VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

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

Pat #4

DEAR PAT: I received a head injury in 1972; I need to know if there is new rehabilitative treatment to try now in 1997.




PAT'S RESPONSE:

There have been major medical advances in the area of traumatic brain injury treatment and rehabilitation in the last 10 - 15 years (not to mention major advances in fashion since 1972). If you are interested in current rehabilitation trends, peruse the literature (i.e., medical journals) at your nearest medical or university library. This Internet site, as well as others, contains a good list of references to start with. For treatment options, you may want to consult your state Brain Injury Association for information on programs specializing in brain injury. The national Brain Injury Association in Washington, D.C. can refer you 202-296-6443  to your state affiliate. And if you're one of those misguided individuals who is swept up in the 70's "retro" thing, stop it.

DEAR PAT:

I suffered a brain injury in a cycling accident. Within a month, in between surgeries to treat my injuries, I entered into a depressive episode that has continued to this day. I have been on no less than four anti-depressant drugs in an attempt to keep my depression in check. The "treatment" has worked to the extent that I am able to function well enough at work to remain employed. But in my private moments of reflection, I feel that I "died" in this accident and in my current state I am little more than a zombie, the living dead. No one, especially my doctors, seems to understand my perception of reality. They seem satisfied that (a) I'm still alive, and (b) I can make a living. This is hardly a consolation.


PAT'S RESPONSE:

Pat is content to have achieved (a). However, each of us defines for ourselves what makes life fulfilling. Pat does not presume to understand your perception of reality. But perhaps, you can revise your perception a bit. Begin by taking an honest look at your life.

Surviving a cycling accident and the subsequent treatments is an accomplishment. Making a living is an accomplishment. Think about it -- so many perfectly healthy people cannot even say they support themselves. You must make a written inventory of your accomplishments and assets. Pat doesn't care if your greatest asset is your ability to yodel in Swahili. Write it down, and remind yourself of this list on a continuous basis -- every morning if you can. Now if you feel equally compelled to focus on your weaknesses or impairments, go ahead. Then take a look at that list and see how many of those things you can change (i.e., bad habits). Do you really need to keep saving all those back issues of Soap Opera Digest? It is critical to see how many of those things you have no power to change, too. Is having fire-engine red hair really so bad? So what if your name is Eunice.

Taking a look at yourself is a first step; looking outside yourself is a good second step. When you spend time pursuing interests and pleasures, you gain happiness. Gravitate toward pleasing things (book stores with coffee shops, baseball games) and stay away from depressing, negative things (insurance seminars, postal workers). Find ways to give to others in any way you can. This is an under-rated source of pleasure.

You have tried different medications and different doctors, but maybe you haven't found the right medicines or the right doctors. You must continue to look. Ask people you know, professionals familiar with brain injury, and referral organizations like the Brain Injury Association for information on experienced doctors. The best option is medication, monitored by a psychiatrist experienced in brain injury, combined with consistent, goal-oriented therapy with a good counselor. You cannot take medications and expect your body to respond unless your life circumstances are satisfactory to you. Counseling can help you get your mind, body, and spirit in order so that you can pursue things you enjoy.

Remember: You alone have the power to define and to achieve fulfillment in your life. You can do it.

DEAR PAT:

My grandson fell out of a shopping cart onto a cement floor at the age of 13 months. He now shows signs of developmental delay (e.g., minor motor dysfunction and communication problems). He knows what a pencil is but when asked to use it, he just looks at you. Could my grandson be experiencing problems due to a brain injury?


PAT'S RESPONSE:

Your situation is all too common, and Pat appreciates your coming forward. Many parents (good parents included) have experienced the terror of a child's fall from a shopping cart; it only takes a couple of seconds. One of Pat's personal pet peeves is the lack of simple safety belts on shopping cart seats.

One way of determining whether your child may have sustained serious injury (warranting evaluation, at least) is to observe the child's behavior after the accident and compare with pre-injury behavior. Are there changes in cognitive, physical, or behavioral functioning? For example, are there differences between pre-injury and post-injury personality, stamina, sleep, habits, memory, learning, attention span, moods? If your child seems different or delayed, take him to a pediatric neuropsychologist, a professional skilled in evaluating and treating (or prescribing treatment for) behavioral and cognitive problems related to brain injury. The pediatric neuropsychologist may suggest a neurological evaluation to help accurately diagnose your child. Should brain injury-related problems be identified, the pediatric neuropsychologist can help you work with rehabilitation and educational professionals to address the child's limitations and accommodate them in the school setting.

