The Brain Injury Dilemma
By Anna Peterson
Monday, February 28, 2005
Head injury, also known as traumatic brain injury, is an
injury that results in damage to the brain.
Head injury may occur in one of two ways:
A closed head injury occurs when the moving head is rapidly stopped, as when
hitting a windshield, or when it is hit by a blunt object causing the brain to
smash into the hard bony surface inside the skull. Closed head injury may also
occur without direct external trauma to the head if the brain undergoes a rapid
forward or backward movement, such as when a person experiences whiplash.
A penetrating head injury occurs when a fast moving object such as a bullet
pierces the skull. Both closed and penetrating head injuries may result in
localized and widespread, or diffuse, damage to the brain.
The chilling fact is that each year, an estimated 2 million people sustain a
head injury. About 500,000 to 750,000 head injuries each year are severe enough
to require hospitalization.
Head injury is most common among males between the
ages of 15-24, but can strike, unexpectedly, at any age. Some head injuries are
mild, and symptoms usually disappear over time with proper attention. Others are
more severe and may result in permanent disability.
Living with brain injury and living with a brain injured person can be difficult and the problems start with rehabilitation.
It is especially critical that you observe and understand the
individual's limitations in the broad area called "executive functions":
attention and concentration, distractibility, initiation, planning and
sequencing. These are the skills which must be developed before you begin to
address more specific areas such as memory, learning, and perception. You must
discover how long the patient can attend to each specific type of task: you may observe
that they are able to process verbal information for only 5 minutes but visual or
motor information for 15 minutes.
A patient may do well on certain activities if the
room is quiet and they are well rested but totally lose that ability if the
slightest noise occurs. You may observe that once they start a task he can finish
it easily but appears unable to get that first step going. Or you may observe
that they consistently stop at the same step or leaves the same step out each
time they try a certain task.
Although it is relatively easy to understand the injured individual's
limitations in physical endurance, limitations in cognitive endurance are more
difficult to observe and to understand. It is important that you keep track of
time as well as activities as you observe the injured individual: how long the
individual can work with words, with visual information, and on motor tasks and
see how abilities in these areas deteriorate over time.
One of the hallmarks of head injury is performance variability: the individual
can do something with apparent ease one day and appear totally confused and
unable to do the same activity another day or at a different time the same day.
In analyzing the individual's abilities, therefore, it is important to
understand the circumstances under which each ability is seen: (a) environment
variables (e.g., who else was present, other activities occurring at the same
time); (b) variables within the injured individual (e.g., fatigue level, how
long the activity went on, what else the person has done earlier in the day,
mood); (c) interpersonal variables (e.g., the mood of family members involved in
the activity).
Memory problems are extremely common following head injury and account for a
large percentage of the problems experienced by injured individuals and family
members. Unfortunately, many people do not understand that attention and
concentration must precede memory: if information didn't get in, in the first place,
you can't remember it later on. We also tend to evaluate memory by verbal
reports (i.e., what the person says) rather than behavioral observations (what
the person does).
Generally the problems are in remembering information since the injury. It is
important to observe what kinds of information the individual is able to
remember and under what circumstances. Is he more able to remember something the patient did than something you told them? Does the patient remember things they heard better than
things he saw or read? Does the patient remember things that happen in the morning better
than things that happen at night? Have you observed them doing things even though
they say they don't remember how to do them? Can the patient remember things in one
location and not another? If you understand the circumstances under which the patient is
most likely to remember things, you have a good handle on how you can retrain
their general ability to remember important information.
After you have carefully observed the injured individual's current abilities for
several weeks, all family members should meet to share the information collected
and make sure you agree on what you have observed. The more you all understand
about the individual's current abilities, the more able you will be to help him
develop appropriate skills and to continue the family's recovery from head
injury. At the end of the observation period, you should have a pretty good idea
of which family member can work best with the injured individual on certain
tasks.
Please remember that serious brain injury usually results in
a loss of consciousness, commonly called coma, which may be brief - lasting only
a few minutes - or may extend to days, weeks, or months. If the period of coma
is short, return to full or nearly full function is likely; but as time in a
coma lengthens, intellectual and speech impairment, behavioral disorders, and
related physical disabilities can occur.
It is important to note that a person does not have to lose consciousness to
have sustained a brain injury. Minor brain trauma, where there is little or no
loss of consciousness and no resulting hospitalization, can also cause temporary
or permanent damage to the brain.
A brain injured person may become easily angered or
frustrated. No one likes to spend prolonged periods of time working on
activities they do not do well. Make sure your cognitive retraining program
includes activities which the individual can perform well and enjoys doing;
guarantee success as much as possible to keep motivation high. Be creative and
flexible but don't change an activity until you are certain it won't work or the
individual has mastered it and is ready to move on to the next step.
When family members have a well-organized plan to re-build skills after head
injury, the injured individual is more likely to continue to recover and to
maximize his abilities while minimizing family stress.
Since insurance generally covers just a small part of the
necessary therapy, having access to the extensive costs of rehabilitation
programs that are often necessary for brain injury patients can be
overwhelmingly difficult and burdensome. If the brain injury was suffered as a
result of negligence, you need to speak to an experienced lawyer. We're here to
answer your questions and if it's a matter of negligence or medical malpractice,
then we'll make sure you get the prompt, professional attention you expect and
deserve.
