The Frazier Rehab Institute Disorders of Consciousness program is called the EMERGE program. The EMERGE program is designed to provide comprehensive care for patients with severe traumatic brain injury (TBI) who are at low levels of consciousness. Severe brain injury causes changes in consciousness. A low level of consciousness means there is little awareness of the self and of the environment.
Research evidence supports getting patients with severe TBI mobile as quickly as possible after injury. The EMERGE clinicians’ approach is to help patients stand on their feet achieving good upright and midline posture and bearing weight on their joints shortly after admission to Frazier. The team provides various forms of arousal and stimulation to the auditory, visual, tactile, taste, and smell senses. These methods have been found to promote brain recovery.
The EMERGE team coordinates care to prevent secondary complications, such as skin breakdown, contractures of the muscles, and infections. A patient in a reduced or minimally conscious state is generally immobile which carries a risk for such complications.
The EMERGE program team is also knowledgeable of best practices in use of medications and assistive technology to maximize arousal, alertness, response consistency, and mobility. Nutrition is a key to a recovering health. Patients will arrive at Frazier taking tube feedings. Ice chips and small sips of water are generally offered to the patient to promote swallowing which is a basic human activity that can be restored fairly quickly in many cases.
Frazier’s EMERGE program is led by Frazier Medical Director, Dr. Darryl Kaelin, who is a nationally recognized expert in brain injury rehabilitation. Dr. Kaelin has published and lectured extensively in the areas of traumatic brain injury outcomes and approaches for increasing awareness and improving cognitive function in patients with TBI. Dr. Kaelin works closely with the EMERGE program team on the care of each patient. He leads weekly team conference, rounds with the families, and meets with the team and the family for planning meetings.
Frazier’s EMERGE program also offers group brain injury education and support as well as individualized family teaching sessions. Families will learn throughout the rehab stay how to provide the care that will be needed at discharge. This could include medication management, nutritional management including tube feeding if needed, bowel and bladder care, safety management, skin care, respiratory care, diabetic care, transfer training, and cognitive stimulation.
As the patient emerges into consciousness, confusion and disorientation are usually experienced. However, the patient is typically able to participate more actively in rehabilitation. The team will continually upgrade the patient’s treatment plan as the patient changes. The patient will leave Frazier with plans for further rehab. Frazier has a specialized, day treatment program for brain injury patients, the NeuroRehab Program. Research evidence supports a comprehensive day treatment program as the most effective form of cognitive rehabilitation which is critical for people who experience a severe brain injury. Some patients benefit from receiving home health rehab therapies prior to starting intensive outpatient rehab.
Frazier’s EMERGE program has achieved an 85-92% rate of emergence into consciousness since its inception in January 2013. The EMERGE clinicians and families have been a great illustration of teamwork that has led to these outstanding results. In the EMERGE program we are inspired each and every day by the heroism of our patients and their families. This is a rigorous journey for the patients and their loved ones. We are fortunate to serve in the EMERGE program.