The Rehabilitation of Gunnar Sandberg
Traumatic Brain Injury: Gunnar Sandberg’s Story
The horrifying accident was captured on video and became a national media sensation. On March 11, 2010, Gunnar Sandberg, a 16-year-old high school student pitching in a baseball game, was hit in the head by a line drive and left in a coma for weeks.
"Even though Gunnar was still in a coma at Marin General Hospital, I could envision Gunnar rehabbing and getting stronger at the Davies campus," said Lisa Sandberg, Gunnar’s mother. "We had heard really positive things about CPMC from families with sons who had similar injuries, and we were impressed by the staff that did the preadmission assessment. As soon as we saw the campus, we knew that it was the correct place for Gunnar."
"Gunnar’s impairment was quite severe—edema in the brain," noted Jeremy Bornstein, Ph.D., rehabilitation neuropsychologist and director of the Health Psychology Program at CPMC. "This results in lethargy and loss of arousal. And he was tired."
The Sandberg family was afflicted by fatigue as well. "The families of patients are often exhausted and emotional. The way we greet them as soon as they arrive on the unit is important," noted Cathy Kennedy, manager, Acute Rehabilitation & Outpatient Specialty Services.
Dr. Bornstein underlined the crucial role of the family in the rehabilitation process. "One of the most important factors is how well involved is the family and can they work collaboratively with the medical team,” he said. “The Sandberg family was extremely attentive."
"I’ll never forget the first day," said Lisa Sandberg. "Dr. Bornstein opened up his arms to us and said, ‘We’re here for you and your family as well.’ It was an unfamiliar setting, but we were put at ease and made to feel very comfortable and knew that Gunnar would be well taken care of there."
"We created a neurobehavioral plan for Gunnar—a plan that evaluated his cognitive, behavioral, emotional, and environmental needs," said Dr. Bornstein. "Although he required a low-stimulus environment, he was given an aggressive rehab program comprising physical, occupational, speech, and recreational therapy."
"Brain injury patients are overstimulated very easily and have difficulty processing the daily barrage of audio and visual input," emphasized Kennedy. "But we have blackout curtains in the rooms and we can dim the lights. The rooms have soundproofing, and if it will be beneficial, we have the ability to remotely monitor patients through a video camera."
"Gunnar has been on a long journey," noted Holli Castelli, CPMC occupational therapist. "He was in a low-stimulus environment for the first seven to 10 days. We gradually started introducing more stimulating environments and assisted him as he learned to adapt. By day 14 he was fully introduced to the indoor environment and thereafter to the campus and surrounding community."
"The rehab staff was unbelievable and we had total confidence that they would treat Gunnar with the care that he would need, as well as push him to the point where he would make amazing progress," said Lisa Sandberg. "This is exactly what happened. The progress both physically and mentally was astonishing. His progress was at a rapid pace—changing so much every day, and it was not only because of Gunnar’s will but because of the talented therapists who worked with Gunnar in the best of ways."
"We learned from the very first day that Gunnar is a very resilient young man able to tolerate intensive therapies a minimum of three hours per day," said Dr. Bornstein. "He was on an anticonvulsant medication and that can be sedating but he managed the aggressive therapy schedule very well."
"The entire staff was not only professional, but so kind and caring," said Lisa Sandberg. "They had created ‘Gunnar’s team,’ a team that wanted to win and succeed. This is just what Gunnar needed. Holli is the absolute best. She completely understood him. Her approach was about tough love. And Kara Phenix, the speech therapist, was all about love and kindness but held Gunnar accountable for his progress. We had been told that when Gunnar first got there, he would be there for about two months. After about a week, the prognosis changed and they thought Gunnar’s recovery would be quicker, and it was. He was out in a month."
There is no "typical brain injury case," noted Kennedy. "Functional and cognitive rehabilitation begin to produce meaningful results when a patient starts responding to stimulation in predictable ways. Then the clinical team can work to mold the patient’s behavior and performance toward realistic goals. One role of the team is to be protective. Patients may start to get restless or agitated when the environment is too stimulating. A patient with brain injury may lack insight about these behaviors and what causes them, but these are generally indications the patient’s nervous system is overwhelmed. A good rehab plan will incorporate structured rest breaks and will monitor the effect of stimulation closely."
"You want the patient to have successful experiences and you want the patient to be challenged," emphasized Kennedy. “This is how neuro-rehabilitation takes advantage of the properties of neuroplasticity. We try to create optimal training experiences so patients can practice skills in the most normal manner possible."
"A little bit of struggle is not only necessary but healthy," added Dr. Bornstein. "Demographics, like age, play a role in neuroplasticity, but the wild card with Gunnar was determining how diffuse his injury was. When presented with a challenge, Gunnar would rise to that challenge and showed consistent performance improvement over time."
The next phase in Gunnar’s journey included a reintegration with home, family, and community. "He was an excellent candidate for our day treatment program," said Dr. Bornstein. "The continuity in care with the acute rehab team was maintained for Gunnar and there was a very important shift in his therapy. At this stage of rehabilitation, we elicit from patients the goals they feel are important. We then design a program and activities to accommodate those goals."
Gunnar’s three major goals included a return to academic study, athletics, and a social life. "With the family’s agreement, our team helped Gunnar transition from rehabilitation into a tutoring program for re-entry into the school system," noted Kennedy. "This demonstrates our ability to reach out to families and the community in a highly individualized manner. In other cases, for example, we may work with employers to help the patient return to their work environment."
Gunnar returned to school in mid-August to start his senior year. Dr. Bornstein, CPMC therapists, and staff visited his school to meet with his baseball teammates and discuss his progress and challenges. "Gunnar’s therapists went to great lengths to coordinate his community support care system to take him to the next phase of his rehabilitation," emphasized Dr. Bornstein.
Gunnar is now playing soccer and has resumed an active social life, including a major trip to Sweden to visit family. The rehabilitation team will be meeting with him for a debriefing and re-evaluation. "We may want to offer him the use of additional tutors and perhaps guide him on how to modulate his activities," said Dr. Bornstein. "Seizure is still an issue and exhaustion can lower the threshold for an occurrence."
Dr. Bornstein is nonetheless optimistic: "I am confident Gunnar will lead a normal life. The testing is very encouraging on his memory functions."
The Sandberg family has already expressed its enthusiastic advocacy for the rehabilitation program at the Davies Campus. "We highly recommend CPMC and in fact we just did to another family," said Lisa Sandberg. "Once there, you learn quickly that it is the best place to be for recovery."