Chat with Pat Blog

Pat #1

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT:

SWM in search of anyone! I am a 30-something male who sustained a brain injury a number of years ago, and my biggest "handicap" is my lack of success with women. Why don’t they like me? Pat, I need a date -- please advise!

Sincerely,
Desperado

PAT'S RESPONSE:

You are not alone. In fact, I myself have experienced some of the more unsavory aspects of modern-day socializing (including the highly coveted "blind date"). When it comes to successful socializing, the place to begin is with yourself. Take a look at the checklist below as you gaze into the mirror.

* Do you maintain attractive hygiene habits (daily showers, shaving, brushing teeth, etc.)?

* How’s your haircut?

* Are you in healthy physical shape (daily exercise of some type, sensible diet, good posture, etc)?

* Do you make the most of your appearance (clean clothes, ladies: a little makeup maybe)?

* Is your manner friendly and confident (speaking clearly, looking at the person whom your are addressing, head up, shoulders back)?

* What activities are you participating in, or what interests are you cultivating? Take a class at the local recreation center, build models, volunteer, work at a job that challenges you, call talk shows, at least read the daily newspaper.

* Are you conversational? Do not focus conversations solely on your injury and disability. Discuss your opinions, talents, and other experiences, as well.

* Are you a slave to fads? Tattoos, unsightly piercings, metallic nail polish, thongs -- avoid them!

My point is that once you take a good look at yourself and become someone you like, then others are more likely to be attracted to you. We all gravitate towards positive, self-respecting, courteous people and avoid negative, self-obsessed, insensitive people. Work hard to be the former; don’t even consider behaving like the latter.

The next skill you need to develop is a true interest in other people. When you interact with others, ask them questions about their interests, their jobs, families, hobbies, favorite movies, most hated fads, ..... Pretend you are a news reporter and it’s your job to casually interview another person so that you can profile that person in a story. (Don’t get too personal.) Try not to show an interest in someone just so that you can assess her dating potential. Make it your goal to become a "people person" who likes to learn about others without the expectation of personal gain. Again, this will make you very attractive.

Lastly, seek friends in places where you would like to be sought out. Do you like to read? Attend an author’s lecture and book signing event. Are you a painter? Take an art class at the university. Do you like reptiles? Work in an aquarium. Are you more comfortable with a woman who has had a brain injury? Seek out the social groups for people with brain injuries in your town. The department of parks and recreation may offer classes and social opportunities for people with disabilities, as well. You want to meet people who share your interests, so go where they go.

Take heart, dating isn’t easy for anyone except sociopaths. Pat knows you can do it, so put away the Fudge Ripple and take a fragrant bubble bath.

Pat #2

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: Can a neuropsychiatrist critique the report of a neuropsychologist for a person who has suffered TBI ?

PAT'S RESPONSE:Yes. Neuropsychiatrists and neuropsychologists specialize in critiquing each other. What you need to keep in mind is the distinction between the two professions.

A neuropsychiatrist is a Medical Doctor (M.D.) who specializes in psychiatry for people with neurological dysfunction. The neuropsychiatrist is knowledgeable about human anatomy (e.g., the physical make-up of the brain) and human behavior. He/she conducts brief counseling or interview sessions with the patient, makes use of medical information on the patient’s condition, and dispenses medication to treat his/her patients.

A neuropsychologist is a Doctor of Philosophy (Ph.D.), a specialized psychologist who evaluates and treats people with neurological dysfunction. Neuropsychologists do not dispense medication, but instead conduct extensive testing and counseling. Neuropsychologists look at how brain injury affects a person’s behavior through the use of written tests, "performance" tests, and interview/discussion sessions.

The neuropsychiatrist offers a medical background, while the neuropsychologist offers testing, assessment, and counseling expertise. In the best of all words, these two professionals compliment each other, healing humanity together.

DEAR PAT: Pat, help! I need an expert witness to reconstruct my car accident -- someone who can testify that someone who does not hit his/her head can still have a brain injury. What leading experts do you know?

PAT'S RESPONSE:Pat knows everyone who is anyone. In fact, if you are not a close personal friend of Pat’s, then it’s time to take a good look at your social circle. To find someone to provide "expert testimony" in your case, you must begin by hiring an attorney who is experienced handling brain injury cases. Such an attorney will know which professionals to call as expert witnesses in your case. For example, your attorney should know and be prepared to call a neuropsychologist who is experienced in treating people with mild brain injuries. This expert witness will have credibility in court and be able to explain how someone could sustain a brain injury without hitting his/her head on the windshield. If you need an attorney referral, contact your state Brain Injury Association, Bar Association, attorney referral service, or the "Directory of Experts" on the National Resource Center for TBI.

DEAR PAT: Hi, Pat. I'm 40 years old and I can't remember the names of my family members. I have a heck of a time lifting my left knee and taking my right elbow down to my left knee at the same time. Thanks, Braindead.

PAT'S RESPONSE: And when you look at an ink blot do you see:

a) Dennis Rodman doing the Macarena?

b) An elephant in a bathtub full of jello?

c) Dennis Rodman and an elephant in a bathtub full of jello?

Regarding your inability to recall the names of family members, consider keeping a list with a photograph of each person and his or her name written beside it. "Quiz" yourself by looking through family photo albums and naming individuals. "Mnemonic devices" also can be useful. To commit a person’s name to memory, make up a little rhyme; connect the name with a memorable thought. For example, Aunt Mable fell under the table. In your mind, connect Mable with table and you may be more likely to remember it.

And, don’t do that knee-to-elbow thing.

DEAR PAT:Pat, help me understand my friend who was involved in an auto accident, has several broken bones, a tracheotomy (done at the scene), has been hospitalized for 7 days, has swelling of the brain which has been drained. Doctors are not saying or doing much until the swelling goes down. I guess he is on a breathing apparatus; he is not awake; he is in a coma. Do swelling and blood clots in the brain mean severe brain damage? Can a brain scan be performed on a swollen brain?

PAT'S RESPONSE: The first days following a serious brain injury are difficult for all involved: family and friends struggle with shock, hope, fear of the unknown, and doctors also struggle with the impossibility of predicting outcome. Tests can be performed on the damaged brain to assess its condition (e.g., CT scan, MRI); however, a sound diagnosis is too much to ask for in the early stage of trauma. Your friend’s injury sounds severe as you describe it. Technically, an injury that results in a coma or a period of unconsciousness that lasts more than 24 hours can be classified as severe (versus mild). For more information on severe brain injury, coma, and outcome, please take a look at the FAQ’s on this Internet site and consult your state Brain Injury Association. Several complex factors will determine your friend’s outcome. What you can do is be there for him; your presence and support will help more than you may think.

ANONYMOUS COMMENT: Pat For President!

PAT'S RESPONSE: Thank you.

Pat #3

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT:

I am a police officer who was on duty when I was hit by a car doing 55 mph. I suffered massive injuries and was comatose for 2 months. Since the accident, I have been questioning my faith in God. Is it normal for a person with a brain injury to experience religious conflict?

