Though Harris and her team are armed with data to benchmark the recovery of their patients, they deploy it judiciously among themselves.

"I don't actually stand at the bedside and say to the family, 'You know, your family member is on the higher end of traumatic brain injury patients, therefore I'm a little less optimistic,'" Harris says. Instead, it's about guiding expectations and directing staff to focus on an evidence-based treatment plan that will, for example, keep a patient on target to recover at the appropriate pace or make measurable improvements in cognition and speech.



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Gaal did not know that this data from the experiences of thousands of patients was guiding his recovery, and it's a realization that doesn't make a difference to him. "I knew they were going to give me the help I needed," he says. "They don't need to be up front about it."

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Dr. David X. Cifu, the VA's director of the physical medicine and rehabilitation program likes to think of the acute and long-term TBIMS data as a roadmap for recovery.

Staff at polytrauma centers, for example, can plug in seven factors and get a patient's expected length of stay at a rate that Cifu says is about 50 percent accurate. Those might seem like lousy odds, but for a patient with a TBI, an amputation and severe burns, knowing how you compare to 10,000 people who have had similar injuries is something tangible.

It also allows hospital staff and families to begin immediately planning for that projection. If there's a setback, like a seizure or an infection, both groups can rally around the road map, using it as motivation for realigning the patient with his treatment plan. Cifu says the staff will remind a service member whose confidence or determination has flagged that pain brings recovery: "If you struggle harder, tomorrow will be better, and we're going to keep laying on more struggle."

Gaal knows this well. He was motivated, privately setting goals outside of physical therapy sessions and exercising in the gym or his room. He drew on old basketball workouts to improve his core strength. He remained a fighter, but there were often moments of despair.

One day he refused to attend a groundbreaking ceremony attended by VA Secretary Eric Shinseki on the hospital's grounds. Gaal couldn't yet independently move himself from the bed to a wheelchair and cited that as part of his reluctance. The center's program director, Pawan Galhotra, and social work supervisor, Scott Skiles, safely transferred him by the sheet of the bed to his wheelchair and escorted him out. "They pushed me," Gaal says. "They wouldn't allow me to sit around in my room and sulk about anything."

Galhotra, who came to the VA from the private sector, says this diligence is necessary: "It's very important to emphasize that because we have resources doesn't mean we can sit back and say we're resource rich. I constantly challenge the team to say how are we pushing this individual forward."