A seemingly normal day in the late ’90s abruptly changed for Jeremy Greene.

With music filling the car and friends chatting, Greene hit a rut while driving on Lone Hand Way near Breckenridge, sending his vehicle into a 180-degree spin. The 16-year-old Summit High School student desperately reached for his seatbelt but never heard it click before the vehicle careened off the roadway and into a tree. 

First responders found Greene unconscious. For the next 85 days, he remained in a coma, leaving his parents, friends and family worried whether he would return to the vibrant life he lived prior to the accident Sept. 7, 1999. 

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“He may have had a black eye, but really the only surgery they did was to put a probe in to monitor the (brain) pressure,” his mother Kim Greene said. “He definitely had brain swelling, and that brain swelling caused injuries all throughout.”

Greene sustained injuries deep in his brain stem and suffered a coup-contrecoup traumatic brain injury, which is caused when the brain bounces back and forth against the skull.

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When he emerged from his coma, he began navigating a difficult recovery process. Through extensive treatment, he exceeded many of the health professionals’ expectations. 

“They never thought he would come out of it. They thought he would be in what they call a persistent vegetative state,” Kim Greene said. “We were being taught how to take care of him in that state of not being alert or responsive. He kind of slowly evolved and started getting better. It was kind of wild.”

Warning signs of a ‘silent epidemic’

While the severity of Greene’s accident and condition often prompts medical intervention, many go undiagnosed. 

A 2004 report from the U.S. Centers for Disease Control and Prevention calls traumatic brain injuries, also known as TBIs, a “silent epidemic” since the problems caused by them are often not visible, and the public is largely not aware of how prevalent they are in society. 

Globally, an estimated 64 million to 74 million people sustain a TBI annually, with an estimated 75% to 90% of those injuries often categorized as mild, according to a 2021 study published by the Journal of Neurotrauma and republished by the National Institutes of Health. Reports from the Brain Injury Association of America state that up to 56% of traumatic brain injuries are not detected in the emergency room. 

Though mild TBIs might not immediately cause noticeable symptoms, these cases can still cause issues with balance, thinking, pain and depression, which can be persistent if left untreated. Since several TBI symptoms — including headaches, fatigue and dizziness — are also common signs of other ailments, it’s easy for patients and even health providers to improperly diagnose brain injuries. 

Stephanie Zavilla, the director of sports performance at the Winter Park Competition Center, spent three years suffering from side effects of a TBI before she received a firm diagnosis. 

Although Zavilla recognized that she was suffering from the symptoms of a concussion, she said every health care professional she saw did not look at her symptoms in depth.

“I asked, ‘What’s really going on here? I am not getting better. Things are in fact getting worse,'” Zavilla said. “It came to the point where I needed to go back to work, and in the end, that was the decision that was the kiss of death.”

Not fully recovered, Zavilla put herself into a stressful work environment and soon developed mini-seizures. 

“I started getting really frustrated, and the emotions started getting more intense,” Zavilla said. “The depression started setting in.”

Worsening symptoms are common for those with traumatic brain injuries. When patients don’t get appropriate treatment, return to everyday activities too soon or are left undiagnosed, they can often spiral.

“There are structural and chemical changes that can happen when we are experiencing a traumatic brain injury,” Middle Park Health psychiatric mental health nurse practitioner Marcie Beroske said. “Each lobe does something differently, and if you are causing damage to those synapses or how the chemicals are being transported throughout the brain, all of that can impact how your body or your mind is going to react to the cues.” 

While it can be easy to brush off a minor-to-moderate concussion, especially in sport settings, it is important to recognize the warning signs and symptoms of a TBI. 

According to the Mayo Clinic, some of the major TBI symptoms include persistent headaches, repeated vomiting or nausea, clear fluid draining from the nose or ears, trouble with speech and sensory problems like blurred vision or ringing in the ears. 

Once a traumatic brain injury has been identified, patients can begin the recovery process. 

Strategies for recovery

While traumatic brain injuries can be devastating to patients and their families, a 2021 study published by the Journal of the American Medical Association suggests the brain is quite resilient and elastic. 

In the study, which involved nearly 500 participants, 52.4% of those with a severe injury and 75% of those with a moderate TBI obtained a favorable outcome. These individuals recovered enough that they could function independently at home for at least eight hours per day.

“Physically, your body needs to recover,” Beroske said. “Sometimes people are able to reach a baseline level of where they were functioning before, but depending on the level of impairment, they may never reach the full level of functioning.”

Despite risks caused by these life-altering incidents, a wide-range of treatments has been proven to be an effective option to get relief — or even fully cure major symptoms.

“Depending on what part of the brain that is impacted, the brain is absolutely resilient and can repair itself with the right treatment and rest,” Beroske said. “Really, it takes a medical treatment team to target all of the different ways we need to be looking into this.”

When Melissa Volkert, an occupational therapist and certified brain injury specialist at Vail-Summit Physical Therapy, first started seeing traumatic brain injury patients in 2011, it was widely believed that the best way to treat a brain injury was to have patients shut themselves in their rooms for several days.

“I think back then there was this prevalent belief that you just sit in a cocoon — no simulation, dark, quiet, you don’t do anything,” Volkert said. “You sit there for two weeks, and you come out a butterfly. The research is showing that is not the belief anymore.”

Unlike previous head-injury guidelines, current research is pushing for light activity early on in the recovery process.

According to a 2022 report published by the British Journal of Sports Medicine, patients with a head injury need to get treatment sooner than doctors originally thought. Instead of waiting for symptoms to go away after a week or two of rest, current research encourages patients to seek treatment almost immediately after an injury occurs.