PAT'S RESPONSE:

It is normal for anyone who has experienced a trauma to experience religious conflict. Traumatic events include brain injury, a relative’s death, war, job loss, the big 3-0, the big 4-0, etc. Events that make us consider the "big picture," the meaning of life, why certain things happen to us can trigger religious ponderings. Many people who survive brain trauma find religion; they may attribute a seemingly miraculous recovery to supernatural forces (i.e., God). Others may wonder why they bothered to be pious in the first place; why did such a bad thing happen to such a good person? Some people may even feel that God is punishing them for their irresponsible behavior, their natural depravity (but then if that’s the case, we’re all in trouble). Bottom line: it is very difficult to reconcile in ourselves why traumatic events occur; we often search for reasons in vain. Don’t blame yourself or God. Pat suggests that you rest in your faith, allowing it to sustain you, as you keep in mind that the things of this world are temporal and eternal peace awaits. (Or eternal damnation, whichever.)

DEAR PAT: My partner (I’m a police officer) suffered a brain injury. He sustained frontal lobe damage. Just looking at him, you would think he’s OK, but he has so many mental problems which he finds difficult to deal with. This man is like a brother to me, and I want so much to help him, but I don’t know how. I try to be there for him when he feels bad but I don’t know what to do. I might be asking an impossible question, but how can I help him? How can I make him feel better? (I wish it were me instead of him.)

PAT'S RESPONSE:

Pat is moved by your compassion. I imagine your friend is, as well. You probably have no idea what a strength you are to him. It is unusual for someone with a brain injury and resulting psychological problems to maintain significant friendships -- most people like this eventually end up alone. Your solid, compassionate friendship is probably the most valuable help you can give him.
It is very common for someone with frontal lobe damage to experience severe personality changes, as well as difficulty controlling their own emotions and behavior. Depression is common, as a result of actual changes in the brain, as well as a natural reaction to the trauma of the injury and its consequences. While you can do little to change your friend’s behavior, you can help by conveying that solid compassion to him in many ways:

* Communicate in simple, direct, understandable terms;
* Be consistent in the way you treat him;
* Repeat things as much as necessary;
* Help create an environment that is calm and nurturing -- not over-stimulating;
* Promote opportunities for success;
* Listen to and respond to your friend;
* Be patient and non-critical;
* Do fun things together often;
* -stimulating;
* Promote opportunities for success;
* Listen to and review each day as a new beginning -- don’t dwell in yesterday or tomorrow. Finally, if you think your friend needs help that he is not getting, assist him in finding a good therapist who understands brain injury. A neuropsychologist who counsels men or possibly runs a support group for people with brain injuries would be a good start. Your state Brain Injury Association has brain injury support groups, as well. Perhaps you could attend a meeting or two with your friend to get him started.

DEAR PAT:Dear Pat, my dad told me that my cousin has a brain injury. I am very nervous because my dad said she may get a tumor. What should I do?

PAT'S RESPONSE: Brain tumors make everyone nervous, especially because tumors can appear in otherwise healthy, young individuals. There are many possible causes for a brain tumor, such as cancer, but sometimes the cause cannot be determined. If your cousin is at-risk for a brain tumor, for whatever reason, she should be evaluated by a neurologist regularly to monitor her health. This is the best way to "watch" for tumor growth and initiate prompt treatment if it becomes necessary. Pat’s advice to you is to find out as much as you can about brain tumors, so that you know what your cousin and family are dealing with. Look at the links on this site, investigate information at a medical library, look through medical journals at a university library. The more educated you are about brain tumors, the better able you will be to support your cousin, and the less frightening this will seem.
The more one knows about anything, the more empowered one is (except when it comes to Pat, in which case the less one knows about Pat, the better).

DEAR PAT:

Pat, my brother sustained a severe head injury and was treated out of state (not in his home state). After treatment, my brother returned to his home state and tried to resume a normal life. However, he has lost his job, experienced paranoia, depression and delusions. The response of health care professionals here has been to "lock him up" in the local hospital. We, his family, feel this is inappropriate. He is not at risk of harming himself or others, but he needs the right kind of help. We are wondering how to find resources in this state similar to those in the state where my brother was injured.

PAT'S RESPONSE:

Almost every state has a Brain Injury Association which can refer you to brain injury rehabilitation specialists and programs, as well as other important resources for people with brain injury-related disabilities. To find out how to contact the Brain Injury Association in your state, contact the national affiliate, the Brain Injury Association, Inc., in Washington, D.C. at (202) 296-6443 or 1-800-444-6443 .

DEAR PAT:

Why would a neuropsychologist recommend Ritalin to a person with a traumatic brain injury? Can a brain injury cause Attention Deficit Disorder (ADD)?

PAT'S RESPONSE:

This question presents Pat an interesting opportunity to reveal some very personal information to the audience. Pat is NOT a neuropsychologist. Pat recommends that you consult a neuropsychiatrist for the following reasons:

* A neuropsychiatrist is a Medical Doctor (M.D.) and can prescribe medicines; a neuropsychologist cannot.
* A neuropsychiatrist specializes in neurological dysfunction/brain injury treatment; a psychiatrist does not necessarily have this specialty.
* A neuropsychiatrist can work effectively with a neuropsychologist and other professionals to determine whether the brain injury possibly caused the ADD. There can be a link between brain injury and behavioral, emotional, and psychiatric conditions such as ADD. See the FAQ’s on this site for more information.

PAT’S FINAL COMMENTS: To those of you who submitted questions regarding the following: helping someone with memory loss, helping a family member understand mild brain injury, and sports concussions, please consult the updated list of FAQ’s or information; look under Problems After TBI-Cognitive; Special Issues-Family; and Basic Aspects-Causes, respectively. Pat is especially concerned about you people with sports concussions . . . don’t become another Mike Tyson.

Pat #4

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

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.)

Pat #5

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: I am wondering if some of the problems I have (due to a traumatic brain injury) will ever disappear. What are the chances of improvement over time? For example, I have heard of patients regaining speech a year or two after an injury. Is there a "typical" course of recovery for people with traumatic brain injuries?

PAT'S RESPONSE: There is no typical course of recovery from traumatic brain injury since TBI affects each person in a unique way. After all, we start out as individuals, and even after the injury, we still are individuals. In general, a person achieves the most dramatic recovery during the first year after the brain injury. Intensive rehabilitation services can greatly enhance one's improvement. However, improvement can continue to occur over the next several years. The physical healing of brain tissue eventually will taper off, but the door remains wide open for personal growth. The key is for the individual with brain injury to STRIVE for continuous improvement. Participation in appropriate therapeutic activities and embracing a healthy, active lifestyle are good for your brain, body, and soul. So, see good therapists, participate in a dance class, take a course in Chinese cooking, and meditate, instead of, say, munching Cheeto's in front of "McHale's Navy."

DEAR PAT:My wife had a postpartum hemorrhage and is in a rehabilitation hospital now. She suffers from lack of oxygen to the brain. Can we classify her as a TBI patient? How can I get more information about her illness and the treatment needed?

PAT'S RESPONSE: Brain injury can include any event which causes bruising, swelling, bleeding, tearing to brain tissue/cells, nerves .... This includes a blow to the head, gunshot, stroke, aneurysm, tumor, and hemorrhage. Lack of oxygen to the brain is called hypoxia (diminished oxygen) or anoxia (complete lack of oxygen). In brain injury, the tissue which is damaged may repair itself (just as a bruised knee eventually gets better). There is debate as to whether nerves can repair themselves. Even if nerve regeneration occurs, the nerves are not the same as pre-injury, so functioning is impaired. In anoxia, brain cells die and do not recover. It sounds like you need to get very clear information on your wife's diagnosis and then consider pursuing information through the Internet and the nearest university library.

DEAR PAT:

I am searching for resources for people with brain injury who live in Canada. Any ideas?

