Recovering from Disorders of Consciousness follows the powerful true story of Hannah Strom, a young woman who survived a severe traumatic brain injury (TBI) and spent weeks in a disorder of consciousness. Through her journey — and the experiences of patients, families, and clinicians — this video explores how consciousness can slowly return, why early prognoses are often uncertain, and how specialized inpatient rehabilitation can change outcomes after severe brain injury.
Featuring insights from leading neurologists and rehabilitation specialists at the Spaulding‑Harvard TBI Model System, this documentary examines the science of recovery, the risks of early withdrawal of care, and the long‑term impact of evidence‑based neurorehabilitation. It also highlights the critical gaps in access to inpatient rehab for people with disorders of consciousness.
Produced by the Model Systems Knowledge Translation Center (MSKTC) and BrainLine, this story is part of the Recovering from Disorders of Consciousness Hot Topic Module.
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Recovering from Disorders of Consciousness
A Traumatic Brain Injury Model Systems Story
Lighthearted music / Hannah and Dr. Hirschberg playing ping pong
Narrator: Five years ago, almost nobody would have been able to picture this scene.
Sound up
Narrator: Twenty-four-year-old Hannah Strom is holding her own at the ping pong table.
Sound up
Narrator: She’s here visiting Spaulding Rehabilitation Hospital in Boston with her mom and dad.
Sound up greeting Beth Hansen
Narrator: Spaulding was Hannah’s home for almost four months … as she worked to heal and recover after a devastating traumatic brain injury.
Music to transition
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Day 1
Narrator: The morning of Wednesday, January 15th, 2020 [twenty twenty], Hannah was in a terrible car crash with her college rowing team.
Photos of crash, serious music
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Gail Strom
Hannah’s Mother
Gail Strom: Tom called and he just said, you need to come home. And I said, well, why? And he just said, you need to come home.
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Brian Edlow, MD
Neurocritical Care, Massachusetts General
Spaulding-Harvard TBI Model System
Brian Edlow: Hannah experienced a severe traumatic brain injury. At the moment of impact, there was swelling, an increase in pressure within her brain, small areas of bleeding, and all of these types of injury together contributed to causing her to be in a coma, completely unresponsive.
Narrator: Hannah was on the edge of survival … in what doctors now call a “disorder of consciousness.”
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Joseph T. Giacino, PhD
Project Director
Spaulding-Harvard TBI Model System
Dr. Joe Giacino: We're at a point now in medical technology and knowledge where we can almost save anybody's life, even the most severe injuries. We can keep the body going. That's not the whole story. The question is how much of the brain can we rescue?
Gail Strom: I was focused on trying to, I don't know, have her wake up. I was definitely in denial thinking she was going to wake up the next day.
Narrator: Hannah would not regain consciousness for weeks.
Dr. Joe Giacino: The dilemma that we have is that in those first few days, we don't really know which patients are going to go on to substantially recover and which patients are either going to die or be left with very severe disability for the rest of their lives.
Narrator: Dr. Joe Giacino is project director for the Spaulding-Harvard TBI Model System Center.
Dr. Joe Giacino: There is a rush to judgment that occurs where there is the need to make a decision about whether we're going to treat this person aggressively after the severe injury. The problem is that that decision most often gets made within 72 hours of injury.
Narrator: The leading cause of death in those first three days is not the brain injury. It’s the withdrawal of life-saving medical care.
Dr. Joe Giacino: The neurobiology of recovery doesn't follow that timeframe. We know now that it takes substantially longer than 72 hours for people to begin to express signs of consciousness. They're just not there yet. The brain's not ready to manifest those signs. So we have a situation where operationally we're making the gravest decision one can make about a human being in a timeframe that doesn't match the biology of recovery.
Brian Edlow: One of the most important lessons of the last several decades of research in our field is that of prognostic humility. We as clinicians need to acknowledge to families that there is a range of possible outcomes. And multiple studies have shown that the manner in which we as clinicians communicate with families is the primary determinant of their decisions about whether to continue or withdraw life sustaining therapy.
