Botox helps Plainfield man recover from traumatic brain injury

Just before Christmas 2013, 49-year-old David Brongiel's life was forever changed by a motor vehicle accident that resulted in a severe traumatic brain injury, or TBI.

A TBI occurs following a violent blow to the head and can cause a wide range of debilitating physical and psychological symptoms in both the short and long term.

After three weeks in a coma, David was moved to a long-term acute care facility for one month, and then spent three months in a rehabilitation facility. At that point, medical providers felt his improvement had plateaued and his care could be managed at home in Plainfield, where he lives with his wife, Rita, and daughter, Marisa.

Once home, a plateau wasn't the plan for David and his family - they were determined to move forward. After David's discharge from the rehabilitation facility, he began a regular exercise routine.

In 2016, the family was referred to Dr. Yonghua Michael Zhang, a neurologist with the Edward Neurosciences Institute.

"When I first met David, he was dealing with severe deficits from his injury; he was right-side hemiplegic (paralysis), had significant muscle spasticity (continual contraction) and was aphasic (language impairment)," Dr. Zhang says.

"After the extensive treatment he'd already received, his parents were desperately searching for anything additional that could be done."

Due to his right-side paralysis, David was not mobile. He had trouble communicating and severe muscle tightness and spasms were inhibiting his movement. In order to relax impacted muscle groups, Dr. Zhang developed a treatment plan that involved administering Botox injections with electromyography guidance.

Botox is a chemical that can result in the sustained relaxation of muscles and is used for a variety of conditions, ranging from cosmetic enhancement to the treatment of headaches, or the spasticity of muscles related to TBI or other neurological disorders.

Guiding these injections with EMG allows a neurologist to target the exact muscles that need it most.

Every three months, David meets with Dr. Zhang and they work together to discuss and determine the muscles that will benefit most from the injections. Following their appointment, the Brongiels head straight the gym to begin exercising the treated muscles.

"Dr. Zhang explained that without regular physical therapy, in addition to the Botox injections, David was at risk of losing functionality permanently, and this scared us," says David's mom, Carol. "We committed to taking him to the gym on a regular basis."

Since 2016, David's parents have been bringing him to the gym three days a week and haven't missed a day.

According to Dr. Zhang, the three-month cycle of EMG-guided Botox injections, followed by regular exercise, is what gives David's muscles the opportunity to increase function, flexibility and strength.

Without this combined approach to his treatment, as well as the dedication of his parents to his care, he wouldn't likely continue to see improvement.

"If you're able to stop the muscles from spasming, a patient can move better, exercise and improve," says Dr. Zhang. "Without the exercise, the muscle stiffness prevents a patient from doing physical therapy and functionality decreases."

Five-and-a-half years later, David continues to progress. He's walking with the help of a walker and fishes regularly, an activity he loves.

Just as important as his physical improvement is the source of inspiration David provides for everyone he meets.

"You should see him at the gym on the elliptical machine," says Carol. "People come up to him constantly, encourage him and thank him for the inspiration and strength he gives them."

David is a source of inspiration for Dr. Zhang as well, who continues to be amazed by his improvement at each appointment.

"It's encouraging for me and such a great learning experience, because I have treated so many TBI patients," says Dr. Zhang. "David's success is beyond my expectations, and his parents' support has played a huge role. They won't quit."

"Dr. Zhang has been our backbone, our encouragement, our support," Carol says. Her husband Don adds, "He is such a personal doctor. He explains everything so well and educates us. He and his nurse, Jenny, are wonderful."

After so many years of continued improvement, this experience has given the Brongiel family, especially David, something they weren't sure they'd have again - hope. Recently, Carol asked her son about his hopes and dreams now.

David's reply? "I want to walk my daughter down the aisle."

For more information about neuro services at Edward-Elmhurst Health, visit www.eehealth.org/services/neuro.