PAT'S RESPONSE: Pat recommends you contact the Ontario Brain Injury Association by telephone 905-641-8877 or e-mail ([email protected]). They have a lot to offer!

DEAR PAT: I teach pre-school children with disabilities. I have a student who is developmentally delayed and has serious emotional/behavioral issues. He has a history of banging his head on hard surfaces. I am curious if all those years of banging his head could have caused some sort of brain trauma which has affected his behavior and his ability to process information.

PAT'S RESPONSE:Emphatically, YES. Children's brains are very vulnerable. The effects of a brain injury in a child may not show up until months or years after the actual injury. This is because pediatric brain trauma injures a developing brain. There is a wealth of information on pediatric brain injury and positive, effective behavior shaping techniques. You may want to start by contacting:

May Institute Center for Education and Neurorehabilitation
Ron Savage, Ed.D. (Specialist in pediatric neurorehabilitation)
35 Pacella Park Drive, Randolph, MA 02368
617) 963-3600

Research and Training Center on Rehabilitation and Childhood Trauma
New England Medical Center
750 Washington Street, #75K-R, Boston, MA 02111
(617) 636-5031

DEAR PAT: I was recently told that the minor head injury I sustained 24 years ago in a bicycle accident may be the cause of several of my current problems. At the time of the accident, I was in the hospital for about 2 weeks. I was in a coma for 3 days. There are no physical effects, but I am slow at everything. For example, I experience comprehension/reading problems. In the past 4 years I have struggled with mood swings and severe depression. I just started college and I am having a difficult time. Could my problems be related to this childhood brain injury, and how can I get help?

PAT'S RESPONSE:

Your situation is common among people with minor brain injuries. Often these injuries are overlooked or minimized because the period of unconsciousness is minimal, the CT scan is negative, and/or the person "looks fine." Twenty-four years ago, no one even heard of brain injury anyway. (They were still using exorcists to cure epilepsy.) A person in need of accurate diagnosis and specific recommendations should see a neuropsychologist, which is a psychologist specially trained in evaluating brain-behavior relationships. In Pat's educated opinion, a neuropsychologist is the best person for you to consult at this point. Then you will have specific suggestions for yourself and your school to help you be academically successful.

DEAR PAT:

I was a teacher for many, many years when I was beaten unconscious by one of my students. I am now learning to accept my brain injury. My husband walked out and has a new girlfriend. My school is trying to make me retire early, but I cannot afford that. I have lost my creativity as well as my spelling ability. Everything seems so pointless. I do not know who I am; will I ever?

PAT'S RESPONSE:Who You Are: a human being with innate value who is deserving of compassion and kindness. There are others who have experienced what you have. They want to help you. Consider contacting the Florida Brain Injury Association and attending a support group for people who have sustained brain injuries. Telephone the Florida Brain Injury Association in Pompano Beach at 954-786-2400 or 800-992-3442 . And send your ex-husband a box of chocolate-covered grasshopper heads from Pat.

PAT'S FINAL WORD: The despair expressed in the previous "Dear Pat" question is a desolation that so many have experienced and conveyed to Pat through this column. Please read some words of encouragement submitted to Pat from our site's visitors.

"You must never give up hope for any type of recovery in your child. Even the smallest steps gained during recovery should be viewed as positive because they can lead to more steps. Kids need their families' support more than anything else."

"I know how you are feeling. I was in a wreck 3 years ago and I have a head injury. I tried going back to work and fell into a depression too deep to express. The injury was work-related and I was on workman's compensation. It took a year of court hearings and doctors to get back onto compensation benefits because no one thought of my depression and other cognitive problems as injury-related. I am, now, sitting in a rehab hospital 3 years after my accident finally getting the treatment I need. Good luck and don't let anyone tell you that you are making anything up!!"

Pat #6

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT:

I was in a serious car accident and sustained a major blow to my head. The CT scan came out negative, but I had a lump literally the size of an egg on my forehead, two black eyes and bruises to the rest of my body and head. I have been evaluated by a neuropsychologist who states that there is nothing wrong with me that was not present before the accident, and that I am complaining of problems for which there is no physical evidence. The neuropsychologist has many academic degrees, so I am questioning myself! It is so hard to put my finger on what is wrong, but it takes me ten times longer to do things now than before the injury. My house used to be immaculate and now it's a disaster. Is it possible that this professional, who is apparently highly trained (and has written books and given lectures), is wrong?

PAT'S RESPONSE:

It is not uncommon for someone who sustains a mild brain injury to receive a clean CT scan. You were smart to consult a neuropsychologist for more diagnostic information. And, the neuropsychologist's conclusion that your problems were present before your injury makes sense. If you stunk in math before your injury, you'll still be counting on your fingers after the accident. A person with depression prior to the accident probably will emerge from the injury with depression. In fact, the depression may be worse because you are reacting to the fact that you experienced a traumatic event. There may be no physical/organic cause for your depression that did not exist prior to the accident. You simply would be reacting normally to a traumatic event. What you need to do is find out why you take longer to get things done, to clean house, etc. if these problems did not exist before the accident. Feeling slowed down is very common after a brain injury, by the way. You may benefit by getting a second opinion from another neuropsychologist or a neuropsychiatrist if you feel that you need medication. This does not diminish the opinion of the first neuropsychologist; a second opinion simply gives you more information.

DEAR PAT:

At the age of 18, I sustained a severe head injury when I was hit by a driver in a pick-up truck, and I was as messed up as a Don King hair-do. I was in a coma for 8 weeks, and I really don't remember much of my recovery except that the food sucked. I guess I'm either too stupid to realize the severity of my injury or too stubborn to let it keep me down, because I'm in college now trying to get into the field of cognitive rehabilitation. I'd like any information you can provide on this topic. By the way, the best advice I can give others: NEVER GIVE UP!

PAT'S RESPONSE:

The Don-King-hairdo syndrome is one of the most disturbing results of a head injury. It's ugly, it's humiliating, it ruins lives...don't even kid about it. Thank heaven you were granted entrance into a college in spite of it. Some good sources of information on cognitive rehabilitation include university libraries (look at the scientific journals), medical college libraries, and university- and hospital-based federal research centers such as the Model Systems of Care and Research & Training Centers. For specific information on resources near you, contact your state Brain Injury Association or the national Brain Injury Association at 1-800-444-6443 . A wealth of information exists.

DEAR PAT:

My friend was caught in the cross-fire of a gun battle between gangs here in L.A. just 2 months ago. A stray bullet passed all the way through his brain and lodged in his skull. The bullet was removed and after a couple of weeks he was moved to a rehabilitation center. He has made a miraculous recovery, but now that he's back home he's not getting the valuable therapy he needs to continue making good progress. He doesn't need my help for motivation and enthusiasm, but I would like to help him with practical therapy to get the left side of his body functional again. He is exhibiting improvement already, so I think it's just a matter of time and appropriate therapy for him to regain function. He cannot afford professional help - any advice?

PAT'S RESPONSE:

A periodic consultation with a professional, such as a physical therapist, might be a good idea. . A physical therapist willing to come to your friend's home would be best. Check with rehabilitation clinics versus major hospitals for therapists that do some private work. You could attend the consultation with your friend and his family and learn some techniques to help him at home. The therapist could be hired to come once a week, once every two weeks, or even once a month to assess your friend and give you guidance on helping him with exercises. Of course regular, frequent physical therapy that tapers off as the person makes progress is best; however, you can be creative and at least get some guidance from a professional who can help you keep your friend active. Some help is better than none, in Pat's opinion. Also, think of ways to help your friend fund more therapy. He should apply to social services for help, at least. Maybe you and his other friends could get together and hold a small fund-raiser. If nothing else, your being there and helping him use his body and mind (instead of lying on the couch all day) will be extremely beneficial.

