Thursday, March 11, 2010

Thinking of Courtney: Beyond well wishes

Like so many people, I'm poised to hear good news from Courtney's family and supporters any day now. But when? Will she be okay? How long before she wakes up, and what does a longer sleep stage mean for her recovery? I did some research.

If you read no further than this paragraph, read this: 1001 loving ways to help a patient, family, or caregiver. It gives wonderful advice. Novel readers may want to read Range of Motion, a wonderful novel of coma recovery by Elizabeth Berg. I read it years ago.

Facts and stats...
Stats on traumatic brain injury can be a bit scary. But the medical experts are quick to point out that each case is unique and progresses in  its own way, at its own pace.  "People with moderate to severe injuries have made remarkable recoveries" (
  • Doctors are saying that Courtney's fitness and age weigh heavily in her favor. It's true -- people under the age of 20 rebound miraculously, and patients under 40 years of age have a significantly  better long term prognosis than older folks, because their body is better at repairing the damage.  . Outcomes for older folks are not so great.
  • The outcome of a patient can be associated with their best response in the first twenty-four hours after injury. We don't have a lot of detail, but it's great that doctors are reporting small improvements at this stage. 
  • Pupil reaction, age, CT-defined brain lesions/injuries, and motor scores (on tests body reactivity) are strong indicators for recovery (see PLoS Med, 2008).
  • The majority of individuals who survive a period of coma eventually regain consciousness. Data from the Traumatic Coma Data Bank indicate that of 650 patients who experienced a vegetative state [note: I don't think Courtney is in this category] after a brain injury, only 14% were released from the hospital in a coma. And of those, about half had regained consciousness after one year's time. (from the Traumatic Coma Data Bank -- see for more)
  • Approximately 20% of survivors of severe TBI remain unresponsive for at least one month.
  • Annually 300,000 individuals suffer brain injuries severe enough to require hospitalization, with 99,000 resulting in a lasting disability.
Many equestrians have made remarkable recoveries from bad falls. Remember  that Darren Chiacchia was in a coma for about a week after his fall -- and despite dire predictions (e.g., he'll never walk), he is now competing every weekend. Everything I've read just confirms the frustration and mystery around brain injury and coma recovery -- there is so much we don't know.

    Lots of info at

    Prognosis of traumatic brain injury from

    More stats in The Diagnosis of Stupor and Coma By Fred Plum, Jerome B. Posner, chapter on Prognosis in Coma.

    Traumatic brain injury by Donald Marion

    Read about the Glasgow Coma Scale at The eye, verbal, and motor responses of a brain injury survivor 24 hours after the accident can indicate—to some degree—the eventual outcome. For example, a person with a best score of 3 to 4 24 hours following the accident is likely to die or remain in a vegetative state. Those with scores in the 11 to 15 range, on the other hand, have a high likelihood—close to 90 percent—of making an almost full or full recovery.


    1. I agree with you that we're hopefully awaiting good news and that there's certainly a lot more hope, these days, than there used to be for such injuries.

      I am glad, however, that we also have much better riding helmets nowadays than when we started riding! I'm also glad that I've modelled good habits for my daughter so that she never mounts up without her helmet in place. It's not a panacea, but every little bit helps!

    2. Praying for her and her family. Thanks for the information and the warning to use a helmet.

    3. Oh thank you so much for that information. She has been on my mind a lot in the past few days. Just the fact that is was not a rank horse, or an inexperienced rider really made me stop and think a bit. It was a clumsy movement the horse made, something that she really could not be prepared for short of just not stepping on the horse. I hope we hear more soon.

    4. A friend of mine from high school was recently in a horrific car accident and remained in a coma for over 2 weeks. Then, she woke up! It was a slow recovery and she was fortunately, a 24 year old college athlete. But she recently went back to work! And shes doing really well, coaching volleyball and all! So keep hoping.

      Thanks for the post Stacey. Informative as always!

    5. I know a trainer here who had head trauma from a horse. He was found laying unconscious in his arena. No one knows how long he was there before found AND he was unconscious for several days. When he did regain consciousness he wasn't really in the hospital all that much longer and I think it was not that long he was back to work. Well under six months, but for head trauma and being out like that, pretty impressive.

      My point is there's still hope! Even though she's still unconscious, full recoveries do happen.

      She's in my prayers.

    6. I found your blog through EntreCard. I live in the Lehigh Valley, too. I had horses before I moved to the area and I'm always interested to find people who write about horse-type things. This really is the good part of EC, finding blogs that you are really interested in.

      I'll definitely be following Courtney's story. I hadn't heart about it before I read your post.

    7. I hope all goes well, sometimes getting better comes in small hardly noticeably increments.


    8. Shay, which blog is yours? Greetings from eastern PA :-)

    9. My blog is

      On your most recent post, I had an Arabian that had a problem with his stifle that had similar symptoms. Of course, he was also nuts and would flip over backwards when I asked him to back up, so I'm not sure that he is a great example of anything other than how to break saddle trees.

    10. Very informative post.

      The stat about the 650 patients and 14% being released in a coma was really confusing. Were they sent home still in the coma and than half of them woke up? Did the other 86% wake up? What percentage did not wake up? I looked at and the stat was just as vague.

      One of my college professors was in a coma for three days following an allergic reaction to a rattlesnake bite (he studies timber rattlesnakes). He said that he awoke feeling very refreshed and with everyone around him completely distraught. He no longer handles the snakes while they are conscious.

    11. Val, I took that to mean of the total population of coma patients, 14% were released (probably to a nursing home or similar facility) while in a coma, and of those, half woke up within a year. which means that less than 1 in 10 are unconscious after a year.

      After reading what I read I wondered how Courtney's basic muscle responses and tone were (not that it's my business) but a recent COTH post said that she was holding her husband's hand (she's got a grip!) and here eyelids were fluttering. This is just wonderful news.


    Hi Guys, Your comments are valued and appreciated -- until recently I never rejected a post. Please note that I reserve the right to reject an anonymous post.