Traumatic Brain Injury

The more effort I put in, the harder they’ll drive to make sure I keep getting better faster.

Ryan Brock, former Madonna patient.


Ryan suffered a traumatic brain injury after slick roads in rural Nebraska caused the pickup truck he was driving to collide with a manure spreader in December 2015. As he progressed through rehabilitation and relearned to walk, the 29-year-old would joke that he was competing with his 14-month-old son. At Madonna, Ryan used specialized equipment to help him regain function in his left arm and leg.
TBI dad in friendly competition with toddler son

TBI dad in friendly competition with toddler son


Madonna’s Brain Injury Rehabilitation Program is a comprehensive specialized program that serves individuals with traumatic or nontraumatic brain injuries of any severity. Our goal is to provide state-of-the-art, evidence-based, quality rehabilitation to help patients return home to the activities that are important to them, and provide long-term support for optimal recovery.

Madonna’s Brain Injury Program develops an individualized rehabilitation program for all levels of brain injury, from those in a minimally conscious state to mild physical and cognitive deficits. Our program provides all levels of care encompassing medically fragile inpatient brain injury through our Specialty Hospital, to our intensive specialized outpatient programs,

On-Site Care

Patients will be seen daily by a physiatrist, also known as a Physical Medicine and Rehabilitation (PM&R) physician, who specializes in the rehabilitative treatment and management of disease and injury affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. The primary focus is to restore function and promote overall health

Registered nurses with rehabilitation training or experience are on staff at all times to care for patients.

Madonna staffs licensed respiratory care practitioners at all times. Our respiratory therapists are able to provide arterial blood gas (ABG) services. Pulmonologists can perform bronchoscopies on-site with help from the respiratory team.

Madonna provides a full range of inpatient pharmacy services, including medication distribution, patient education and clinical/dosing services.

Madonna provides radiology services that include X-ray, ultrasound, echocardiogram, venous doppler, arterial doppler, Holter monitor, sleep study and electroencephalogram (EEG).

Madonna's in-house laboratory provides anticoagulation, hematology, chemistry, therapeutic drug level testing and urine analysis services with results available the same day in most cases.

Madonna has registered dietitians and licensed medical nutrition therapists who are part of the care team and ensure the patient's individualized nutrition plan is met. 

Neuropsychologists and rehabilitation counselors are an integral part of rehabilitation at Madonna.  They provide a variety of services, including neuropsychological assessment, adjustment counseling, pain management, family therapy, concussion or mild brain injury evaluation, memory testing, dementia evaluation, neurofeedback, biofeedback, behavioral management and psychoeducation.

Specially trained therapists help our patients establish proper seating and positioning for patients who use mobility devices.

Madonna is committed to meet all the needs of its patients--physical, spiritual and emotional. A spiritual care professional is a member of and consults with the care team. The chapel, the heart and soul of Madonna, is there to nurture faith and hope during times of crisis.

The goal of Madonna’s Brain Injury Rehabilitation Program is to help the individuals we serve become as independent as possible after their injury.  Madonna strives to establish a partnership for life that the patient and their family can depend on throughout their recovery and beyond. Programming is highly individualized, dependent upon each individual’s needs, functional level and personal goals. Family members are encouraged to be actively involved in therapy and nursing care so they may reinforce learning new skills.

We serve survivors with traumatic or non-traumatic brain injuries including children ages 0-18 and adults of all ages. Madonna’s continuum of care serves patients with brain injury who may be emerging from coma (Rancho Level II or higher) to those who are actively participating in their rehabilitation, all the way through their last stages of rehabilitation focusing on return to home, community and work re-entry skills. Madonna Rehabilitation Hospital in Lincoln is one of the only hospitals in the region to be accredited by CARF, the Commission for the Accreditation of Rehabilitation Facilities, as a Brain Injury Rehabilitation Specialty Program for multiple levels of care, including  Acute Rehabilitation, intensive outpatient and traditional outpatient. Throughout Madonna’s continuum of care, the brain injury program specializes in recognizing, assessing and treating conditions related to brain injury and preventing complications related to brain injury. Our program also focuses on educating patient and families on prevention and reducing the risk of future brain injuries.

