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

Pat #18

DEAR PAT: I've read in your prior e-mails that you have been contacted by police officers that suffer from TBI. Do you still have their e-mail address so I may contact them? Unfortunately, I suffer from the same problem and I would like to talk with them about their return-to-work experience.

PAT'S RESPONSE: Pat believes privacy on the Internet is important. Therefore Pat does not release names, e-mail addresses, phone number or any other information. While Pat is convinced your request is genuine, there is no way to easily verify that you are who you say you are. Also, many people do not wish to have unsolicited e-mail from strangers (even if well meaning).

You might try contacting your local Brain Injury Association. Police departments sometimes have organizations to help injured officers. If there is one in your community, they may be able to help you find fellow officers with similar experiences.

DEAR PAT: Do you have any information that a fetus can sustain a brain injury? I was involved in a motor vehicle accident at 6 months gestation and my son has severe language and developmental delays. My insurance company refuses to pay any medical bills for my son stating that a fetus is protected and cannot be injured.

PAT'S RESPONSE: I’m afraid I don’t have any information about fetuses sustaining brain injuries (A difficult subject to research). Unfortunately, even if you can find documentation of fetuses sustaining brain injuries, it will be very difficult to figure out if your son’s problems have resulted from the accident, genetic factors, or factors associated with the prenatal or postnatal environment.

DEAR PAT: I was talking to someone and they told a story of coma that I find hard to believe. This person said that they were hit on the head with a large book from a height of about 10-12 feet. She claims she was in a coma for three weeks. She also claims that she woke up with no disabilities and no need for rehabilitation. She claims to have been back to work within a week of waking up. I do not believe that this is possible. From what I understand, it takes quite a bit of trauma to keep a person in a coma for that long. And sustaining that kind of trauma means that part of the brain were damaged severely. That a coma of as little as a week would cause someone to have months of therapy. That they would have to re-learn a lot of menial tasks including walking, taking care of themselves and basic cognitive functions. Am I wrong in my assumption that all head injuries that lead to a prolonged coma require extensive rehabilitation or can someone just wake up and have no after-affects of a traumatic brain injury?

PAT'S RESPONSE: At the very least it’s an extremely unusual story. Certainly the usual course of recovery from coma is slow and requires substantial rehabilitation. Some people are able to recover many of their pre-injury skills, but this also takes considerable time and usually many hours of rehabilitation. Without having valid medical records, Pat is skeptical of this woman’s report. On the other hand, strange things do occasionally happen.

DEAR PAT: Ten years ago my husband had a brain aneurysm followed by two strokes. The doctors told me his whole brain was full of blood. In the last few years, he has had spells of memory loss, confusion, and agitation. He cannot do everyday normal work. In the last year, he has gotten much worse. He has become very violent and has told me he will kill me when I’m asleep. He is paranoid. When he was in the hospital, they said he was fine and his EEGs were normal. His answers to most of the things they asked him were wrong. He tells them about events that have not happened. I am not safe in my own house. I don’t know what to do anymore.

PAT'S RESPONSE: If you believe that your husband is a serious threat, you need to make sure you are safe. As tragic as his injury is, if he is paranoid and threatening you, you need to protect yourself – even if you know the behavior isn’t your husband’s fault. If your husband is currently a danger to you, you really need to leave the home and stay somewhere else until you believe his behavior is under control. As sad and tragic as your husband’s illness is, think how tragic things could be if he hurts someone else.

I’m not sure what’s happening when you say the doctors "said he was fine." Are you talking about when he was hospitalized for the strokes? Or are you talking about more recently? Clearly, he should receive a comprehensive psychological and/or neuropsychological evaluation. You need to make mental health professionals aware of his symptoms so he can get proper treatment. There are some medications that can help control psychotic symptoms (such as paranoia and delusion). If he is making threats or exhibits other dangerous behavior, you may be able to ask the police or a judge to hospitalize him until his behavior is under control.