DEAR PAT:

I teach pre-school children with disabilities. I have a student who is developmentally delayed and has serious emotional/behavioral issues. He has a history of banging his head on hard surfaces. I am curious if all those years of banging his head could have caused some sort of brain trauma which has affected his behavior and his ability to process information.

PAT'S RESPONSE:

Emphatically, YES. Children's brains are very vulnerable. The effects of a brain injury in a child may not show up until months or years after the actual injury. This is because pediatric brain trauma injures a developing brain. There is a wealth of information on pediatric brain injury and positive, effective behavior shaping techniques. You may want to start by contacting:

May Institute Center for Education and Neurorehabilitation
Ron Savage, Ed.D. (Specialist in pediatric neurorehabilitation)
35 Pacella Park Drive, Randolph, MA 02368
617) 963-3600

Research and Training Center on Rehabilitation and Childhood Trauma
New England Medical Center
750 Washington Street, #75K-R, Boston, MA 02111
(617) 636-5031

DEAR PAT:

I was a teacher for many, many years when I was beaten unconscious by one of my students. I am now learning to accept my brain injury. My husband walked out and has a new girlfriend. My school is trying to make me retire early, but I cannot afford that. I have lost my creativity as well as my spelling ability. Everything seems so pointless. I do not know who I am; will I ever?

PAT'S RESPONSE:

Who You Are: a human being with innate value who is deserving of compassion and kindness. There are others who have experienced what you have. They want to help you. Consider contacting the Florida Brain Injury Association and attending a support group for people who have sustained brain injuries. Telephone the Florida Brain Injury Association in Pompano Beach at 954-786-2400 or 800-992-3442. And send your ex-husband a box of chocolate-covered grasshopper heads from Pat.

PAT'S FINAL WORD:

From a very wise site visitor: "One thing I have learned since recovering from amnesia: to ignore is worse than forgetting."

Pat #7

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT:

My brother sustained a right frontal lobe injury about ten years ago and has cognitive difficulties which my family and I do not fully understand. He cannot find certain objects, such as clothing and cookware, when he needs them unless they are in his immediate visual field. He needs quite a bit of assistance. How can we get him the help he needs to perform day-to-day functions? Could Occupational Therapy help, and if so, is it provided by the Department of Vocational Rehabilitation?

PAT'S RESPONSE:

You are on the right track in considering Occupational Therapy, which focuses on helping people perform activities of daily living, such as self-care. In addition, you may wish to consider referring your brother to a neuropsychologist for evaluation and treatment recommendations. Neuropsychologists specialize in addressing how a brain injury affects/impairs behavior. The neuropsychologist, working with the Occupational Therapist and possibly others, can help your brother and your family understand the problems and formulate potential solutions. If your brother has not been in a formal brain injury rehabilitation program, consider this option -- it is the best way for your brother to receive comprehensive services. The state Department of Vocational Rehabilitation can help by paying for services, like those mentioned, IF they are necessary to help the person become employable. Basically any person who has a disability and the potential to work can receive services from the Department. Fees are based on individual income. Definitely contact your state Department of Vocational Rehabilitation to find out about eligibility and available services.

DEAR PAT:

I am an educator working with a 7-year-old student in the second grade. He has been diagnosed with Oppositional Defiance Disorder (ODD) and is taking Ritalin. It has been brought to my attention that when this student was 2 -3 years old, he choked and had difficulty breathing for several hours. After medical intervention, he was able to breath on his own. Later, he had to relearn how to walk and talk. Presently, I observe that he is socially delayed; for example, he is combative with authority figures and he is a loner. His emotional development seems to have stalled at a 2-year-old level. He refuses to follow classroom rules. He does not even attempt to do classwork. However, his teachers feel that he is of average academic intelligence. Is it possible that, as a result of oxygen deprivation, he could have suffered brain damage to the extent that it inhibits his social skills development? Is a diagnosis of ODD and a prescription of Ritalin consistent with a circumstance such as I have described?

PAT'S RESPONSE:

This student is fortunate to have you as an advocate. Your observations are very astute. Yes, it is possible for oxygen deprivation (anoxia/hypoxia) to result in serious brain damage. If you have not read the Frequently Asked Question on this site which refers to anoxia, please see the FAQ's, under brain injury causes.... Brain injury in children can result in impairments which become more and more apparent as the child matures. For example, cognitive impairments could manifest in language problems at age 2, social problems at age 5, reading problems at age 6, etc. A child with a brain injury may have difficulty managing his emotions, controlling his behavior, comprehending written material, following instructions, staying on task, interacting socially. Memory problems and distractibility are common problems for these children. If you have not done so, I would encourage you, along with the student's parents, to enlist the services of a pediatric neuropsychologist -- a good one. For a referral, contact your state Brain Injury Association. An experienced neuropsychologist can evaluate the relationship between the child's brain functioning and his behavioral functioning. This professional can make specific recommendations for the family and the school in assisting this child properly. A neuropsychological evaluation give you a better perspective on the effectiveness of Ritalin.

DEAR PAT:

I am the caregiver of my 48-year-old wife, who survived a traumatic brain injury (TBI) in an auto accident 2.5 years ago. Although she underwent a CT scan which showed no damage, my wife has a "mild" brain injury. While she has been able to hide her deficits from most people, she has expressed concerns about her cognitive and physical functioning to me. I have observed many problems in her, such as personality change and difficulty understanding conversation. However, I have not been able to convince her to pursue further treatment. My wife doesn't want to accept that she is different since the accident. She has put up an emotional/prideful wall. We are dealing with a highly educated person, a dedicated mother, friend and wife. As the spouse of someone with TBI and a parent, I am almost at the end of my capacity to cope. Please offer suggestions or someone I may speak with that has experienced such difficulties dealing with the mild TBI survivor who cannot move beyond the "public denial" to get the help needed.

PAT'S RESPONSE:

While survivors of trauma face overwhelming challenges in the aftermath, "significant others" face significant challenges of a different sort. As a spouse-turned-caregiver, you have experienced major changes in your relationship with your wife and taken on much more responsibility in the family than previously. You and your wife both need support; however, it may be time to rely on resources beyond each other. If your wife is having difficulty coping with her impairments, help her to find a neuropsychologist for evaluation and treatment, as well as a counselor skilled in helping people cope with trauma and disability. She may need to talk with the counselor about her feelings, the change in her self-image, the frustration in trying to resume a normal life, before she is willing to see a neuropsychologist for further treatment suggestions. If you are at the end of your rope, specifically identify those responsibilities that someone else can help with. For example, can a neighbor take care of the kids for a night every other week or so, giving you some down time? Can you pay someone to clean the house once a week or so? More important than such practicalities is your emotional condition. While your wife may benefit by talking with an understanding counselor, you may benefit by the same. By seeing a counselor regularly, you can talk about your true feelings, you can vent the frustrations and exhaustions involved in supporting someone with TBI. Talking about these somewhat uncomfortable feelings is better than keeping them inside where they manifest in frustration and hostility. Another option to consider is attending a support group for caregivers or family members of people with TBI. It can be very helpful and validating. Inquire at your local hospital or contact your state Brain Injury Association for more information on counselors and support groups. You and your wife need each other, but you cannot be all things to each other. Give love . . . but get outside help, too.

