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BRAIN INJURY:

Omar Al-Dhafiri's Story

Finding the Way Back with a Trip to Chicago

Omar Al-Dhafiri sustained a traumatic brain injury

Omar Al-Dhafiri and his
father traveled from
Kuwait for Omar's care
after he sustained a
traumatic brain injury

Omar Al-Dhafiri, 21, a citizen of Kuwait, was on his way home from getting the results of his final term in August 2006, when he was in a car accident that threw him more than 20 feet from the car.

Omar, who was studying for a degree in chemical engineering, was badly injured. The impact of the car ejected his body from the vehicle, and he skidded along the 115-degree pavement causing bad burns along his back. He was unconscious and extremely cut up on his face and body.

By coincidence, a family friend, who was also an emergency medical technician, was on that same road and helped clean up his face and applied first aid. Though he had known Omar for years, he didn’t recognize the young college student because of the severity of the injuries to his head and body.

Emergency crews arrived and took Omar to the hospital where they stabilized his neck and treated his burns. Six hours later, Omar’s family members, who had started to look for him because he was so late returning home, found him in the hospital.

"I did not even recognize my son," said Jarrah Al-Dhafiri, Omar's father. "Doctors told us that Omar had suffered a traumatic brain injury (TBI) and was in a deep coma. They said that his case was considered 'hopeless' and that he only had a 5% chance to live."

After a few days had passed, Omar had surgery to remove a piece of his skull to alleviate the pressure from the swelling of his brain. Though he was still in a deep coma, his condition had stabilized. Omar had a shunt put in his head to alleviate swelling and drain excess fluids, used a tracheotomy tube and ventilator to breathe and was fed through a tube into his stomach. After a month, he started to open his eyes.

"His eyes started to flicker. We prayed for him. His family, friends and relatives prayed for him and when my son opened his eyes; it gave us hope and we wanted him to have the best care possible," said Al-Dhafiri.

Finding New Hope

Though Omar had opened his eyes, he was still severely brain-injured and could not breathe, eat, communicate or move on his own. The Al-Dhafiri family searched the Internet for the world's best rehabilitation centers. They tried to get Omar admitted to hospitals in England, Germany and Washington, D.C. His case was refused because of the severity of his injuries.

Finally, Omar's case was accepted by the University of Chicago Medical Center (UofC) where Omar was to undergo a comprehensive assessment. Omar and his father flew from Kuwait to New York and then took a UofC air ambulance from New York to Chicago. It was at UofC that doctors referred Omar to the hospital ranked as the "#1 Rehabilitation Hospital in America" for 18 consecutive years: the Rehabilitation Institute of Chicago (RIC). Omar was admitted to RIC in October 1, 2006, for acute inpatient rehabilitation for his brain injury.

"We were so happy when he was admitted here. We wanted to do whatever we could to make sure our son got the best care," says Al-Dhafiri.

Making Progress

When Omar was admitted to RIC, he was at a level four out of 15 on the Glasgow Coma Scale, a measurement commonly used by clinicians to gauge the level of coma. Omar was alert but also restless. He displayed agitation. While he had begun to move his limbs, it was without purpose or control. Omar was not conscious, nor could he communicate.

Omar's rehabilitation included aquatherapy in RIC's pool.

Omar's rehabilitation included
aquatherapy in RIC's pool

His head hung down and his arms remained in his lap. He used a wheelchair in which his father or caretakers would have to push him around. He remained intubated with a tracheotomy tube to breathe and a feeding tube to make sure he was getting the necessary nutrition.

The day Omar arrived at RIC, his collaborative care team including his physiatrist, rehabilitation nurse, psychologist, physical and occupational therapists, and speech language pathologists met and spoke with Omar's father about his condition and the plan for his rehabilitation.

"Omar's team was very encouraging," said Al-Dhafiri. "His doctor gave me so much knowledge and answered so many questions for me. She changed my thinking about Omar's brain injury, and I felt very hopeful at that point."

Omar's physician immediately changed his medications to decrease Omar's risk of seizures and to increase his alertness so he could participate in therapy right away.

"Omar was very restless when he was first admitted," remembers Stacey McCusker, one of the physical therapists who worked with Omar at RIC. "He couldn't sit unsupported by himself and couldn't communicate because of his injury."

