VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

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

Pat #12

DEAR PAT: My father had heart failure and it took him 20 minutes to bring him back. The doctor gave him medication and he was supposed to wake up in about 10 hours. It has been over 72 hours and his is in a coma. His heart and organs are functioning well and a brain scan showed no signs of stroke. Can you tell me how long it takes to get out of a coma?


PAT'S RESPONSE:Afraid I can’t answer that one. These things vary from patient to patient and are always hard to predict. The physician treating your father is the best source of information about his particular case. It sounds like your father may have experienced what is called a hypoxic coma. This means that there is oxygen deprivation to the brain. A heart attack is one of the most common causes of hypoxic coma. Because the brain does not store oxygen, the brain needs a constant supply. If that supply is interrupted, brain cells begin to die.



Generally, the longer in a coma the less likely there will be a good outcome. However, if your father shows good brain function, there is a good chance he will "emerge" from his coma. Sensory stimulation may help him emerge from the coma, although there is some controversy over the effectiveness of this intervention. After he is awake, he may need a significant amount of rehabilitation therapy and may experience many of the problems with attention, memory and behavior that are experienced by other survivors of brain injury.

DEAR PAT:I’m a 27-year-old brain injury survivor. I’m going to college, but I’m having problems with math. I’m working with disability services. Otherwise I’m doing fine in school. Should I keep going or give up? Math is the only subject I have real problems with. I was treated in the emergency room and released. I didn’t even spend one night under observation! Is this weird?


PAT'S RESPONSE: A college student having trouble in math? Shocking! Unless you’re writing from MIT, I doubt you’re rare. I’m quite sure graduation rates across the country would plummet if every student who is doing well in all other subjects "gave up" because of math.



Most people are able to overcome math-related learning disabilities or other deficits to make it through an undergraduate math or statistics course. If you just need to get through one course, you might consider auditing it before you take it for credit. Sometimes exposing yourself to the material without the "pressure" of having to make a grade helps. If your school offers math in large classes with little individual attention, find out if you can take the course at a smaller school and transfer the credit. Also, many students need tutoring. In most cases, it’s worth your investment of time and money because you get individual help tailored to your needs. Discuss your needs with your instructors. Request untimed testing to take pressure off. If you have anxiety related to math or testing, consider seeing a counselor to help develop strategies for coping. Most schools offer free counseling services to students.

If you’re taking math because it’s a required part of liberal arts curriculum, your school may be willing to waive or substitute the requirement for a student with a documented disability. (For example if Calculus is required, and you’re a History major). On the other hand, if you’re trying to enter a field that demands the use of math as part of the profession, you may need to consider if that profession is right for you. Consider another field that better suits your strengths and abilities. You can’t be an engineer without calculus, a psychologist or economist without statistics, or an accountant or pharmacist if you make frequent calculation errors. Find a field of work that plays to your strengths.

There’s nothing weird about having a brain injury that resulted in math problems. Math is a complex cognitive task requiring sustained attention, symbolic processing, abstract reasoning, good memory, and the ability to process multiple steps. Even minor brain injuries that disrupt any of these abilities can lead to problems in math skills.

DEAR PAT:I had a TBI in October 1996. The thing I notice now is that I obsess over certain things. For example, I’ll take a bottle of Windex and some paper towels in my room and start cleaning EVERYTHING. What’s up with that? I mean it’s bad enough to have obsessions, but getting into a cleaning frenzy?


PAT'S RESPONSE: Maybe you can clean Pat’s office? On the other hand, even you might not be able to handle that!



You may be experiencing symptoms of obsessive-compulsive disorder. It depends on how often you obsess and how much it disrupts your life. Obsessive-compulsive disorder has been linked to several areas of the brain including the frontal lobe and the neurotransmitter called serotonin. It is possible that damage to certain parts of your brain such as the frontal lobe may have contributed to your symptoms. Medications affecting serotonin such as Prozac and Luvox have been used with some success in treating OCD. In addition, cognitive-behavior therapy can be very effective, particularly for milder cases. Don’t be afraid to seek help. Talk to your physician or make an appointment with a psychiatrist or psychologist who can help you evaluate your symptoms and discuss options.