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Day 6
Medflight from Lawnwood Hospital in Fort Pierce, Florida
to Massachusetts General Hospital in Boston
Narrator: After six days in a Florida intensive care unit, Hannah was flown back to Boston, for treatment at Massachusetts General Hospital. And her family embarked on a long journey of uncertainty.
Gail Strom: I would ask all the doctors, therapists, even strangers. Do you think she'll walk again? Do you think she'll live on her own? Will she talk again? Will she just be herself?
Narrator: Neurorehabilitation specialist Dr. Ron Hirschberg was one of the people charged with trying to answer those questions. He first met Hannah seven days after her injury.
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Ron Hirschberg, MD
Physiatrist, Massachusetts General Hospital
Spaulding-Harvard TBI Model System
Ron Hirschberg: The first thing that we did was observe and see if she was interacting with her environment at all, if she was moving spontaneously, moving her limbs, moving her head around.
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Day 7
No spontaneous movement
Narrator: Hannah was not.
Gail Strom: He sort of paved a path to expect maybe that she might not recover. And I don't think they thought she should.
Ron Hirschberg: We weren't sure. A lot of people weren't sure within the first couple weeks that we got to know her.
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Day 15
No spontaneous eye opening
Eye opening in response to touch
Narrator: Fifteen days after her injury, Hannah still was not spontaneously opening her eyes. But she would open them in response to touch.
Ron Hirschberg: We tested her corneal reflex that was intact bilaterally, and we knew that she had a gag reflex with the endotracheal tube. So those were all relative positive signs that her brainstem was getting back online, so to speak.
Narrator: Part of Dr. Hirschberg’s job was to help decide if Hannah was a good candidate for inpatient rehabilitation at Mass General’s partner institution Spaulding Rehabilitation Hospital.
Ron Hirschberg: It was February 3rd that someone had noticed that there was a difference in her eyes, very subtle. And when something's very subtle, you need to prove it. You need to keep on examining. And I remember specifically, she was able to look to one side and with multiple trials, was able to fixate on a mirror.
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Day 19
Eye fixation on a mirror
Narrator: This was a big moment for Hannah, being able to respond to something in the world … and her responses grew over the next days.
Ron Hirschberg: She was starting to become conscious. She was starting to look around the room. We knew that she was getting into this next phase of recovery where she would start to participate and get better and better.
Narrator: Decisions made and treatments given during those first few weeks saved Hannah’s life. What happened next would determine what kind of life it would be.
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Day 27
Moved from acute care to specialized inpatient rehab
Narrator: The team moved Hannah to Spaulding Rehab.
Dr. Joe Giacino: We don't really understand yet what the true active ingredients of rehabilitation are. It is certainly the case that we can help basically neurons reconnect by repetition … kind of how do you build a muscle? By doing reps. Doing the same thing functionally can increase neuronal connectivity and restore function.
Narrator: Beth Hansen is the therapy manager on the brain injury floor at Spaulding. Her team began treatment for Hannah right away, even though Hannah’s level of consciousness was very low, what is called minimally-conscious.
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Beth Hansen, PT, DPT
Therapy Manager, Spaulding Brain Injury Program
Spaulding-Harvard TBI Model System
Beth Hansen: We work on positioning in the wheelchair, in the bed. We use something called a tilt table when people are first starting out so that we can start them laying flat and then gradually get them to a near standing position so that their body can get used to being more upright.
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Less than 15% of traumatic brain injury patients receive inpatient rehabilitation care.
15%
Narrator: Less than 15% of people with injuries like Hannah’s ever get the chance to have inpatient rehabilitation like she got at Spaulding.
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Everyone else will most likely go home or to a long-term care facility, where the people who will take care of them don’t have the training to do it.
