Last Ramadan, Fatima Saleh Abdulla Omar’s sister Reem was involved in a tragic car accident. A passenger in her friend’s car, she wasn’t wearing a seat belt and was thrown from the vehicle, suffering serious injuries.
Reem’s initial treatment was in an Abu Dhabi hospital’s acute unit, where her condition was stabilised. But this did not address the significant disability she was left with as a result of her traumatic brain injury. For this, Reem was transferred to the specialised brain rehabilitation team at Amana Healthcare’s Medical and Rehabilitation Hospital in Abu Dhabi.
Dr Vaqas Amin Farooqi, an Australian Physical Medicine and Rehabilitation Consultant at Amana Healthcare, describes the extent of Reem’s injuries when she was admitted: “Reem had a very severe traumatic brain injury. She was bedridden and did not even have the strength to sit in a wheelchair comfortably. She required nursing care for pretty much everything — including personal hygiene, dressing and feeding.”
Fatima, who is ten years older than Reem, resigned from her position as the first female flight engineer at Etihad Airways to help take care of her younger sister during this critical period, with the goal of helping Reem recover as much as possible.
Dr Farooqi explains why Amana’s approach is so unique: “Unlike most rehabilitation providers, which focus on simple outpatient cases with a focus on musculoskeletal rehabilitation, Amana Healthcare is specialised in brain rehabilitation and has a team that is also specialised in neurological rehabilitation.
Like everything in medicine, specialisation is important — and in this case it matters to not only have specialised physicians but also a full team of specialised therapists and nurses with experience in brain injury rehabilitation. This gives every patient the best chance at recovery through the full range of rehabilitation disciplines including physiotherapy, occupational therapy, speech therapy and others.”
When Dr Farooqi initially assessed Reem, he noticed that although her disability was severe, she retained some movement in her arms and legs. “This was our starting point,” he says. “We felt confident Reem’s strength and control could improve with intensive rehabilitation — despite tremulous movement and lack of coordination — and that her memory, which had been damaged by the accident, could also be significantly improved. Her strength at the time was her ability to understand instructions and remember information: this allowed us to provide her with an intensive three hours-a-day rehabilitation programme.”
A key challenge for Reem and the Amana Healthcare team was rebuilding core strength and coordination so she could sit, transfer and manage her wheelchair independently. “Reem remained in bed for a long time after the accident and many of her muscles had started to wither,” says Claudia Soares, Director of Clinical Operations at Amana Healthcare.
“With instructions from the physical medicine physicians, our nurses and therapists focused on addressing weaknesses in her core, back and abdomen. It was not only difficult for her to stand but also to sit, as her core muscles simply could not hold up the weight of her body, which would twist and collapse causing pain.” Reem’s initial rehabilitation focus was therefore on building strength so she could sit independently and eventually stand. Speech therapy, neurological input and other rehabilitation measures were carried out in parallel.
“Amana Healthcare’s rehabilitation programme was extremely intensive,” says Fatima. Dr Farooqi adds, “We noticed improvement with speech very quickly, so speech therapy became less important and she was spending more time in physical therapy. One challenge was spasticity in her legs and resulting pain, which proved difficult to manage.”
Once Reem recovered the ability to sit independently and moved on to more challenging activities, the need to control spasticity and pain became pressing. “Reem’s injuries were extensive so we had to approach each part of the body differently,” explains Dr Farooqi. “After finding basic painkillers ineffective, we used specialised injection of botulinum toxin into key muscles to address spasticity and give her the freedom to move and recover. Two weeks into the programme of injections, Reem was able to stand — a major physical and psychological milestone.
At Amana Healthcare, therapy goals are discussed with patients and their families and regularly updated based on progress. Patients and their families are closely involved in all decisions and encouraged to share their hopes and ambitions for the therapy programme. Dr Farooqi was full of praise for Reem’s family in this regard. “The family did a great job because they focused on Reem’s needs and didn’t forget the importance of allowing patients to have autonomy and choice. The family were mindful of this, so they made sure that Reem herself was at the centre of decisions and plans.”
A challenge in this regard was the sequence of care, which the family did not initially understand. Reem’s therapy began with retraining in some basic skills learned during childhood. “The family initially thought Reem was going backwards with her treatment,” says Dr Farooqi. “We had to explain that teaching her how to sit is a prerequisite for her ability to stand, and that skipping steps — pushing her to walk before she can even sit independently, for example — would be counterproductive.” As the therapy programme moved forward and Reem’s achievements became more visible, the logic behind the sequence of therapies became more clear.
Life After Amana
On March 27, Reem was discharged from Amana Healthcare. Staff from the hospital came to assess her home and made recommendations for modifications to ensure Reem’s transition would be as smooth as possible. In the two and a half months she was at Amana Healthcare, Reem recovered her ability to speak, to eat independently and to sit without support, allowing her to leave the confines of her bed. Most importantly, however, what she regained was her confidence and a quality of life she never thought possible after the accident. “After nine months in hospital, Reem’s stay at Amana Healthcare gave her the skills and support necessary to go outside, return home and have hope for the future,” explains Fatima.
“She loves to watch TV, spend time in nature and listen to music — she likes Chris Brown! She is even showing signs that with continued therapy, she might start walking again. It is hard to believe she’s come this far after such a severe accident and it’s clear that without such an intensive rehabilitation programme, she would have remained bed-bound and dependent for the rest of her life.”