DEAR PAT:

I teach pre-school children with disabilities. I have a student who is developmentally delayed and has serious emotional/behavioral issues. He has a history of banging his head on hard surfaces. I am curious if all those years of banging his head could have caused some sort of brain trauma which has affected his behavior and his ability to process information.

PAT'S RESPONSE:

Emphatically, YES. Children's brains are very vulnerable. The effects of a brain injury in a child may not show up until months or years after the actual injury. This is because pediatric brain trauma injures a developing brain. There is a wealth of information on pediatric brain injury and positive, effective behavior shaping techniques. You may want to start by contacting:

May Institute Center for Education and Neurorehabilitation
Ron Savage, Ed.D. (Specialist in pediatric neurorehabilitation)
35 Pacella Park Drive, Randolph, MA 02368
617) 963-3600

Research and Training Center on Rehabilitation and Childhood Trauma
New England Medical Center
750 Washington Street, #75K-R, Boston, MA 02111
(617) 636-5031

DEAR PAT:

I was a teacher for many, many years when I was beaten unconscious by one of my students. I am now learning to accept my brain injury. My husband walked out and has a new girlfriend. My school is trying to make me retire early, but I cannot afford that. I have lost my creativity as well as my spelling ability. Everything seems so pointless. I do not know who I am; will I ever?

PAT'S RESPONSE:

Who You Are: a human being with innate value who is deserving of compassion and kindness. There are others who have experienced what you have. They want to help you. Consider contacting the Florida Brain Injury Association and attending a support group for people who have sustained brain injuries. Telephone the Florida Brain Injury Association in Pompano Beach at 954-786-2400 or 800-992-3442. And send your ex-husband a box of chocolate-covered grasshopper heads from Pat.

PAT'S FINAL WORD:

For those of you seeking information on brain injury and the resources in your state, contact your state Brain Injury Association. If you cannot find it in the telephone book, contact the national Brain Injury Association, Inc., 105 North Alfred Street, Alexandria, Virginia 22314. Telephone: (703) 236-6000. Internet: http://www.biausa.org

Pat #8

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT:

I am a high school student. A friend of mine, who is 18, sustained a serious brain injury in a skiing accident. I understand that he has made a good recovery and the biggest problem right now is his emotional functioning (he thinks all the nurses want a relationship with him). In the next few days I will be visiting him and I am wondering how I should approach this. What should I talk to him about? Thinking longer term, what can I do to help him in his recovery? Several of my other friends and I are going to the same college, which is where he had planned to attend -- should I expect him to join us? If not, what can I do to help this person not feel abandoned?

Pat's Response

You actually have posed an easy question. The best thing you can do to help your friend throughout his recovery is to be a consistently supportive presence in his life. While he is hospitalized, visit when you can. Even if a person is comatose, it can help to talk to him, let him touch his favorite teddy bear, let him smell his favorite lavender oil, play his favorite Puff Daddy tape. In other words, create an environment that gently stimulates his senses and reminds him of everyday life. This is comforting to someone in the hospital.

When your friend comes home from the hospital, he will face a difficult adjustment period as he reorients himself to his home, school, friends, etc. He may not be able to do some of the things he did before the injury (e.g., driving a car). He may feel and act different because his brain is different -- it has been injured so it will control his body in a new way. By visiting him regularly and just being yourself, you can help make the transition a little easier. Your friend may have lost the ability to do some things; he may lose friends that move on without him; he may lose opportunities he had counted on before the injury -- your enduring friendship will become one of the most important things in his life. By accepting the person he has become since the injury, you will help him accept himself and move forward.

So, to summarize, visit your friend, talk about yourself, ask him how he is doing, listen, don't be afraid to talk to him about the injury and how it has affected him, take him out with your other friends, help him set new goals for himself and support him in his endeavors. Lastly, keep reminding yourself and your friend that recovery from brain injury can take a long time; give him time to get better and try to stay positive.

Dear Pat
I have a question regarding my rights as an employee with epilepsy. I have myoclonic and complex/partial seizures. Every once in a while I have problems which keep me home from work. With my previous boss, I had an agreement for making up the time when I was out due to seizures. Now I have a new boss, so I discussed my situation with him to see if the same arrangement could be a possibility. He said he would think it over and a few weeks later called me into his office. The new boss said he had taken my question to senior management. I thought our original conversation had been confidential and I never gave him permission to discuss my situation with anyone else. Now senior management wants documentation from my neurologist. What are my rights and were any violated?

Pat's Response

You have several options, but the first thing you must do is establish what exactly went wrong. You "thought" your conversation was confidential, but did you ever specifically state to your boss that you preferred it be? Have you been denied a reasonable accommodation for your disability? If so, you may have a legitimate complaint.

Another critical first step is to collect any evidence to help prove your point (i.e., written information, letters, memos -- even your own dated, written account of events is useful).

Next, if your company has an internal grievance procedure, pursue that. The personnel department should be able to advise you.

You can contact your state's disability advocacy organization. Look in the telephone book government pages for something like: "Disability Rights Protection." Contact that agency and ask for information and advice.

The U.S. Department of Justice investigates claims of disability discrimination under the Americans with Disabilities Act (ADA). Write: Department of Justice, Civil Rights Division, Disability Rights Section, P.O. Box 66738, Washington, D.C. 20035-6738. Telephone: 1-800- 514-0301 ADA Homepage: http://www.usdoj.gov/crt/ada/adahom1.htm

The Dept. of Justice does a thorough investigation of complaints so it's worth a try if you feel you have a good case of denial of disability rights (e.g., access to public services, fairness in employment, etc). However, if you can work with your employer to resolve the situation, that is much better for both of you in the long run. Harmony can be preserved.

Dear Pat

As a very young child, my daughter sustained a skull fracture due to a fall. At the time, a CT scan and EEG showed normal results. Now my daughter is 6 years old. Having been diagnosed with Attention Deficit Disorder (ADD), she is on regular medication. Although she does well on the medicine, she and the rest of the family experience continuing frustrations. Did the skull fracture cause the ADD? Who might we contact for help?

Pat's Response

It would be helpful if you specified what the continuing frustrations are. Is your daughter sad most of the time? Is she having problems paying attention in class? Does she fight with siblings alot? Does the family need more information on the side effects of her medicine? Is the family unsure how to act when she gets angry?

A couple of factors which you mention make it imperative to identify specifically what the problems are. First: Attention Deficit Disorder (ADD) is not very well understood -- what exactly is the cause? what exactly are the symptoms? do children outgrow it? It's difficult to help your daughter when the diagnosis is this general; it describes the behavior but what about the etiology? Second: The long-term effects of brain injury in children are not predictable to any precise degree. Researchers have not identified a typical post-injury behavior pattern. However, uninhibited behavior, hyperactivity, and inattention are frequently reported problems. Perhaps your daughter's behavior is "normal" for someone experiencing the residual effects of brain injury (the effects of pediatric brain injury can show up years after the trauma, as your child grows and attempts to learn new skills).

The diagnosis of ADD may describe your daughter's behavior, and the medication may help, but do you fully understand why your daughter behaves the way she does? If you have more information, you can make better decisions about how to help her.