DEAR PAT: had a truck accident 7/30/98 and I sustained a serious closed head injury among many other injuries. All of the doctors I’ve been seeing are thoroughly impressed with the recovery that I have made, but now that I’ve been out of therapy since January, the neuropsychologist recommended that I go back into therapy just when my life started to regain some normality. I am 29 and had spent the last 9-10 months recovering with my parents. Now, my mother doesn’t want to let me out of her sight. I can understand her concern, but I’m tired of my whole life being about the accident. I’ve recently gotten engaged and I want to put my time into my relationship. I don’t have a problem going back into therapy, but I want to be able to do it here, with him, instead of living with my parents again. I’ve lived on my own since I was 17 and managed very well. What should I do?


PAT'S RESPONSE:Pat can’t figure out from your question why your neuropsychologist has suggested you go back into therapy, or what kind of therapy is being suggested. It sounds like you’re getting a lot of advice. Remember that these are choices about your life and you get to make them. Brain injury or not, you’re an adult and you’re entitled to make choices about your own life. Consider what the neuropsychologist suggests. Be sure you understand what his or her concerns are and why therapy is being recommended. Sometimes people try to get their "old life" back too soon. Maybe that’s the concern. However, discuss this with your fiancée, family, friends and other people you trust. You can always try therapy for a while and change your mind if things are going well. Or if you and your loved ones think you are doing well now, you could try life without therapy and try it later if you need help. It’s really up to you.



As for your mother, this is not at all uncommon. Your mother is likely very concerned that you can’t handle things or will get hurt again. She may be afraid that you’re trying to do too much, too fast. Maybe she’s concerned your fiancée doesn’t understand everything about your injury. She could be right. Talk with your mother, fiancée and others about those concerns. Find out if the medical professionals that work with you share her concerns. Then make an informed decision. Remember that it’s your life. As an adult, it perfectly appropriate for you to start your own household and, at some point, your mother is going to need to let you and your fiancée live your own lives and make your own decisions – whether you’ve had a brain injury or not.

DEAR PAT:I have a friend who was in an accident over a year ago. He says he had a brain injury and now uses this as an excuse to abuse his wife and the people around him. I do believe that people suffer from brain injuries, but I also know this person’s reputation for conning money from others. Is there physical evidence involved in the diagnosis of brain injury or do the doctors just go by the patient’s reported symptoms? We have been told that all of his inappropriate behavior is not his fault and is due to medications and injury, but what I fail to understand is that he is the exact same person he was before the accident. Only now he is suing for a lot of money and he has the doctor’s support. Help! We don’t understand.


PAT'S RESPONSE:Why are you friends with a wife-abusing con artist? Seriously, if his "abuse" is physical, it is a crime and he should not be allowed to continue harming other people. Even if his "abuse" is just verbal, why are you, his wife and "others" continuing to put up with it? Having a brain injury is not a license to treat people badly.



Regarding the "evidence." Sometimes there is physical evidence you can see with brain imaging (CT, MRI). However, sometimes the effects of injury cannot be directly observed and doctors use patient and family reports of symptoms and neurospsychological testing (tests of things like memory and attention) to gauge the effects of injury. Can people lie? Yes. Can they fake injury effects? If they know what to fake and how to fake it, it could be done. Is it easy to fool a good, well trained medical professionals? No. But it can and does happen. Doctors are fallible just like all of us.

It is also not uncommon for an injury to cause someone who had pre-existing problems with anger management or impulse control to get worse. Frustration resulting from memory or attention problems, physical pain, or mood swings can contribute to making an already angry and aggressive person even more angry and aggressive.

The thing to remember is that you don’t know what the medical professionals know. You probably don’t know his medical history, medial records or the results of medical tests. Unless you’ve talked directly to his doctors, you don’t even know exactly what he has been told because you are getting information second hand. Also, keep in mind that if this is litigated, there will likely be professionals on the other side that will scrutinize things very carefully to be sure he really has suffered an injury and to challenge his doctors’ findings. Unless the opposing side just settles the case, this person may have to undergo several evaluations and depositions. Also, if the accident wasn’t his fault, he may be legally entitled to some reimbursement for medical expenses, lost wages, and pain and suffering even if his injuries didn’t cause his angry, aggressive behavior.

