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Brain injury: One teen's story
By Mayo Clinic staff
A car accident snapped Kirsten Jensen's left leg, fractured her pelvis, knocked out her front teeth and bounced her brain against her skull. The impact scrambled the connections that allow her to move, think, communicate and learn. When Kirsten woke up in the hospital, she couldn't walk or talk. She couldn't sit up by herself, or hold a spoon. She had forgotten how to comb her hair and brush her teeth.
Less than three months later, Kirsten was back in high school, studying algebra and making the honor roll — a distinction she'd never before accomplished.
"I never took time to study in ninth grade. C's were good enough for me," Kirsten said. "When I went back to school, I thought it was going to be really hard, so I worked really hard at it. Then I saw that I could get good grades if I study, so why not?"
Therapy to retrain Kirsten's muscles and brain was the key to her remarkable recovery.
Rehabilitation begins immediately
Anne Moessner, a clinical nurse specialist in traumatic brain injury, helped coordinate Kirsten's care at Mayo Clinic, Rochester, Minn. "Even if they're in a coma, patients can benefit from physical therapy. Their bodies still need to be moved. It helps keep them flexible," Moessner said. "Cognitive therapy should begin as soon as they're awake."
Kirsten had to relearn how to talk and read. "I would say things, but it didn't make much sense," she said. "I had to learn a lot of things over again, like where commas and periods go. They had to take me from a second grader's vocabulary to a 16-year-old's vocabulary."
Reminders often enough
Luckily, Kirsten didn't have to learn everything from scratch. "I rebuilt my pathways to that information. It wasn't like I couldn't remember. I just couldn't find it," she said. "When they'd show me how to do something, I'd go, 'Oh, yes! That's right!' "
The more automatic a skill has been, the easier it is to relearn. For example, therapists simply put a spoon in Kirsten's hand and helped her mimic the motion of feeding herself. "Using a spoon has a whole bunch of small behaviors involved with it," said Tom Bergquist, Ph.D., a neuropsychologist involved in Kirsten's rehabilitation. "First you have to recognize that it's a spoon. Then you must coordinate the movements of your hand and mouth. And then swallow properly. All of these skills originate in the brain."
Lost in a fog
In the very early days of Kirsten's rehabilitation, her body often seemed out of control. Suddenly, she'd be covered with sweat, for no apparent reason. Or her skin would itch so fiercely, all over her body, that she would scratch herself bloody. Sometimes her hands would have to be tied down so she couldn't hurt herself. "I told her parents that this part of it was much worse for them than it was for her, because she wouldn't remember any of it," Moessner said.
It's a common misconception to believe that people with head injuries recover as soon as their eyes open. But that's just the first step of a long process. "Being awake is a huge accomplishment. It's a lot. But there's so much after that," Moessner said. "Even if they're conscious, no new memories are being stored. In Kirsten's case, she was in a confused state for quite some time." This is evidenced by the fact that Kirsten can remember only three visits from friends and family out of more than 400 that occurred during her 53-day hospital stay.
"People can't understand why I don't remember them coming to see me," Kirsten said. "I talked with them at the time. Sometimes, we even went and did something together. But it's gone. I don't remember it at all."
Finding her way
Kirsten Jensen remembers very little of her hospital stay. Here, her grandparents visit her less than a week after the accident. Her blank stare and contracted right hand illustrate the starting point of her long road to recovery. A brain injury can affect how your body works, but the brain is also home to your personality — the part of you that makes you different from everyone else.
Some people experience such dramatic personality changes after a brain injury that they become strangers to their families and friends. In the hospital, David and Laurie Jensen looked into their daughter's confused eyes and hoped the girl they loved would find her way home. "She looked lost. She wasn't really there yet," David said.
"It was so scary," Laurie said. "The brain is unknown territory. And every child is different. Every child's recovery will be different." This uncertainty was the most difficult aspect of Kirsten's recovery. "The hardest thing was not knowing if she was going to get better," Laurie said. "I wondered if she was ever going to walk again. But the doctors didn't know. All they could tell us was that we had a long road ahead of us. And that it was going to be a marathon."
Step-by-step progress
During her hospitalization, Kirsten's rehabilitation began with basic self-care, such as standing, walking, dressing herself, feeding herself, taking a shower, using the toilet. "When she first started dressing herself, she'd put her underwear on over her clothes," Laurie said. "The first time she took a shower, she just stood there. When I put the soap in her hand and showed her how to do it, she started screaming. But the next day, she did it all by herself."
A kindergarten teacher, Laurie wept the first time Kirsten tried to write her name. "It looked like it did when I taught her how to write her name when she was 3 years old," Laurie said. "The S was backwards and everything. It was heartbreaking. But she went from writing her name to reading novels in two months."
Unusually rapid recovery
Kirsten's rapid recovery was anything but typical. In fact, it was exceptional. Some people with brain injuries never recover well enough to regain their independence and take care of themselves. "Most end up in the middle, recovering well enough to lead productive lives in their own homes," Moessner said. "If given enough time, support and therapy, most people make a significant recovery. But they need to dig in for the long haul. It usually takes a while."
High school as therapy
In contrast, Kirsten went back to school less than three months after the accident. "We gradually started back, with just one hour a day, and then two and then three," Kirsten said. "School was a type of therapy for me. My therapist wanted me to take a math class, so I took algebra. I got a B in it. I made the honor roll that quarter."
Although Kirsten regained her self-care skills after her injuries, certain memory problems have lingered. It's much harder for her to learn new things. She's also more easily distracted, so multitasking requires extra mental effort. "People who have had brain injuries learn to compensate for things that aren't working so well," Dr. Bergquist said. "One example is using a day planner. They develop the habit of writing things down so they can remember to pay the bills and take their meds. They keep their lives in these books." For students such as Kirsten, compensating in the classroom might include sitting in the front row, recording lectures and discussions on tape or taking tests in a quiet room.
Fully Recovered
A year after the accident, Kirsten's parents describe her recovery as "miraculous." "There came a point where I decided she was all the way back," Laurie said. "Then a month later, I was like: 'No, now she's all the way back.' And then a month later, I see even more improvements. It still keeps happening. We still see changes, especially in her maturity levels." Kirsten laughed and shot back, "Well, I'm not done growing. I'm going to keep changing and getting more mature."
Dr. Bergquist explained that it's hard to tell if some of Kirsten's behaviors are due to her head injury, or if they're merely a product of being a normal teenager. "I'm inclined to believe Kirsten is different than she was before the injury. But it's hard to tell what causes these differences, especially in teens," Dr. Bergquist said. "Is it the head injury? Is it the realization that she could have died? That could make a person more serious or less serious. Just going through the experience she's had would make anyone different."
Kirsten wants to use her experience to help others.
"Coming back from something like this takes hard work, there's no doubt about it," she said. "I want to go to a four-year college and maybe work in the health field someday, where I can use my head injury and the accident to help people — maybe as a counselor."
She and her parents have spent hours talking to other families in similar situations. Her advice to parents is to keep their spirits up and to not lose hope. "Your child needs to see you strong and confident that they're going to get better," Kirsten said. "Without my family's support and that of my friends, I would not have recovered so quickly. They all had a positive attitude, every single one of them."
Reprinted with permission. © 1998-2005 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.