DEAR PAT:Our 39 yr. old brother suffered a closed head injury Sep. 11, 1999. He sustained shearing to midbrain, thalamus, and brainstem. He was in a coma for several days following injury and is now what is considered a "locked in" state. As of yet, his left side seems to be unaffected, while he has hemiplegia to right. He has made more progress than the doctor's ever thought he would. For instance, he'll answer yes/no questions using his fingers, and is learning American Sign Language alphabet. His memory doesn't seem to be impaired; he knows his name, age, brother's names, etc. He has also started writing his name on a notepad. Recently, he has started exhibiting somewhat aggressive behavior-pulling our hair, noses, and such. Our question to you is-is this new behavior common with such injuries? Some of the nurses at the Rehab hospital have told us this means he is "waking up", it that true? And, is it possible to recover from an injury to the brainstem?

PAT'S RESPONSE: Yes, agitation or unusual behaviors are often seen as patients begin to emerge from a coma. "Locked in" states generally refer to patients who are seen as "awake" but cannot consistently respond to or act on the environment. As for future recovery, it is likely that he will show continued improvements. However, you should probably be prepared for the fact that your brother’s recovery will probably be slow and he may never "fully" recover. Many patients wither severe injuries eventually can resume many normal functions, but some will require long-term care. As Pat always says – it is important to be very optimistic – but also realistic. Please be sure to talk to your brother’s doctors for information about his specific prognosis.

DEAR PAT: I have a nephew that has been in a pre-vegetative state for 1 year and 6 months. He is still in the hospital. He hung himself. He also suffers from schizophrenia. The doctors have given up hope of recovery. He can tell when someone is in the room, and likes for you to read to him. Do you know of any other cases like this where they recover?

PAT'S RESPONSE: Most recovery takes place in the first 6-12 months after an injury. Lack of oxygen to the brain can quickly kill brain cells, and it sounds like your brother probably suffered some serious damage. You can hope for continued improvements as these can continue to occur even years after an injury. However hoping for a "full recovery" may be too optimistic (but consult with your nephew’s physicians for specific information about him). I hope you will continue to give your nephew love and support and visit him as often as you can.

DEAR PAT: My Son fell 35 feet in May and woke up in September. He is progressing every day. He wants to go home but he is in a subacute hospital. He will be there until March or April of Next year. He is mildly agitated. They say he will get more agitated, but I don't think he will get that bad. I see him everyday and he seems to understand he has to work to get better. He wants to go home and that is his main word. The caseworker at the hospital tells me it will be impossible to have him home. The way he made it sound it was a death sentence. My son really wants to go home and I feel that home visits will help him a lot. I want him to come home in March-April. He has a severe head injury, but he is currently at the ranchos of 5 working toward 6. Is it always the case that he will get more agitated or could he get a little worse and now go past that? Please help!

PAT'S RESPONSE: You may be put in the unfortunate position of making a very difficult decision. Most people want to return home immediately after a brain injury. However, agitation, mental confusion, aggression, and diminished impulse and emotional control are frequent consequences of brain injury. These behaviors are not easy for family members to deal with. Unfortunately, survivors often cannot control their behaviors. Also, remember that inpatient rehabilitation units provide intensive services that are often not available in the home (such as physical, speech, occupational, or psychological therapies). In the long run, it may be better to wait until your son is in better control of his behavior and you have a better sense of his long-term needs. If you do decide to take him home, please be sure to educate yourself as fully as possible about what to expect. Arrange for home health care if needed. If agitation is a problem, he will probably need someone monitoring him at all times. No matter how much your son wants to come home, it’s important that you realistically understand everything that will entail.