Madonna-Lincoln is one of only seven organizations in the U.S. which is accredited in both Brain Injury and Pediatric Specialty Programs. This means that Madonna meets higher standards relating to staff competency, programming, patient and family education, advocacy and outcomes management.  Madonna-Omaha is accredited by the Joint Commission and will undergo its first CARF accreditation visit in 2018.   

In fiscal year 2017, 60 percent of patients with brain injury admitted from the Midwest region, outside of the Lincoln or Omaha area. Madonna admits patient from multiple in-state and out-of-state trauma systems and acute care hospitals. We served 856 individuals with brain injury across the continuum of care over both Madonna campuses. Outpatients are referred to our services from a variety of physician specialties. A referral from a physician is required to access Madonna’s continuum of care.

Scope of services

Madonna’s Brain Injury Program is comprehensive, providing a wide array of services including physical, occupational, speech, respiratory, recreational and nutritional therapies, rehabilitation psychology, neuro-optometry, case management, social work services, spiritual services and orthotics/prosthetics as needed. In addition to these specialties, rehabilitation nursing and access to a physician with training in physical medicine and rehabilitation is available 24 hours per day, seven days per week on an inpatient basis.  Family members and caregivers for the persons served are provided with structured training and education on brain injury and providing care for their loved one. Education topics include: Deficits experienced post-brain injury, understanding the rehabilitation process, risks associated with brain injury, long term resources, aging with brain injury, relationships after brain injury and multiple others. Family and patient preferences are solicited and used as part of the rehabilitation process. Families and caregivers are involved in developing an appropriate discharge plan. They are provided resources to help access life-long care as needed. While most of our patients with brain injury are discharged to a community setting, patients who need additional time in a more structured, residential setting after discharge are also served.

Clinical Expertise:  Each patient’s care is directed by a physician who specializes in physical medicine and rehabilitation and/or a physician with specialization in internal medicine. A pediatrician is involved in the daily care of individuals 18 years or younger. Madonna nurses are specially trained in providing care for patients with brain injury, and several Madonna nurses have specialty training as a Certified Rehabilitation Registered Nurse (CRRN). For very low-level patients, weaning them from a mechanical ventilator might be the first part of treatment. Madonna’s Pulmonary Program has an excellent track record for successful weaning. Patients requiring specialized services and interventions such as cardiology, pulmonology, and orthopedics are referred and provided the appropriate medical and follow up services.

Rehabilitation:  Madonna’s dedicated team of professionals complete special competency training in treatment of persons with brain injury. The team, consisting of physical, occupational, speech, recreational and respiratory therapists, as well as neuropsychology, social worker, rehabilitation nurse and case manager, work together to meet the complex physical, cognitive, social and emotional needs of persons with brain injury. On average, inpatients receive three hours of therapy each weekday on an acute rehabilitation level of care. Weekend therapy is provided on an as-needed basis. Madonna’s therapy staff is also trained in coma stimulation to assist in arousing patients in an altered state of consciousness. Madonna has a full staff of specially trained rehabilitation psychologists on site who are an integral part of the rehabilitation team. They participate in team meetings, lead behavioral intervention plans and provide counseling and support for both the patient and their family members. Madonna’s interdisciplinary team members have received nationally certified training in working with individuals with brain injury.

Days and Hours of Service:  Therapy services are provided Monday through Friday, 7 a.m. to 5 p.m. Patients receive on average, three hours of therapy per day, five days per week in acute rehabilitation and are seen on average, 2-3 times per week on an outpatient basis as appropriate. Saturday and Sunday therapies are provided on an as needed basis for inpatients.

Fees:  Cost of care is determined by diagnosis, level of care, acuity of care and length of stay. 

Madonna accepts patients with a wide variety of funding, including Medicare, Nebraska Medicaid, commercial insurances such as Blue Cross and Blue Shield, worker’s compensation, and will consider out-of-state Medicaid and non-funded patients on a case-by-case basis.

For more information about admissions, click here.

Environment: Madonna’s environment is designed and specialized for the brain injury populations. Patients with a recent brain injury may go through an agitated and restless stage in their recovery. Madonna has the capacity to lock sections of the brain injury rehabilitation unit to provide better security for patients as they emerge from coma and go through this stage of recovery. Madonna also provides one-on-one supervision and video monitoring as needed for patient safety. Adolescents and children 18 years or younger are admitted to Children’s Rehabilitation Unit. These children are provided rehabilitation in a dedicated, secure area designed specifically for children and adolescents.

