BACKGROUND: This article describes the rehabilitation of a patient recoveringfrom a prolonged coma (defined as lasting longer than 4 weeks). The case is noteworthy because it exemplifiesthe possibilities and difficulties entailed in treating these patients, who are often regarded as tooseverely impaired to justify intensive rehabilitation efforts. CASE REPORT: The patient is a 28-yearold Polish male, unmarried, who suffered serious closed head injuries in an automobile accident in Aprilof 1999. He was in a comatose state for more than two months, with a GCS score of 5. When admitted forrehabilitation he was bedridden, with global aphasia, agraphia, limb apraxia, and executive dysfunction.The rehabilitation program developed for him is described in detail. RESULTS: Over the course of rehabilitation,which began in December 1999 and continues to this writing, the patient has regained locomotion capabilities(though with impairments), and his speech has improved considerably. The apraxia has largely resolved,and he is able to write his name and copy words. He is now capable of performing many activities of dailyliving. CONCLUSIONS: A comprehensive program of rehabilitation characterized by a strategic, heuristicapproach is capable of achieving a good outcome even in very difficult cases, such as prolonged coma.

Keywords: Accidents, Traffic, Activities of Daily Living, Apraxias, Brain Damage, Chronic, Brain Injuries, Cerebrospinal Fluid Shunts, Coma, Post-Head Injury, Frontal Lobe, Glasgow Coma Scale, Head Injuries, Closed, Hydrocephalus, Language Disorders, Movement Disorders, Neuropsychological Tests, Physical Therapy Techniques, Severity of Illness Index, Speech Disorders