultimately patients return to the community and in most cases home.

Bernice would ultimately like to take Ian home — back to Timiskaming First Nation Reserve in the Abitibi-Témiscamingue region of Quebec. “We would be returning to a simpler pace,” said Bernice, “because I want Ian to be comfortable and not to stress.” However, Bernice is well aware that before that can happen there are a few more procedures, and a lot more rehabilitation that Ian will require.

The signs are good: recently Ian’s neurologist noticed that Ian has made quite a lot of progress since May when he last saw him. But still more work is needed. Ian is scheduled to return to SHSC at the end of October for another hydrocephalus treatment.

“The health care team at SHSC,” said Bernice, “needs to see that his cerebrospinal fluid is completely drained and will not collect before they consider attaching a plate to Ian’s head.

Bernice believes choosing the TGHC was the right choice, saying, “When I need to leave Ian, I don’t worry or feel guilty, I know he’s getting excellent care here at the TGHC.

“What I want for Ian,” Bernice says, “is for him to remain at the TGHC until he is strong and steady before I take him home. In acute care it seemed he would make some progress and then there would be a set back. I want every step he makes now in his rehabilitation to be positive, and that he improves towards becoming more independent.”

“[At the time of the accident] he had moved to Toronto from the reserve to live with me, and worked part-time while going to school even contributing to the rent. He was very active, and I hope he can return to some capacity where he can function independently.

“You know we would argue a lot and butt heads, and he would challenge me — who would be crazy enough to miss that?”