Institute offers help, hope to people with traumatic brain injury

August 17, 2021 | UHCL Staff

When Sean Carter was 22, he was like most other college students. He was working on getting good grades, thinking about becoming a real estate attorney, and hanging out with his friends. He was also enjoying a growing modeling career in New York.

Now 38, he has a career he never considered — he is a public speaker who can't speak. Through his work, Sean shares a powerful message: Think before you get into a car with someone who could be intoxicated.

"Today, Sean speaks through an iPad," said his mother, Jenny Carter. "He has a traumatic brain injury from his accident. His friend was driving the truck and was not seriously injured, but Sean is not able to speak or walk. Everything that you or I do, like talking, eating, drinking, walking, is all automatic. Nothing is natural for him anymore. His cognition and memory were not affected, but it took him two years to learn to swallow liquids again."

Sean said that he has great faith and has never given up hope that he can someday walk and talk again. "At times, it might have even seemed irrational, but now that I'm working with (Clinical Director of the Health and Human Performance Institute) Dr. Joe Hazzard, (Executive Director of the HHPI) Dr. Bill Amonette, and the team of students, my goal of walking unassisted again feels attainable," he said. "I know from my many years of work on my physical body that nothing is easy or a given, but my hope is what drives me and has helped me remain optimistic."

In the years since his injury, Sean has experienced hospitalizations, surgeries, rehabilitation and physical therapy. Qualified resources and support for people with traumatic brain injuries, or TBIs, like Sean's can be difficult to find. However, Sean and his mother have found a crucial resource in the University of Houston-Clear Lake's HHPI.

Amonette, now also an associate professor of exercise science, first worked with Sean in 2011 while in graduate school, and his case was top of mind when Amonette developed the HHPI's mission when it was founded in 2017.

"The HHPI's goal is to improve the health and functional performance of people suffering from chronic diseases or injuries through exercise, nutrition, and rehabilitation interventions," he said. "But my work with Sean is the reason the clinical aspects of the Institute exists. Ever since I worked with Sean, I have thought about him and others like him who have limited access to exercise services needed to continue recovery many years after the initial injury."

Making a difference in TBI

The reality for TBI patients is they have about a year to make significant progress with insurance reimbursement for physical therapy. After that, most insurance benefits stop.

"There are difficulties for people like Sean who have significant neurological injuries after the insurance coverage has been exhausted," Amonette said, recalling his work with Sean before HHPI was founded. "I watched him make some remarkable progress toward walking. He was completely wheelchair bound when I first met him, then moved to a walker. I thought it was a shame there were no resources for people in this position, where they could continue rehab post-injury, without insurance."

Cases like Sean's motivate HHPI's work. "Sean can't go to a regular gym; they don't necessarily have the expertise or equipment to help him. Continuing physical therapy is cost prohibitive because insurance doesn't cover it anymore. But at the HHPI, we have equipment, faculty with exercise expertise, and graduate students who are hungry to learn," he said.

Jenny said that over the years since Sean's injury, she had tried to get him help from everywhere she could.

"The work here at HHPI is so necessary for people with TBIs," she said. "Sean and I travel all over the state with our foundation, WhenSeanSpeaks. Pre-COVID, we put in 26,750 miles in one year speaking to schools, churches and safety groups about drunk driving, so I know from all our traveling, there is nothing like HHPI anywhere else."

Sean's journey with HHPI

Twice a week, Jenny and Sean make the two-hour drive from College Station for four hours of intense exercise rehabilitation overseen by Amonette, Hazzard, and three graduate students who are committed to keeping Sean on the road to achieving his goal to walk unassisted, no matter how long it takes.

"One of Sean's biggest challenges is his kinesthetic awareness," Amonette said. "He doesn't 'feel' where his body is in space. He leans backwards, but he needs to feel like he's able to lean forward safely. We have a harness system, that allows us to practice walking, cueing leg pattern movement, body lean and balance."

Sean also walks in an air-adapted treadmill, providing significant body weight support. "This way, he can focus on driving his knee up when he's walking," said Amonette. "We cue him to lean forward, drive his knees up, and practice that repetitive motion."

It's not easy. The motor skills that Sean lost must be redirected — in effect, rewiring his brain. The process is long and arduous.

"Sean's injuries are all over his brain," Jenny said. "The accident violently shook his head from side to side. If you get hit in the head with an object, it's usually local. But he has a severe diffuse axonal injury. The majority of people who have this never even emerge from coma."

Students in other exercise sciences programs are accustomed to delivering exercise programs to clients. "But, this is a special delivery," Hazzard said. "Students are taught in class to work in certain parameters to deliver certain exercises, but here at HHPI, students are forced to think differently."

In Sean's case, explained Hazzard, hamstring strengthening is one element of his exercise prescription. "We have effective equipment for strengthening, but in his case, it has to become a different type of delivery. Students have to adapt to what they learn from working with Sean. The principles of exercise still apply, but this experience forces them to think of different ways to do things."

Because Sean's case is so complex, Hazzard continued, students have to determine what exercise can he do from a rehabilitation standpoint. "There is no entity in rehab medicine that would work with a client in this way," he said. "We are here to help him gain strength and improve his physical condition. We can't predict the outcome, but we will put everything we have into it, and we know Sean will do the same."

Jenny said she and Sean dream and pray that someday, he'll be able to walk without a walker. "Everything he gets physically from this program is helping him," she said. "We both have a very strong faith. Sean doesn't allow himself to become depressed. We believe miracles are being done at the HHPI."

The Health and Human Performance Institute offers exercise and nutritional support to people with a variety of chronic health challenges, including heart disease, obesity and diabetes. For more information, visit HHPI online.