DEAR PAT: I stumbled across this site while doing research for a course I am taking towards a certification in Business Education and a certificate in Instructional Technology(Technology for Special and at Risk Populations) I am a 35 year old female who suffered a mild-moderate Traumatic Brain Injury from a very serious car accident. I spent close to 2 years feeling like I was walking in a dream, forgetting whole conversations, involuntarily dropping things, fighting the world etc. I guess you can get the picture. This happened in Fall 1995. I worked full time in computer and technical sales at the time. I was trying to do my job after the accident and realized I was just not the same. After extensive Neuropsychological testing, I knew I was brain injured. The recovery has been an adventure filled with all kinds of psychological, visual, occupational, and physical rehabilitation as well as surgery. In 1997 I attended a Business Skills program to determine what I was capable of and to possibly secure supported employment. I thank all who were there to help and support me each and every day as I struggled to find the right mix of compensatory strategy and acceptance of my disabilities (physical and sensory). In 1998 I went back to school with great anxiety to prove to myself and to everyone else that this thing was not going to lick me. What I have found out is that the type of injury I have basically slows me down but it doesn't hold me back. I must take frequent breaks while doing work and I use adaptive technology (keyboard and word-processing software). I use imagery and relaxation techniques to cope. I lead a full but different life now and in February I will be student teaching on the secondary level. My intention is to work in Special Education. I probably will never work full-time again. Ironically I am working on an Executive Summary on TBI. My questions are: Do you know of specific site with criteria for identification on TBI? Do you know where I can find information on educational interventions being used? (Obviously I can draw on what I know personally) However, I do need a reference page etc. P.S. What you are doing is great.

PAT'S RESPONSE: Wow! Sounds like you have worked hard at recovery, and I’m sure you serve as inspiration for people who know what you’ve been through! As for educational information, please see the two references on Pat column #16 (Just click on the "Archives" button at the end of this page).

The homepage for the Brain Injury Model Systems is This should provide you with some good information about brain injury. However, there is no substitute for going to the literature in the peer-reviewed journals in your college or university library. There are several devoted to current research on brain injury and rehabilitation – Examples include Brain Injury, the Journal of Head Trauma Rehabilitation, and the Archives of Physical Medicine and Rehabilitation. Learning to use Medline or PsycInfo will be invaluable to you if you are interested in keeping up with research in the area of brain injury or rehabilitation.

DEAR PAT: I had encephalitis is May 1997, and was kicked out of my home, and forced to pay child support. Now I can't work anymore, and my wife is trying to have me put in jail for non-payment. My trial is Dec 6, with a hearing Nov 23, is there any resource I can turn to for help besides legal aid as they refused to help me in August. I am also looking for a new neuropsychiatrist in the Richmond -Charlottesville area. I take 40 mg, of Ritalin per day, and my current doctor is in Winston-Salem. Hoping for answers. Thanks.

PAT'S RESPONSE: First, I should tell you that there are two excellent medical centers nearby. In Charlottesville, the University of Virginia Hospitals, and in Richmond, the Medical College of Virginia. In addition, you will find other professionals in hospitals or private practice in both cities (you can locate some experts by using the "Find the experts" section of this website).

Finding a new neuropsychiatrist sounds like the least of your problems. I f you are disabled due to your illness and cannot work, you should apply for Social Security Disability. Some of this income can go toward child support payments if you are qualified. Remember, that financially supporting your children is your responsibility whether you are married or not. (It should be something you want to do as a father, not something you feel "forced" to do). If you haven’t already, you might consider a neuropsychological evaluation to examine your strengths and weakness. If you are disabled, this type of report can help substantiate your claim. You may need an attorney to help guide you through this process.

If you believe you might be able to work (but maybe not at whatever you did before) - there are supported employment services to help people with disabilities find viable jobs. In some cases, it may mean a new career, developing compensatory strategies on the job, or simply finding an employer willing to be supportive and provide accommodations.

DEAR PAT: Do you have any information regarding the use of Ritalin with children with TBI?

PAT'S RESPONSE: Pat always has some information! Whether it’s the information you want, I don’t know…

Here are the basics – Ritalin (Methylphenidate) is an Central Nervous System stimulant and is a widely used treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adults. Using a stimulant to treat inattention may seem like a strange idea. Treatment effects are believed to occur because the drug stimulates the release of neurotransmitters needed to focus attention.

Regarding Ritalin’s use as a treatment for brain injury, research has shown it can be effective in treating symptoms such as inattention, impulsivity, or hyperactivity. In addition to these uses, research indicates that stimulants can be helpful for treating other symptoms common after brain injury including fatigue, apathy, and hypersomnia (sleeping too much).