For specific information on your daughter's psychological assets and deficits, which will help your family and the school understand and support her, consider a pediatric neuropsychological evaluation. This will involve testing of her intellectual ability and behavioral tendencies, which will help guide you in creating a nurturing homelife and will help the teachers in creating a learning environment that works for her. For referral to a pediatric neuropsychologist, contact your state Brain Injury Association. If you need help doing this, contact the national Brain Injury Association at (703) 236-6000

(Reference: Waaland, P. (1990). Pediatric Traumatic Brain Injury. Rehabilitation Research and Training Center, MCV: Richmond, Virginia.)

Dear Pat

I sustained both a brain and spinal cord injury in 1996. I have poor balance and I walk to the left. Although my balance has improved with time, I wonder if my it will ever be restored.

Pat's Response

Balance disturbances have various etiologies and treatments; what works for some problems may not help others. You should consult your neurologist to pinpoint the cause of your balance problems. It probably will lie somewhere in your vestibular system, the body organs which control balance. Components of the vestibular system are located in the ear and the brain. So, irregularities in the brain and/or the ear can cause vestibular disorder, i.e, balance problems. In addition to your neurologist, you may need to see an ear specialist, known as an otologist.

Many vestibular disorders can be treated with drugs, therapy, surgery, and other interventions. There is no guarantee that a person with such a disorder can be cured. In cases where balance problems persist, compensatory strategies can be developed.

For more information, contact the Vestibular Disorders Association, P.O. Box 4467, Portland, OR 97208-4467; telephone: (503) 229-7705

(References: Office of Scientific and Health Reports, National Institute of Neurological and Communicative Disorders and Stroke. (1986). Dizziness: Hope Through Research. National Institutes of Health: Bethesda, Maryland.

Vestibular Disorders Association. (1993). Vestibular Disorders: What Are They? Vestibular Disorders Association: Portland, Oregon.)

Dear Pat

My 16-year-old son had a moderate brain injury about 18 months ago as the result of a car accident. He still struggles for word identification. Some words he appears unable to retrieve, no matter how hard he tries. These are words which he did not frequently use before the accident. Is this a learning impairment that he might overcome with repetition, or are there some words that may never become part of his vocabulary?

Pat's Response

Even though your son was injured over one year ago, he still can continue to make progress. It is worth the effort to assess his current problems and pursue treatments that may help. You can take the first step in this assessment and then consult the appropriate professional(s).

First step: Make a written record of the communication problems. Try to answer the following questions.

What words are problematic? Your current observations are very helpful -- he has trouble with words not used pre-injury. Your son is having difficulty partly because information learned prior to an injury may be easier to recall than information attempted post-injury.

Are there any clues to why he cannot say certain words? Is he receiving your message? That is, can he hear and understand what you are saying to him? If so, does he have the ability to express himself? For example, can he mentally retrieve words? physically speak the words? put them in a meaningful sentence?

Note the environments in which problems occur. Are there distractions in the environment? Is it too noisy? I someone making him nervous?

As you can see, communication involves complex cognitive and physical functions. Once you have gathered detailed information about your son's difficulties, you may wish to consult a speech language pathologist for an evaluation of your son and therapy recommendations. The speech language pathologist can advise your family with suggestions such as speaking only when facing your son, slowing down your rate of speech, simplifying your vocabulary, etc. If a hearing problem is suspected, an audiologist may be consulted.

(Reference: Blosser, J., DePompei, R. (1996). Crossing the Communication Bridge: Speech, Language and Brain Injury. Brain Injury Association, Inc.: Alexandria, Virginia.)

Pat #9

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT:

I have a large bump on my head as a result of a car accident. I thought I was OK after the accident, but now I get a little dizzy and my vision is sometimes blurry. My head feels sensitive. Should I be concerned?

PAT'S RESPONSE

The bump and sensitivity could be skin problems (i.e., bruising from the impact) or they could indicate deeper problems; the dizziness and vision disturbance are warning signs. Read on....

Many people who sustain head injuries are seen in the Emergency Room and released, not admitted to the hospital. At the time of the injury, you may have been unconscious for an indeterminate period of time, dazed, dizzy or confused. You may have gone to the Emergency Room, been examined by a doctor, given a CT scan (Computerized Tomography), and been told that you were well enough to go home. If you felt fine, you went on your way. For most people who sustain a mild, closed head injury, the above scenario is typical. Most mildly injured people experience no further problems. However, some people who sustain mild HEAD injuries also sustain mild BRAIN injury. This occurs when the brain bounces around inside the brain; nerves in the brain may be stretched and broken, brain tissue may be bruised and broken by impacting the bony skull. It is very difficult to tell if an Emergency Room patient with a mild head injury has sustained BRAIN injury. Believe it or not, CT scans often DO NOT detect mild brain injuries.

How do you know if you are going home with a brain injury? First, look for the following problems in the first 24 hours after the injury; contact your doctor if you experience any:

1. Weakness in one arm or leg.
2. Vomiting more than once.
3. Continuing or worsening headache.
4. Neck stiffness or pain.
5. Unequal pupil size.
6. Vision changes (e.g. seeing double).
7. Clear or bloody drainage from the ear.
8. Convulsions ("fits" or seizures).
9. Difficulty swallowing or speaking.
10. Difficulty in arousing or waking.
11. Loss of consciousness.
12. Confusion.
13. Failure to improve.

In children, also look for:

1. Restless or fussy.
2. Cannot pay attention.
3. Forgetful.
4. Difficulty learning.
5. Lethargic (takes longer to do things).
6. Tires easily or wants to sleep extra.
7. Does not act the same; personality or mood changes.
8. Easily upset or loses temper a lot.
9. Impulsive; acts before thinking.
10. Drops things a lot.

It can take several hours up to several weeks for problems to resolve, so if you experience any of the above symptoms at any time after the injury, consult your physician. A simplified way to determine whether a head injury may have caused a brain injury requiring further attention is to consider whether you or your child are behaving differently since the accident. The change may be so subtle that you cannot specifically identify the problem, but if you just know that "something is wrong, something is different" then further attention may be warranted. While most MILD BRAIN injuries do resolve, some people experience problems for up to a year or more. Some people with mild brain injuries experience difficulties for an indefinite period of time. Long-term effects of mild brain injury include memory loss, difficulty learning, fatigue, head or neck pain, sleep changes, difficulty focusing attention, depression, and other changes. There is help available for people who have long-term problems after a mild brain injury; contact your state Brain Injury Association or your physician for advice and consider seeing a neuropsychologist for assessment and treatment recommendations (see FAQ's for more on neuropsychology).

References: (1) "Head Injury Precautions." The Emergency & Trauma Center, Fairfax Hospital, Virginia. (2) "Head Injury." Sentara Hospitals, Virginia. (3) "When Your Child Goes Home After Being Examined For Head Injury In An Emergency Department." Research and Training Center, New England Medical Center, Boston, MA.

DEAR PAT

I had a brain injury in February 1995. I am 27 years old. Would it be extremely harmful to go out and have a few drinks with friends?

PAT'S RESPONSE

It depends on the drinks and the friends. Pink lemonade is OK; Yoo Hoo is great; Shirley Temples -- go for it. If you are referring to alcoholic beverages, think again. And while you're at it, think about your friends. If you drink alcohol, true friends will designate a non-drinking driver. If you decide not to drink, true friends will support this. Pat recommends the latter.