Once treatment has been sought, doctors and health care providers following the current research will then implement a gradual progression back to activity that will stimulate the brain but not overly push it, which would put it at risk of further harm.

“I think it is really hard for us to do things gradually,” Volkert said. “We are all or nothing. Or we don’t really know how to make a task simpler, or how to ask for modifications or adjustments to your work or school. That is kind of the role I see for therapy.”

For Volkert, who works with head injury trauma patients at St. Anthony Summit Hospital in Frisco, she sees patients less than 24 hours after their injury. 

While the injury might still be taking shape, Volkert wants to make sure patients have the best game plan and strategy to recover before being discharged from the hospital. 

“We are working with a lot of people locally but also tourists,” Volkert said. “That education and treatment looks a lot different. We really emphasize symptom monitoring, so we give them a symptom log of all of the potential symptoms. … We want to make sure people are not having a headache for two weeks.”

For those who are from the county or are planning to stay in the county for an extended period of time, Volkert uses the patient’s symptom chart from the hospital to set up treatment options. 

Depending on the symptom and the amount of time a health care worker has with a patient, treatment can range from posture strategies and balance exercises to sensory-calming strategies. 

In terms of outpatient treatment, Volkert sees patients at Vail-Summit Physical Therapy who may need help with symptoms related to whiplash, balance issues and vestibular problems. 

“Physical therapy can really work on those whiplash neck symptoms,” Volkert said. “They will do manual therapy, dry needling, craniosacral work and posture strengthening. Those are all for the neck pain, the headache and dizziness.” 

Physical therapists will also conduct vision, balance and cognitive tests to make sure patients are gradually improving and symptoms are not getting worse. 

Beyond working to address symptoms, Volkert will make sure individuals with head injuries are doing OK mentally with the injury. With brain injuries often being hard to recognize from the outside, it can be easy for individuals to feel isolated and experience mental health issues. 

The lack of mental health resources for patients is one of the main reasons Dr. Lisa Ansell, a licensed professional counselor at A Listening Ear Counseling in Granby, became a therapist. As an individual with a TBI, Ansell offers a space for brain injury patients to filter through the emotions and feelings they may be having.

“I went through this process myself,” Ansell said. “… I have been through where my clients have been — where people are saying that you are weird, you are awkward. I even had a boss make fun of me in front of my peers, but I kept going.”

Seeking an all-in approach

Feeling like she was at her wit’s end, Zavilla became part of a project called Concussion Code.

It was during this project, which was put on by Dr. Chad J. Prusmack, that Zavilla’s symptoms got looked at in a more holistic way.

For the first time in Zavilla’s recovery, she said Prusmack took a full assessment of everything going on in her life, including diet, lifestyle, balance and cognition. 

She also received several MRI and medical scans that finally gave her a firm diagnosis. After years of trying to get answers, Zavilla found out she had several lesions on her brain and a bad case of post-concussion syndrome. 

While at Prusmack’s clinic in Denver, Zavilla engaged in five to six forms of therapy.

After revolutionizing her diet and working through physical and occupational therapy, suddenly the majority of Zavilla’s symptoms went away. Although Zavilla continues to live with a seizure disorder, she considers herself lucky to have found practitioners who looked at her injuries with a larger lens.

“They basically changed every aspect of my life trying to get at these lingering symptoms,” Zavilla said. “For three years, I had been struggling, and within three months of working with Concussion Code, they gave me my life back.”

How support groups can help TBI survivors find community

Like Zavilla, many of Greene’s major TBI symptoms were able to be addressed with a wide range of therapy options. Whether attending vision therapy sessions or going to horseback riding therapy, Greene saw success addressing his lingering symptoms and weaknesses with different forms of treatment. 

“You name it — if it was out there or something we could try, we did it,” Kim Greene said. “I told somebody, ‘We will go walk on hot coals if that is going to make him better.'”

Although Greene’s recovery was challenging at times, he steadily improved from one week to the next, and he steadily regained movement and functionality. 

“I had to relearn everything,” Greene said. “I had to learn how to eat, how to drink, how to swallow, even.”

Outside of the speech therapist helping him to be able to swallow, he also saw therapists to help him improve his speech and vision after coming out of the coma. 

“The vision was weird to get used to,” Greene said. “The way I talked after I woke up from the coma was very slow and slurred. Just everything — readapting to life.”

“I did most of the hard work myself,” Kim Greene said about caring for her son. “I took off work for at least a year, but we had PT, OT and speech. We had great therapists. … We had very high quality therapy for him for a long time.” 

Despite doctors thinking he might remain in a vegetative state for the rest of his life, Greene was able to graduate from high school and then went on to attend Colorado State University in Fort Collins. 

While at college, Greene completed a bachelor’s degree in fine art in painting and now lives independently in Summit County. 

“Our story, there is a lot of positive stuff, but there is also a lot of negative stuff,” Kim Greene said. “It is a roller coaster. It still is a roller coaster. That is the thing we want to convey: Here we are 25 years later. It does not go away.”

While Greene still struggles with some mobility, vision and speech issues related to the car accident, he finds great comfort through painting. Artistically talented even before his head injury, the act of creating art from his mind and portraying his emotions serves as a form of escape, release and therapy.

“I’ve always used art, or art and painting and expression making, as just a way to cope with the tornado of insanity that is everyone else,” Greene said. “It’s a way for me to focus and not think about everything else.”

Sky-Hi News reporter Emily Gutierrez contributed to this report.