Side effects can include increased anxiety or nervousness, loss of appetite, disrupted sleep, nausea, dizziness or an increase in blood pressure. In rare situations, it may trigger cardiac arrhythmias. If you or someone you care about is taking Ritalin, it is important to be alert for possible side effects. In addition, always inform your physician about all your medications due to the potential for adverse drug interactions. Although Ritalin has been used extensively in treating children and adolescents with ADHD and brain injury, effectiveness and safety in children under 6 is not well established.

DEAR PAT: My husband was in a car accident over 4 years ago and sustained a minor brain injury. Two months after the accident he started getting involved in criminal activity and drugs. He is not violent, but has continued to get into trouble. He has been in jail over 8 times in the last year. He is a very successful manager of a car dealership and makes over $180,000 dollars a year income. There is no reason for his criminal doings. It baffles everyone that knows him. He is now in jail and is non-bondable. His behavior changed after the accident and he is very impulsive. He says he cannot control his criminal activity. Is this possibly caused by the brain injury? I s there any evidence relating to this kind of behavior.

PAT'S RESPONSE: His brain injury could be contributing to his current behavior. Brain injuries often result in people having difficulty with impulse control, trouble delaying gratification (waiting for what they want), and thinking about the consequences of their actions. In other words, a person’s personality can change dramatically after a brain injury. It is a little surprising that such a dramatic change would occur after a "minor" injury, but Pat has seen cases where people have long-term effects from a concussion or other "mild" injuries. Drug and alcohol abuse after a brain injury are also common problems. Sometimes pre-injury substance abuse contributed to the injury, but in other cases, people who feel badly after an injury may attempt to "self medicate" through using alcohol or illicit drugs.

If your husband is not already working with his physicians to control his behavior, he should be. A comprehensive neuropsychological examination, and/or brain imaging (like the MRI) may help to determine if he sustained a brain injury that is contributing to his behavior. Working with his physicians and a psychologist may help to find medications as well as behavior management and coping strategies to help control his behavior (even if the brain injury did not cause his behavior).

Having a brain injury does not give someone an excuse to commit criminal acts. Only he can make the choice to get help and to work to gain better control of his behavior. Certainly you can encourage and support your husband. Just remember the old saying – "You can lead a horse to water, but you can’t make him drink."

DEAR PAT: I am a 29-year-old who has suffered several concussions.

1. Bicycle accident at age 6
2. Fall and blow at age 8
3. Fall and blow at age 10
4. Car accident at age 19
5. Car accident at age 28
6. Hockey accident at age 29

The first one resulted in stitches and the 6th one with a loss of memory of the day it happened. I have had headaches for several years and then they went away. The last car accident restarted them. I am now seeing a psychiatrist that is helping me deal with my emotional difficulties such as memory, anger and social skills. I am on a diet that includes fatty acids to help heal my brain. Am I going about things correctly or should I be doing more? After the last accident my wife left me due to my behavior. Thanks for the information as it is helping me understand me.

PAT'S RESPONSE: Are you Evel Kneivel’s long lost son? Seriously, I don’t know if you’re just unlucky or if you have tended to be someone who is impulsive or likes risks. The fact that you were injured playing hockey, after all of your other injuries, suggests that you probably like excitement and physical activity. However, in choosing your activities, it is important to understand that having multiple brain injuries is a serious problem. If you pay attention to sports, you know this has become a major issue among professional football players. Many ex-players now talk about the serious problems they have experienced after their football careers because of multiple concussions. Certainly, you should remain as physically active as possible, but you might want to choose sports and activities with less chance of head injury. Also, be sure to drive carefully and defensively. Otherwise, it sounds like you are working hard to understand the effects the injuries have had on your behavior, and to move forward with your life. I’m certainly sorry to hear about your marriage and hope you will find happiness with someone in the future. Please continue working with your psychiatrist as it sounds like it is really helping you. Consider contacting the Brain Injury Association and locating a brain injury support group. Talking to other survivors is often very helpful. You’re to be commended for working very hard at recovery, and I suspect things will continue to improve with time.

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