Therapy can also be provided in a community setting. Therapists integrate functional activities in these areas to prepare patients for real-life activities in their home community.

Community Re-entry: Rehabilitation does not stop when the patient gains basic skills of self-care and mobility. Participation in community activities is also an important part of the recovery process and is integrated into therapy sessions. Recreational therapy provides a variety of adaptive sports and recreational outings to help patients and families recognize that they can still participate in enjoyable activities. Patients may also work on specific goals related to return to driving, school re-entry, or visit with a vocational rehabilitation counselor about work re-entry.

Preparation for Home:  Madonna's brain injury patients and their caregivers are provided with a self-care training program based upon principles of self-advocacy and self-direction. Patients, with or without their caregivers, are taught how to direct their care and what to do if emergencies arise. They are provided with opportunities to practice these skills during their stay, often ending with a stay in Madonna's transitional living apartment. This apartment is located on the unit, with easy access to medical staff if needed, with the expectation that a family member or other caregiver will assist with the personal care required during their stay. The patient will direct his/her care and independently follow his/her therapy schedule.

Home Assessment:  Another way to prepare the patient for a successful transition to home is by offering the opportunity for patients to return home for the day to practice skills in their home setting while evaluating the home for accessibility and any adaptations or modifications that may be required. For patients and families who live outside Lincoln and Omaha and the surrounding communities, a paper/pencil home assessment form is provided for the family member or caregiver to complete.

Long-Term Follow-Up: Madonna offers many ways to help individuals with brain injury and their family members continue to improve and maintain their functional gains, therefore maximizing their participation throughout the rest of their life.

It is important that individuals completing rehabilitation stay active and exercise safely. We promote success by teaching how and what to do in a community based fitness environment, featuring trained staff and specially adapted equipment.

After you experience a brain injury, you may be confronted with a wide range of challenges throughout your lifetime. Because these challenges and limitations may not be evident until later, focusing on maintaining health long-term, including preventing secondary complications, is an important part of lifelong care planning.

A representative from Madonna will contact you 6-12 months after discharge to see how you are doing and to gather outcome information.

Brain Injury Follow Up Clinic:  Survivors of Brain Injury can experience changes in function months and years post injury. Madonna provides a Brain Injury Follow Up Clinic for survivors of moderate to severe brain injury requiring a previous Inpatient Rehabilitation stay, either at Madonna or an external rehabilitation facility. This follow up clinic provides a comprehensive assessment of current function and changes in function and makes appropriate recommendations for continued care and rehabilitation.

Mild Traumatic Brain Injury Clinic:  Some individuals who have sustained brain injuries are not initially recognized or treated because they are mild. Often the need for treatment may not be identified until months after the incident, when academic, vocational, personal or family adjustment difficulties arise. Madonna is regionally known for its Mild Traumatic Brain Injury services — a comprehensive two-day assessment focusing on medical, physical, cognitive (thinking) and emotional aspects of mild traumatic brain injury. Patients may then receive treatment at Madonna based on the results of the assessment or treatment may be obtained in their local area if appropriate.

Program Highlights

Rehabilitation for patients with a brain injury includes specialized services that promote mass repetition and neuroplasticity required for recovery: 

Additional Programs and Services

Madonna offers additional unique specialized services that focus on real-life skills to help people achieve their greatest level of independence and get back to their families, work, community and activities.

Awards and Accreditations

View a list of awards and accreditations that demonstrate our commitment to providing the best quality of care for our patients.  

State-of-the-Art Technology

As a nationally recognized rehabilitation leader, Madonna has some of the most advanced rehabilitation technology available.

Brain Injury Online Resources

The amount of information available about brain injuries can be overwhelming.  Madonna coordinates with local, regional and national organizations to help patients find the most helpful online resources.

Patient Stories

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Preston Gusoskey is moving forward despite being involved in a car crash that nearly took his life. Suffering severe brain trauma from the March 2016 accident, Preston was given a two percent chance of surviving. Through strong faith, hard work and determination, along with incredible family support, Preston says graduating high school is just the beginning.

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Tomas "Mossy" Casillas is a resilient, young man who doesn’t give up. He's also a brain injury survivor. Recently spending time recovering at Madonna for brain surgery, this is Mossy's second time in our care. Mom says support and therapy has helped him make gains even she didn't imagine.

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