Narrator:
Around 85% will most likely go home or to a long-term care facility, where the people who’ll take care of them don’t have the training to do it.
There are a lot of complicated reasons for this, including healthcare policies.
Dr. Joe Giacino: If you're in the United States and you have a severe brain injury, in all likelihood you're going to get state-of-the-art care and your life is going to be saved. And we spare no expense in doing that.
Narrator: What happens next is the issue.
That's the critical point. That's where these rules kick in about who gets to go to inpatient rehab. So because it's 15% of individuals who get through that door, that means more than 85% are not going to get in and basically they fall off a cliff at that point.
Narrator: One of the major challenges is that current regulations around rehab hospitals require active participation from the patient, which is not possible for people in disorders of consciousness.
B-roll the big room of docs and therapists, no patient
Narrator: Dr. Giacino and other researchers are working to generate more evidence of the benefits of inpatient rehab for severe traumatic brain injury, or TBI. Their approach includes ongoing evaluation of patient progress and communication among members of the rehab team.
Dr. Joe Giacino: And when doing things that are complex like calculations, he's accurate?
Speaker 1: He is accurate. I'd say 90% of the time.
Narrator: Today, they are discussing a current patient … 20-year old Theo Visco, who was injured in a downhill ski crash in Vermont just three weeks ago.
Theo: I can see the difference in my writing from a week or two weeks ago. I couldn’t even move my right hand. And now, this is where it is … better than both my parents.
Gene Visco: It’s true.
Narrator: Theo’s consciousness has returned relatively quickly compared to Hannah’s, due to differences in their injuries.
Narrator: Today the team is discussing Theo’s impulse control.
Dr. Joe Giacino: Can you tell me what the impulsivity looked like? Examples of …
Speaker 4: It was a lot. I mean, in our sessions it was a lot of just trying to stand and walk from wherever we were.
Dr. Joe Giacino: So safety issues? Safety issues. Starting without taking precautions on.
Speaker 4: Yes, there was a big deficit with his right leg and foot where he was kind of crumpling any time he would stand.
Narrator: To work on both impulse control and control of his right leg, the team would mix physical therapy with neurologic music therapy … giving Theo a steady, rhythmic cue for his brain to respond to.
Gene Visco: And she said, I'm just going to just strum and just listen. And he started to bump to the music and strumming and he was just listening to music and walking better than I had ever seen. // And then she would speed it up and it would go a little faster and then she'd say, I'm going to change the rhythm and you could see it.
Speaker 4: Now he's at a level where he can be doing all of his daily routines of bathing, dressing the basic stuff with someone just with an arm's reach if he's not having to walk.
Dr. Joe Giacino: And that's because of the impulsivity still there?
Speaker 4: No, it's just because he'll need hands-on assistance to make sure he's steady enough
Dr. Joe Giacino: All because of the physical problems?
Speaker 4: Yes.
Dr. Joe Giacino: Okay.
Speaker 4: He knows. He's great. He'll ask every time before he stands up if it's okay if I'm ready. That insight and impulsivity has improved substantially.
Narrator: After their discussion, Theo joins the team, so that Dr. Giacino can demonstrate how he assesses someone at Theo’s level of recovery.
Dr. Joe Giacino: And if I do that, all right, here we go.
Narrator: Dr. Giacino and his colleagues will use what they learned here today to make adjustments in Theo’s treatment.
Theo: Oh
Dr. Joe Giacino: No, you're good, you're good. I screwed up. That gives you a chance to screw up too.
Narrator: When Hannah was four weeks out from her injury, the team was looking for much more subtle improvements.
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Day 49
Narrator: Her mom and dad witnessed one seven weeks after the crash.
Gail Strom: So Hannah's dad, March 4th, it was his birthday. So he came to visit, he and I went to a birthday dinner just down the street, and her friend came to stay with her.
