VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Pat #10

DEAR PAT:

I was in a car wreck last September in which I went through the windshield. I have an inch-long gash and a large dent in my forehead. I did not feel anything weird until this January when I started having shooting pains behind the affected area of my forehead. When the pain comes, my vision is messed up and I cannot think very clearly. I went to the doctor and he just said I was having migraines. It's starting to scare me and I don't know what to do. Who should I contact to find some answers?

PAT'S RESPONSE

I'm not sure what type of doctor you have consulted but you may want to consider seeking the opinion of a neurologist and/or a physiatrist. A neurologist is a doctor who is trained to assess central and peripheral nervous system disease and illness. A physiatrist is a doctor who specializes in rehabilitation medicine. The physiatrist both diagnoses and treats neurological, muscular, and skeletal problems. Look for someone who is very experienced in assessing and treating headache -- someone who will identify the cause of the pain and then suggest a variety of treatment options. Headaches can have many physiological origins -- muscular, vascular, joints, etc. -- and pain can be alleviated a number of ways, including medication, physical therapy, diet, and visualization. Any intervention will be more effective if it addresses the cause of pain, not just the symptom, in a holistic manner. For help in locating a physician who can help, contact the following resources:

1. Brain Injury Association, Inc., 105 North Alfred Street, Alexandria, VA 22314. Phone: (703) 236-6000
2. American Council for Headache Education, 875 Kings Highway, Suite 200, Woodbury, NY 08096. Phone: (800) 255-ACHE
3. National Headache Foundation, 428 W. St. James Place, 2nd Floor, Chicago, IL 60614. Phone: (800) 843-2256

DEAR PAT

I am currently attending a 2-year college for individuals with learning disabilities. I am learning a lot here, but I am looking for a school or program that deals specifically with students who have brain injuries. Do you know of any?

PAT'S RESPONSE

To anyone with a brain injury (or other disability) considering college, Pat has the following advice: (1) You will need to think about the same things everyone does, such as educational and career goals, financial needs and assets, living on-campus or off, taking classes full-time or part- time, etc. (2) In addition, you will need to think about your special needs, such as classroom accommodations, courseload alterations, personal assistance using the campus, etc. (3) In resolving these issues, seek advice from someone like a school counselor or teacher at your high school or at one of the colleges you are considering. (4) To decide which college is right for you, talk with as many people as possible, such as your high school teachers and advisors, as well as college graduates whom you know. Get college catalogues and pamphlets, and look for colleges which meet your academic needs. The pamphlets also will give you a general idea of the accessibility of the campus layout, the transportation system, and the surrounding town. When you contact the colleges and visit, you will get a better idea of how your special needs will be addressed. (5) Visit prospective colleges and while you are there, meet with the person in charge of making special arrangements and accommodations for students with disabilities. There should be an office of "student services" or "student support" or something similarly titled. The person in this office who handles disability issues will take care of arranging untimed tests, books on tape, interpreters, personal assistance on campus, and other accommodations. You want to feel confident that this person will be on your side and help you get your college education. Without a strong on-campus advocate, you could face a continuous series of roadblocks. (6) Once you choose a college, be prepared to provide the college documentation regarding your disability (e.g., intellectual test results) in order for you to receive accommodations. You must be prepared far ahead of each semester's registration period to identify and secure the appropriate accommodations (e.g., interpreters must be recruited and hired months ahead of time).

People with disabilities who would like information about post-secondary education options and issues (including financing college) may contact the HEATH Resource Center. HEATH provides answers to individual questions and a variety of helpful publications, including guides to choosing and financing college.

HEATH Resource Center, National Clearinghouse on Post-secondary Education for Individuals with Disabilities, American Council on Education, One Dupont Circle, Suite 800, Washington, D.C. 20036-1193. Telephone: (800) 544-3284 or (202) 939-9320

DEAR PAT

I am a 29-year-old woman who recently suffered a mild stroke. Is it normal to go through severe depression after a mild stroke?

PAT'S RESPONSE

Wait until you turn 30 and tell us how depressed you are.

On to your real question. After a traumatic event such as a stroke, it is not surprising that you feel depressed. A stroke can result in major life changes. You may not feel like your old self. Perhaps your abilities are impaired now. Or, maybe you are just having a hard time getting back in to the routine of life after such an unexpected upset.

You need to consider two possibilities. First, you may have sustained organic injury to your brain which is causing this mood alteration. Neurological and neuropsychological tests can reveal that. For example, someone with frontal lobe damage may be expected to act different than he used to prior to the brain injury, since the frontal lobe controls much of our personality/behavior.

Second, you may be reacting normally to a traumatic event. In this case you could be told by a psychologist or psychiatrist that you are experiencing a major depressive episode. If you have 5 or more of the following characteristics most of the day, nearly every day, for a continuous 2- week period, you could be diagnosed as clinically depressed: (1) Depressed mood; (2) Diminished interest in almost all activities; (3) Significant weight loss or gain; (4) Cannot sleep or need much more sleep than usual; (5) Psychomotor agitation or retardation; (6) Fatigue or lack of energy; (7) Feelings of worthlessness or excessive guilt; (8) Diminished ability to concentrate; (9) Recurrent thoughts of death, or suicidal ideation, plan or attempt.

In any case, Pat would feel better and probably you will too if you see a psychiatrist for an evaluation and possibly medication; there are many medicines that can alleviate depression. At the same time, you should see a counselor. This piece is critical to your examining your life and feeling good about it again. This combination of psychiatry and counseling should help (and then maybe 30 won't be so devastating either).

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