A brain injury can result in many cognitive and physical impairments -- problems which become worse under the influence of alcohol and other drugs. According to research from the Ohio Valley Center for Head Injury Prevention and Rehabilitation, the following is true:

* The use of alcohol or other drugs impairs recovery from brain injury. Keep in mind that recovery can occur for years after the injury.
* Brain injuries can cause problems in balance, walking, and/or talking which get worse when a person uses alcohol or other drugs.
* Brain injuries can cause a person to act impulsively, without thinking first. Judgment may be impaired. Alcohol and other drugs definitely exacerbate this, significantly compromising a person's decision-making ability.
* Brain injuries can impair cognition, causing difficulties with concentration and memory. Alcohol and drugs can make problems like these even worse.
* People with brain injuries can become depressed; alcohol and drugs can make someone more down. The high is only temporary, and the subsequent low is REALLY low!
* Alcohol and drugs can cause someone with a brain injury to have seizures.
* Alcohol and drugs can be dangerous when used in combination with prescription medications, (which many people with brain injuries may be taking).
* A person who uses alcohol or other drugs after a brain injury is more likely to experience another head trauma.

Think about that last statement, and consider this: alcohol is present in more than half of all head injuries. Alcohol alone is a factor in 66% of head injuries resulting from motor vehicle accidents, the leading cause of brain injury. To all: think before you drink. To those with brain injuries: think about not drinking.

Resource: User's Manual for Faster, More Reliable Operation of a Brain after Head Injury. Ohio Valley Center for Head Injury Prevention and Rehabilitation,1166 Dodd Hall, 480 W. 9th Avenue, Columbus, Ohio 43210. www.ohiovalley.org

Pat #10

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

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).

Pat #11

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: Six months ago, I had a serious brain injury and have been unable to return to work. I recently found out that my husband is having an affair. I want to confront him, but I am worried about what happens if he leaves me. I’m not sure I can take care of everything on my own.

PAT'S RESPONSE: A place to start may be simply asking him how he feels about you, whether he is satisfied in the marriage, and what he would like to see change to make things better. Talking to your husband about these issues may give you an indication of how he will react if you confront him, and whether he wants to work on the marriage. It will also give you a better idea of how he feels and whether you think the marriage is worth saving.

Before you make a decision about what to do, you need to remember that you are an important, valuable person who deserves to be treated with respect. The second thing to is to remember that you won’t be alone. Your family, friends, neighbors, or religious community are likely sources of support. You are not alone and you won’t be alone no matter what happens. People will be there to support and help you. Don’t be afraid to ask for help.

Ultimately, you will have to make a choice. You really only have two choices.

Seek a divorce

Try to work it out

If you want to seek a divorce, you should consult an attorney before you confront your husband. You need to know your rights and how to protect yourself legally. Don’t just leave the house before consulting an attorney –especially if you have children. In many states, this is considered "abandonment" and can hurt you in court. Seriously consider whether you really want a divorce.

You will also want to talk to family and friends about the type of help and support you’ll need. Find people who will help you around the house or provide transportation. Finding a therapist that specializes in divorce is often a good idea. Many people benefit from talking to an expert about how to adjust to life after divorce. If you have children, consider arranging for family sessions for them to discuss their feelings about the marital separation. Talk to your doctor, therapist or counselor about what resources may be available to assist you should you need them.

If you want to work it out, you have to tell him you suspect an affair. Doing nothing won’t make it go away. You will need marital therapy. Very few couples can resolve the anger, feelings of betrayal and lack of trust on their own. Consider the quality of the marriage before his affair. Affairs can be a symptom of long-standing marital problems, not the cause. Were there problems adjusting following the injury or did problems exist before you were hurt? Is the relationship worth salvaging? How long has it been since you felt the marriage was strong? Was it strong before you got hurt? Remember, if you decide to work it out, you will have to be prepared to work toward forgiveness. Both of you will have to work hard to regain trust, intimacy, and commitment.

If you want to work it out, the hardest part will be facing the possibility that your spouse might not. The thing to remember here is that if he doesn’t, your marriage isn’t going to improve anyway. Talking to him is the only way to find out if he’s willing to try. You may want to consider talking to a therapist about your dilemma. A therapist can help you decide how to approach your husband, and how to cope with things if he decides he doesn’t want the marriage any more. Either way, it won’t be an easy road.

A good man is hard to find. Too bad a bad man isn’t.

DEAR PAT: We are being accused of shaken baby syndrome and we did not do it. We don’t know how it happened. I have bumped my 5-month-old son’s head on the car door and my five-year-old daughter accidentally kicked him in the head. However, I’m told neither of these could have caused his injury. I’ve read other stories saying it doesn’t have to be a hard hit. If you have any information that can help, please let us know.

PAT'S RESPONSE:Shaken baby syndrome is a constellation of brain injuries that occur after the baby has been shaken violently. Infants with shaken baby syndrome typically have subdural hematoma, cerebral edema, and may show retinal hemorrhage. In other words, there is bruising and bleeding in the brain and often retinal damage due to violent shaking. Other injuries consistent with shaken baby syndrome can include neck injuries, skull fractures, or bruising or broken bones to the arms of chest (where the baby was grasped). The injuries result from the force generated by shaking the child violently back and forth. Studies have shown that the forces necessary to cause these injuries greatly exceed those sustained in routine play, infant swings or fall from low height. Certainly your child bumping his head on the car door or being accidentally kicked by a five-year-old would be insufficient for this type of injury. There is no other medical condition that mimics all the features of shaken baby syndrome.

Why are babies shaken? Most often it is the result of caregivers who are frustrated with crying. Shaking the baby often results in the child appearing dazed or drowsy – and the baby often stops crying (reinforcing the caregiver for the behavior). Unfortunately, the baby’s drowsiness and silence is usually the result of brain damage. Shaken baby syndrome can result in blindness, permanent disability, or death. I hope that your child is able to make a good recovery.

DEAR PAT: About 10 years ago, I fell out of a truck that was towing a camper. I was run over by the back wheel of the truck and had numerous cuts and bruises. I was very lucky to be alive! The most serious issue after my accident was a "personality change." Everyone noticed it! My sister said it was like I was a stranger! My taste in food, music, and clothes changed. I even lost a fear of heights I always had! Is this type of change common?

PAT'S RESPONSE: Actually, personality and behavior changes are quite common after a brain injury. Many people experience a decrease in inhibition – making them less anxious about things. On the other hand, it can also make them more impulsive, aggressive or irritable. Some people even describe the person as being calmer and quieter after an injury. It’s hard to predict and sometimes the changes are temporary. Also, sometimes people who experience a traumatic event that brings them close to death make changes in their lives that have nothing to do with a brain injury.

DEAR PAT: Hi! About two years ago I fell and hit my head and was found unconscious. 6 CT scans later no one can find any "damage," yet I still have intermittent memory loss and now symptoms of stroke. What should I do? I can’t afford to keep having CT scans.

PAT'S RESPONSE:CT scans are good at showing many types of physical damage to the brain. However, they aren’t perfect and there can be damage that the CT scan doesn’t pick up. I would suggest that you consider a neuropsychological assessment. This evaluation won’t tell you what your brain looks like. Instead, you will be given a number of tasks related to attention, memory, auditory and visual processing and visual-motor skills to assess how your brain is working. In many cases, it may be helpful to also have a follow-up evaluation in about 6 months to determine if things are getting better or worse or staying the same.

DEAR PAT: I am writing regarding a friend with a brain injury. Do you have any recommendations for a person who refuses to seek professional help to deal with his behavior? He thinks it is going to get better, but it is only getting worse.