DEAR PAT:

My mother fell 2 weeks ago and is still getting dizzy and has an upset stomach. Is this normal?


PAT'S RESPONSE:

Good question! When you figure out what exactly is "normal," let us know. For now, the important question to ask yourself is: what is normal for my mom? Unless your mother experienced the same dizziness and stomach upset prior to her fall, there is reason to see a doctor. Falls are the leading cause of brain injury in older adults. Sometimes seemingly mild head bumps can result in problems like those you describe. Bottom line: see a neurologist for an evaluation of the brain (e.g., CT Scan, MRI), and consider seeing a neuropsychologist for an evaluation of cognitive and behavioral functioning.

DEAR PAT:

Suicide and suicidal ideation, as the professionals like to call it, are words that I read about but seldom hear verbally discussed. It is time to take the risk! I believe it would be a relief for a lot of people to know the reality and for a lot of therapists to no longer be afraid that the mere mention of suicide will trigger death. If it is done right, it will break the cycle for many.


PAT'S RESPONSE:

Good point. Not talking about suicide will not make it go away. Pat encourages anyone who has suicidal thoughts to contact a counselor through the local mental health center. The phone number is in your telephone book in the city or county listings. There are people at your local mental health center who are trained to help you discuss your feelings, even suicidal thoughts. Until you have tried talking with a good counselor about your troubles, you have not given yourself a chance. Support groups can be a good source of encouragement, as well. Pat says: the world is a much better place with you in it.

DEAR PAT:

My son suffered a brain injury due to shaken baby syndrome. Where can a person look to find more information on this subject?


PAT'S RESPONSE:

Shaken Baby Syndrome or Shaken Infant Syndrome is one of the abuse-related causes of childhood brain injury. When someone violently shakes a baby, the infant's fragile neck cannot support its large head, so the head flops back and forth and the brain bumps against the skull. This can cause bleeding, bruising, and tearing of brain tissue. This is how child abuse leads to problems like learning impairments, seizures, delinquency, and worse.

You can search the medical literature at your nearest university library for information on Shaken Infant Syndrome and pediatric brain injury. Another source of articles on these topics is the Brain Injury Association, Inc. in Washington D.C. telephone: 202-296-6443. More information on pediatric brain injury is available from The Research and Training Center on Rehabilitation and Childhood Trauma, which is a joint program of the New England Medical Center and Tufts University School of Medicine. You can reach the RTC at 750 Washington Street, #75 K-R, Boston, MA 02111 telephone: 617-636-5031.

Lastly, you may try to contact your regional Kiwanis Club to see if they are participating in the Kiwanis International effort to educate the public about Shaken Infant Syndrome. Talk with a Kiwanis member in your community or contact Kiwanis International at 317-875-8755. The Kiwanis Club has established guidelines and materials for conducting a local educational campaign on Shaken Infant Syndrome.

DEAR PAT:

Our son suffered a serious TBI 18 months ago. He remains very spastic in both his upper and lower extremities. He cannot walk or use his hands. What state-of-the-art approaches are being used to help patients with this problem regain normal motor function?


PAT'S RESPONSE:Recently the FDA approved a new treatment for spasticity due to brain injury or cerebral palsy called Intrathecal Baclofen Therapy. Clinical studies showed a reduction in spasticity and improvements in functioning (e.g., self-care). Intrathecal Baclofen Therapy involves the implantation of a pump and catheter which dispense a liquid form of baclofen to the spinal cord area. The pump can be refilled through the skin by a medical professional, such as a nurse. This type of therapy is more potent than oral medications, without the undesirable side effects. Results of Intrathecal Baclofen Therapy vary, but in many patients the therapy successfully controlled spasticity, completely replacing other less effective treatments on a long-term basis. For more information on Intrathecal Baclofen Therapy, talk with your doctor.



(Information from "FDA Approves New Treatment for Spasticity in TBI Patients." by Greg Marlin of Medtronic Neurological, Inc. 1996.)

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