I call it an interesting twist because the Tony character was more than just the leader. He is smart, good-looking, always got the girl (or boy) kid, who cooked up many parties and other schemes for the other teens, while being seen as a wunderkind by the adults in the show (mostly parents and teachers).
Sunday's episode did a good job, I think, of not sugarcoating what faces someone who's experienced a major head injury. He obviously isn't going to make a miraculous recovery, soap opera style. In fact, it's unclear if he will be able to return to school because of his cognitive impairments. I hope the show doesn't go for a quick recovery or even any recovery because the show appears to trying to deal with his disability in a realistic way. Something that TV needs more of.
You can read a NY Times article about the first season of "Skins" here.