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Thomas Strom
Hannah’s Father
Thomas Strom: I had to leave by four so I wouldn't hit the traffic and to get back to work and I reached over and kissed her and she squeezed my hand, which was I got for me, that was a sign that it's going to be okay. But that's what I felt that day.
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Day 52
Hannah’s consciousness is emerging: she expresses a preference.
Narrator: Four days later, Hannah’s primary physical therapist remembers noticing Hannah’s consciousness emerging. Here’s PT Abigail Spaulding.
Sound up
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Abigail Spaulding, PT, DPT, NCS
Spaulding Brain Injury Program
Spaulding-Harvard TBI Model System
Abigail Spaulding, PT: We wrapped her hands onto the machine and she started trying to pull her hands out. And at first we were like, well, that's not what we're trying to do. But at that point, she was still in a minimally conscious state. And so it was pretty amazing to kind of just see that moment.
Abigail Spaulding, PT: Oh, so you’re gonna do it that way instead. Well, you gotta pull this out. See. It’s gotta go …
Abigail Spaulding, PT: She was clearly trying to figure out how to get her hands out of these wraps. It was just like, all right, we’re, she's in there.
Narrator: Speech was a challenge for Hannah for a long time. But with months of daily work from Hannah, her mom, and her team of therapists, she slowly recovered her ability to talk.
Gail: What’s Dad’s name?
Hannah: Tom.
Gail: What’s my name?
Hannah: Mom. Gail.
Gail: What’s your name?
Hannah: Hannah.
Gail: What’s your brother’s name?
Hannah: David.
Narrator: Hannah’s progress accelerated. By June, it was time to go home.
Gail Strom: When I left anyone that touched her life here, I wrote a card out to each one in Abigail's. I wrote, I wish you could come home with me, cause I meant that.
Narrator: Hannah’s father and her brother, David, were preparing their house for Hannah’s return.
Thomas Strom: We put two shower handles, just lock 'em on the wall. We installed a ramp.
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Day 141
Hannah goes home.
Hannah Strom: When I went home, it was also a crazy experience because the streets of my town and Marion were filled with people. They were so excited to see me come home, but I still didn't know why. They were all so excited to see me. I had felt like I had only been away for a day.
Narrator: Part of the support that Spaulding provided was continuing therapy at home for Hannah.
Thomas Strom: The therapist would come see her and she was lifting weights and I think there were two pound weights and she looked at me like, I don't want to do this. She didn't need to do that. She goes, I want to walk. We just made her walk further every day. So whether it was 10 feet or one foot, but every day we went out, we went further and further.
Hannah Strom: And I remember I had a goal. By December of 2020, my goal was to run the mile loop. So my PT Abigail and my high school coach Finch, they both came down to run with me. And I wasn't fast at all, but I didn't stop and I ran the mile. And at the finish line was a puppy.
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Day 333
Hannah runs a mile, meets Ruthie, her therapy dog.
Thomas Strom: So she just walked by everyone and grabbed the puppy, which was funny.
Hannah Strom: My memory? I've definitely found school to be a challenge, but I'm pushing through. My memory's definitely been affected.
Ron Hirschberg: It's an incredible thing to speak with someone that has emerged into consciousness, beyond minimally conscious state. They won't remember you. They won't remember being in the intensive care unit. And Hannah, I remember visiting her at Spaulding, and I remember her smile. I remember her saying how she was starting to eat. She was talking about rowing. And that to me is just incredible because yes, we're seeing the brain recover. We're seeing their ability to create and recreate and relearn the ability to do all these things.
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Roughly 1 out of 5
Narrator: Roughly 1 out of five people who sustain a severe TBI will recover their independence, like Hannah.
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Roughly 4 out of 5
Narrator: The other four out of five will need some level of care for the rest of their lives, ranging from help with finances or driving to, say, bathing or eating. A small fraction of those people will remain unconscious, or minimally conscious, unable to engage with the world in a meaningful way.
