After a traumatic brain injury, the path to recovery is not linear, and the journey is not quick, but every small step in the right direction deserves to be celebrated. This is especially true for people who experience disorders of consciousness—a variety of conditions characterized by altered levels of awareness and arousal. A car accident in March of 2024 left then-18-year-old Dhonavanh ‘Dhon’ Cain in a minimally conscious state.
“Emerging into consciousness and the timeframe is going to be different for everybody, but after this type of severe brain injury, we’re not talking weeks and months of recovery,” Brooke Murtaugh, Madonna’s brain injury program manager, said. “We are really talking months to many years.”
For the last year, Dhon has been slowly emerging into consciousness. Being young and active prior to his injury helped. His progress really took off during two months of intense daily physical, occupational and speech therapies at Madonna Rehabilitation Hospitals. Getting Dhon to Madonna was a victory in itself, according to his brother, Duece Phaly.
“We knew Madonna was great,” Duece said. “We heard great things. My mom and sister were in Nebraska, so we were ready to come all the way out from Oregon right then and there.”
In January, Duece’s determination to get Dhon the necessary medical rehabilitation at Madonna finally paid off, despite the initial denial from insurance. “It’s a pretty special thing to know how hard Duece fought for Madonna specifically,” Abby McDonald, MOT, OTR/L, CBIS, Dhon’s occupational therapist, said. “It goes to show how important Madonna is that you want to come from all different places to see what Madonna can do. The equipment we have, the advocacy we have with our patients, the bond that we build with our patients, and then also the push that we try to provide to get them additional therapy outside of Madonna when they leave here. We just have so many resources right here in our back pocket that it’s pretty cool to see that people are coming from states away to get that help.”
Dhon arrived at Madonna after months of not standing up, struggling with limited arm movement, and not consistently communicating his wants and needs. Because he was further out from his injury and hadn’t received medical rehabilitation in the first few months of his recovery, Dhon’s physician-led care team adjusted his goals accordingly. They didn’t expect him to walk out of Madonna or talk anyone’s ear off, but what he accomplished during his time at Madonna was a victory for his family.
“The biggest goal we had for him was to reduce the amount of help he needed with his daily skills, so we started training family on the best techniques for them to be utilizing,” McDonald said. “We really wanted to get him going from needing two people to help him to one person to help him with his dressing, his bathing, his transfers and moving from one surface to the next. We were able to involve his family quite a bit, and by the time he left, his family could do it all.”
With special caregiver training and educational resources, Dhon’s family could maximize his time at Madonna. Taking advantage of their free time, Duece and Dhon did independent therapy sessions on their own during weekends. These sessions included exercise programs created by his therapy team using Madonna’s specialized equipment. McDonald trained the family on how to set up the functional electrical stimulation (FES) bike, and Dhon’s family made sure he used the machine for at least an hour or two every weekend.
“The very first day that I met Dhon and Duece, Duece made it very clear that he was going to advocate for Dhon every step of the way,” McDonald said. “He was very eager in asking, ‘What else can I do?’ It made sense to train him on setup of the FES bike. So, instead of twice a week, three or four times a week, Dhon was getting on that bike, getting his arms moving and reducing that tone that he had, because his brother was capable of doing those things for him.”
From January to March, Dhon worked diligently in therapies, and Duece was next to him to offer the extra support he needed. He gave pep talks, played pump up music and motivated Dhon to push a little further in each therapy session.
“He was a three-sport athlete in high school,” Duece said. “He worked out three, four, five hours a day, day in and day out for that and I know that he’s capable of doing that.”
When Dhon left Madonna, he could stand with minimal assistance and communicate his wants and needs through hand gestures and an eye gaze communication device. They may seem like small things, but they were huge triumphs for him.
“To see that kind of progression after a year, that wouldn’t have happened if it wasn’t for Duece fighting for him and making the calls and making the push and getting him through the doors of Madonna,” McDonald said. “If it wasn’t for him doing that, Dhon would not have the quality of life that he does now.”
Duece also credits Dhon’s Madonna care team for restoring their hope for Dhon’s future. He and his family feel confident they can give Dhon the care he needs while also caring for themselves.
“Madonna has helped us take steps into not only what is next, but what is the full future for Dhon?” Duece said. “They do a good job giving that big picture of what’s possible. They show us what to do and show us that this intensity of rehab never has to stop. We can continue it as a family using these tools. The therapists here were really good at passing on that knowledge. Not just giving Dhon therapies and exercises, but equipping us to do the same things at home.”
As Dhon transitions to the next step in his recovery journey, Duece says the sky is really the limit.
“The doctors are really impressed with how well Dhon’s been doing here,” Duece said. “It’s been really hopeful for us, and more barriers are going to continue to be broken. A year from now, two years from now, whatever it is. We don’t expect anything less than Dhon to continue to make progress, whatever that looks like, big or small.”
His care team echoes that sentiment.
“I think it’s very important for everyone to see that length of time since a traumatic event doesn’t have to be the end-all be-all determining factor of success if you have the right motivation and the right drive to progress,” McDonald said. “Dhon is going to be a force to be reckoned with.”