Probably the best thing for you to do is not to worry too much about it and avoid spending lots of time with someone who isn’t pleasant to the people around him. Hopefully the system will work for the best. Most of the time it does. Sometimes it doesn’t.

DEAR PAT:I am the wife of a TBI survivor. We have reached a point in our lives where the resources are gone. My husband has had rehab, counseling, therapists for cognitive functioning, etc. We are currently seeing a marriage counselor through my husband’s vocational rehabilitation case manager who is pulling services since my husband will not be employed in the near future. What resources do he have after everything else has been used? He has been seeing a psychiatrist, but they haven’t found a medication combination that works. He suffers from mood swings, cannot hold down a job, and does nothing but sit all day and play on the computer. He has suicidal tendencies and gets angry easily. Please tell me where I can find more resources.


PAT'S RESPONSE:Spouses of brain injury survivors with emotional control problems really understand the meaning of "for better or for worse." One of the hardest things to do is to adjust a marriage to life after brain injury. It is even harder than adjusting to life after other kinds of serious illness or injury because behavior changes often make it seem as if the TBI survivor just "isn’t the same person."



Your question is a good one. Unfortunately, there is no easy answer. There are a number of websites that are devoted to TBI and there may be a Brain Injury Association in your area that can help. Some websites are available through the "links" page on this site. Find out if there is a brain injury support group in your areas or in an area nearby. Other TBI survivors and family members of TBI survivors can often given helpful guidance since they are likely to have encountered similar problems. If you belong to a religious community, ask for help. Many religious groups and organizations may be able to assist with providing social support, respite, or spiritual counseling. Couples therapy is a good idea, especially if the counselor is educated about the effects of TBI. If you can, locate a psychologist or counselor in the area with experience helping families with brain injury. Consider consulting them on an individual basis. Family members caring for TBI survivors experience high rates of depression. You need to take care of yourself as well as your spouse.

DEAR PAT: I work for an organization for people with developmental disabilities. I recently received a request for information for a 15-year old girl with a TBI. She is being released this weekend from the therapy facility and has no place to live. She is being placed in a residential home with emotionally and behaviorally challenged girls. I am unable to find her an alternative place to live. There is no agency in my area that provides residential care for TBI under 18. I fear for this young lady’s well being. I would appreciate any suggestions you may have. Thank you.


PAT'S RESPONSE:problem of limited resources is serious in some places. It’s not clear why she is being placed in a residential facility. If she has no family available or is in the custody of the state, she could be placed in a foster care home. Some states have foster parents with medical training who can provide homes to medically challenged youth. However, if this isn’t an option, Pat suggests you locate a hospital that treats pediatric brain injury. They should have a social worker or services coordinator who could point you to services and professionals who deal with children with TBI. Your best bet may be to work with existing agencies to make modifications that will best help this young woman. Good luck!



To the Parent looking for TBI professionals in Nebraska. Pat doesn’t have anyone specific in mind. You might try contacting the Psychology Department at the University of Nebraska-Lincoln for names of therapists or neuropsychologists. Locating a hospital that treats brain injury could help you locate a neurologist or physiatrist. Also, following is information for the Brain Injury Association of Nebraska. They probably have a list of resources in your state.



Brain Injury Association of NEBRASKA
President: Kathy Feldman
Co-Executive Directors: Jan Kauffman & Sharon Auld
PO Box 124
Gothenburg, NE 69138
UPS PACKAGES: 1108 Avenue H, Gothenburg, NE 69138
Phone: (308) 537-7875 or (308)-537-7663
In State: 1-888-642-4137
Fax: (308)-537-7663 >> Please Call First!
E-Mail: bi13135@navix.net
Web Site: http://www.biausa.org/Nebraska/bia.htm

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