Narrator: The knowledge of that possibility is a heavy weight for families and doctors in emergency rooms and ICUs.
Dr. Joe Giacino: It's not always the case that the decision to withdraw a life sustaining treatment is wrong. A person may have expressed a wish prior to their injury that they, for example, would not want to live with a disability of any type, express that to the family and the family is respecting the person's wishes. I would make the case that it's wrong if the main reason we're doing that is we believe there's no hope for further recovery.
Narrator: Five years after her injury, Hannah is living on her own in an apartment. And she’s been able to find work doing something very meaningful to her.
Hannah Strom: I've been the rehab aide for the past four summers at Spaulding where I myself did therapy. And it's weird to see some of the therapists who were helping me in my rehabilitation. thanks to them, I can now help patients get back to their old life.
Narrator: And she’s also hoping to get back behind the wheel.
Thomas Strom: I think we have one thing on the list and I think it's just driving. Once that gets my approval and it's not yet, that will be the next step.
Narrator: Something that has been really hard is what the injury has done to Hannah’s ability to express emotion. She’s not been able to have the release of crying about this traumatic experience.
Thomas Strom : Besides the driving. I just want her to cry. I, that's it, probably.
Narrator: For Hannah and her family, there is grief at what they’ve lost. And there is deep gratitude for what was saved … saved by dedicated researchers, doctors, and therapists, people committed to giving everyone that same chance to live again.
On-Screen Titles
Narrator: TBI Model System Centers provide coordinated and multidisciplinary care and conduct research to improve care and outcomes for people with brain injury.
Narrator: This video is a product of the Model Systems Knowledge Translation Center, in collaboration with the Spaulding-Harvard TBI Model System Center, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research.
Narrator: To learn more about the work of the TBI Model System Centers, please visit MSKTC.org.
Narrator: Visit MSKTC.org for the entire Recovering from Disorders of Consciousness Hot Topic Module.
Producer
Christian Lindstrom
Montage
Alan Brain
Camera
Allie Humenuk
Audio
John O’Connor
Production Assistant
Stella Little
Narrator
David Ginder
Model Systems Knowledge Translation Center
Cindy Cai
Music
The Worlds by Tape Studio
Might Be Happening by Big Score Audio
Embrace by Swan Productions
Garden of Fireflies by Material Music
Endless Dreams by Tristan Barton
Photo Credits
© Corey Arwood – USA TODAY NETWORK via Imagn Images
Tim Seeberger, Sippican Week
Special Thanks
Rachel Bleimeyer, PT, DPT
Christine Chen, PT, DPT
Jodie Chickvara, OT|
Kiera Druhan, MT
Lindsay Ladue, SLP-CCC
Cheryl Langlais, PT, DPT
Ellyn Pier, MPH
Craig Rovito, MD
Shirley L. Shih, MD
David Strom
Tim Sullivan
Julia Taylor
Primma Valera
Narrator: We’d like to offer our sincere appreciation to Hannah Strom and her parents, Gail and Thomas Strom, and to Theo Visco and his parents, Courtney and Gene Visco, for allowing us to share their stories.
The contents of this video were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this video do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
© 2026 Model Systems Knowledge Translation Center (MSKTC)
Produced by the Model Systems Knowledge Translation Center (MSKTC), this story is part of the Recovering from Disorders of Consciousness Hot Topic Module. The content of this video is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model System (TBIMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research, as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs. The content of the video has also been reviewed by individuals with TBI and/or their family members.
Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this video were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this video do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.
Copyright © 2026 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.
About the author: Model Systems Knowledge Translation Center (MSKTC)
The Model Systems Knowledge Translation Center (MSKTC) is a national center operated by the American Institutes for Research® (AIR®) The MSKTC collaborates with Model System researchers to translate health information into easy to understand language and formats for people living with spinal cord injury (SCI), traumatic brain injury (TBI), and burn injury and those who support them.