Stacy worked with Omar to begin to regain balance so he could sit in his wheelchair or on the bed and engage in activities. It took time, but Omar made great progress and soon was able to sit in his wheelchair and begin to move around.

Occupational therapists worked on stretching Omar's hands and arms and getting him to use them to communicate on a Dynavox, a computerized device that allows people to communicate by pressing letters or pre-programmed words or sentences, and eventually in helping to push his chair.

After a few weeks, Omar's tracheotomy tube was removed, and he was breathing on his own. Speech therapists then worked in building Omar's attention span by flipping through magazines, then by reading stories in magazines and eventually asking questions about the stories and asking Omar to use the Dynavox to respond. They also began to increase the sensation in Omar's mouth by brushing ice chips on his lips and eventually teaching him how to swallow liquids.

Patient Services and Family Education

And important component of any person's rehabilitation is his or her family's understanding and involvement. Al Dhafiri remembers how important family education was in the process.

"The care team was so knowledgeable about Omar's condition," he said. "They helped prepare me for what to expect. The family education classes on the unit were also very helpful to understand how unique brain injuries really are."

Because Omar did not know English, RIC translators were at every therapy session. Omar's father also was an integral part of his therapy. He worked with Omar's care team to translate directions from therapists to his son as well as his son's questions and responses.

"RIC's translators are great," said McCusker. "I did not see the language differences to be a barrier in working with Omar."

After more than three months in acute inpatient rehabilitation, Omar began to achieve some of his most important goals in communicating and moving unassisted. Though he still used a wheelchair to get around, Omar was a lot more responsive and was even learning to stand and take steps with assistance.

"Omar made great progress, and his level of improvement would not have been possible without the support of his father," said McCusker. "He was realistic about Omar's condition but never gave up hope for his son."

Transitioning to Independent, Community Living

Omar, his father and his RIC care team assessed Omar's progress and decided that he could still benefit from RIC day rehabilitation, an intensive therapeutic environment that would help Omar further develop his cognitive and physical abilities and provide a smoother transition to community living. It also would help enhance his social and communication abilities.

Omar went to RIC's DayRehab Center in Ravenswood for three hours a day, three days a week. There, physical therapists continued to work with Omar on improving his balance, strength and coordination. It was at day rehabilitation where Omar began to take steps and eventually walk.

"His therapists were so patient with him," said Al-Dhafiri. "RIC has been the best medical center I have ever experienced. Everyone at RIC has been wonderful from the people that clean the floors, to the top, everyone here has hope, and that leaves an impression."

Occupational therapists worked on improving his ability to dress and groom himself, and they worked on the more complex skills necessary for transitioning back to the community. Soon, Omar was dressing himself and playing games like Memory to retrieve his cognitive processing skills.

Omar also made vast improvements in his ability to communicate.

"I will never forget the first time Omar spoke," said Al-Dhafiri. "It was 4 a.m. and I heard him knocking on the wall of the apartment we were staying in, which meant he had to use the bathroom. While I was getting up and walking to him, I asked if he had to use the bathroom and he replied, 'Yeah.' It was amazing."

Omar had made so much progress that physicians decided Omar's brain swelling had reduced enough to replace the piece of skull that has been removed to relieve the swelling after his injury.

"Omar's doctor at RIC was wonderful during this time," said Al-Dhafiri. "When one hospital's surgeon was reluctant to do the procedure, she reached out to a colleague at Northwestern Memorial Hospital who then conducted the surgery. She was so kind and really cared about Omar."

Finally, the care team thought it was important that Omar return to his environment and his community in Kuwait . It would be important for Omar to learn to operate within his home and with his family, friends and community, so Omar and his father returned to Kuwait for a year.

In October 2008, they returned to RIC for additional outpatient therapy, which Al-Dhafiri considers "fine-tuning."

"RIC's international guest relations team has been so wonderful throughout this process," said Al-Dhafiri. "They call to ask about Omar, and when we decided to come back, they helped make arrangements for our return to Chicago."

Omar received outpatient therapy five times a week. He participated in aqua therapy in RIC's therapy pool, which helped him improve his balance and coordination.

Despite the challenge of being away from family, Al-Dhafiri says he feels positive about the progress his son has made and is optimistic about his son's future.

"RIC has been so wonderful in helping my son. It's my hope that he will be able to go back to school or work someday," said Al-Dhafiri. "My wife and his brothers, we all will love him and support him."


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