PAT'S RESPONSE:The best thing you can do is to continue to provide your friend with feedback about his behavior. If he does or says things that make you uncomfortable or embarrassed, let him know. Encourage other friends or his family to provide feedback as well. Be sure to balance criticism with positive feedback. Remember, if the behavior is due to a brain injury, he may not always be in control of his behavior. Some people aren’t aware of the impact of their behavior on others. Don’t give up. Have faith that things can always change for the better.

DEAR PAT: I suffered a severe brain injury this past August and according to my neurologist I am between 85-90% back to normal. However, I have returned to work in a very busy environment and am still only part time building back up to my full-time position. We had an impromptu meeting last week and I was thoroughly upset. I was sure they were picking me apart even though they told me it was supposed to be constructive criticism. I wonder if that is a normal response and if there would be something that I can do to make this whole transition easier for myself as well as my co-worker.

PAT'S RESPONSE:There is virtually no one who has sustained a severe brain injury that does not experience some difficulties returning to work. Most jobs require a number of skills such as attention, memory, auditory and visual processing, reaction time, and good motor skills. Even relatively minor disruptions can cause problems on the job. Imagine a lawyer who has even slight difficulties remembering case law or a truck driver who can’t pay attention to the road. Even jobs such as working at a fast food restaurant can require people to work quickly in a high stress environment. Many people also find they have more difficulty coping with stress and are more easily frustrated.

There are a couple of things you need to consider. The first is whether or not your employer is supportive of you and willing to show tolerance as you re-integrate into the workplace. A supportive employer is extremely important for people returning to work after a brain injury. If you believe your employer and co-worker are supportive, talk to them about your situation and ask for feedback. If you don’t think they are supportive, find out about your rights in the work place. You may have rights under the Americans with Disabilities Act or other legislation.

The second is whether or not you’re ready to come back to work. Many people simply come back too early before they are ready.

If you haven’t already, consider having a neuropsychological assessment. This can help you identify your strengths and weaknesses. Think about consulting with a psychologist or other therapist that specializes in rehabilitation. They may be able to offer you good ideas, suggestions for compensatory strategies, stress management techniques, and provide a neutral perspective that you can’t get from friends or family members.

If you want more help, a new book titled "The Brain Injury Work Book: A Guide to Living and Working Productively" is available from the National Resource Center for Traumatic Brain Injury. This book is written for persons with a brain injury and provides a number of useful ideas related to working (or not) after injury. Ordering information is available on this website.

Pat #12

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

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: [email protected]
Web Site: http://www.biausa.org/Nebraska/bia.htm

Pat #13

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: My dad is a young 65 and had a subarachnoid hemorrhage in November 98. He’s spent the last 6 months in this great transitional living center for brain injured people. He’s almost ready to go "home" and herein lies the problem. Before his brain hemorrhage he was extremely independent. He managed investment property for his family. He put over 70,000 miles on his car last year. He divorced my mom and has had no permanent home for the last couple of years. Right now he has a very structured environment. He’s great in the moment and doesn’t confabulate any more. However, he’s been obsessing over opening his own rehab center (brings up the subject every 10 minutes as if we’ve never discussed it). We have to remind him that he can’t run a business if he can’t remember what happened the day before. The senior day programs are not stimulating enough for my dad. He has to do something with more purpose than playing cards. My aunt said she’d love to live with my dad, but doesn’t know what he’ll do every day. My sister and I also live in San Francisco. Are there any programs in the San Francisco area for brain injured people like my dad? That is, for an active, capable person who needs a little extra guidance, compassion, and consideration of his deficits? Thanks so much for your help.

PAT'S RESPONSE:It sounds like your dad is a pretty interesting guy who can still do a lot of things and has some big dreams. Usually what I recommend is for the family and the patient to visit several facilities to see which one is the best match for the patient. You and your father will better be able to judge if a facility is a good match for him than any "expert." If your dad does need 24-hour supervision or cannot be left alone, it may be necessary for you to use an adult care facility even if it’s not the "best" possible option. A less restrictive option may be to locate mentors or other people that can work with brain injury survivors one-to-one. Find out if there are local brain injury support groups. Often these are the best sources for ideas and information since they consist of survivors and family members who have gone through similar situations.

On the other hand, if your father only needs minimal supervision your family may be able to help out a lot. Most people very much prefer the company of their family to the company of strangers. If you, your sister, and your aunt all work during the day, perhaps you could hire someone to provide in-home or part-time supervision. Maybe as your dad recovers, he will require less supervision during the day and can live with a family member without the need for daytime supervision.

Consider consultation with a physiatrist or neuropsychologist who may be able to assess your father’s strengths and weaknesses, suggest an appropriate level of care, and refer you to the necessary resources.

DEAR PAT:: My brother Rusty was in a bad accident on December 6, 1998. He is 30 years old and has severe brain damage. He was in a hospital for two months and is now in a nursing home where they basically keep him alive but don’t give him enough therapy to ever be able to walk again. They help him get out of bed but don’t work with him enough to be able to get back the way he was. He needs therapy, not just someone throwing him a chair and then walking away. He is not able to talk yet but he can read and remember things. Is there any way I can help him start to talk again? It seems he wants to talk and I find he tries to make sounds but takes him along time. It seems to be taking my brother forever to get better. The doctors have given us no real hope. They say he has microscopic damage in many areas and I’ve read enough to know that this is hard to detect. Can you help me?

PAT'S RESPONSE:One of the things family members want the most is for their loved one to be back "they way they were." I would love to tell you that with enough therapy, love, and prayer that is what will happen. Unfortunately, total recovery rarely happens after a serious brain injury. Persons with brain injury followed for 10, 15 or more years often continue to report problems associated with their brain injury. Many are unable to return to work. The other thing to keep in mind is that the fastest recovery takes place in the first 6 months. Further recovery often occurs, but it can be a slower process. Recovery occurs at its own pace. It is important to view recovery on a day-to-day basis rather than to compare things to way they were before the injury. Goals should be set based on your brother’s current status. I’ll bet that if you look at where he was back in December, you can see some progress from where he was. Some families like to videotape things so they can look back two or three months to see if progress has been made. Many families are amazed at how much progress they didn’t see – because they kept thinking back to "the way the person was" instead of appreciating how far the person had come already.

The best thing you can do for your brother is to continue to spend time with him, talk with him, and encourage him. Even though he may have trouble talking, it sounds like he can hear you and I’ll bet he appreciates the time you spend with him. Talk with the hospital staff to see what you can do to help. If your brother can communicate through gestures or writing, use those and don’t get frustrated by his not talking. It sounds like the doctors are saying that your brother had a very serious injury = a kind that often occurs when the brain is jostled around during a motor vehicle accident. (Try shaking an egg really hard and then cracking it. The yolk and whites are all mixed up. It’s a similar thing when the human brain gets shaken really hard during a car accident). Given the injury you describe, the length of time since the injury, and the symptoms you describe, I expect the doctors are correct in saying that he won’t ever get back to the "way he was." But that doesn’t mean he won’t improve. It doesn’t mean his life doesn’t have meaning or value. It certainly doesn’t mean you should give up hope. Just be realistic about what you hope for.

DEAR PAT:Thanks for your column. I have had a traumatic closed head injury for 2 ½ years now. I have balance problems, am sensitive to sounds and lights, and have memory problems. I am on Imitrex and other drugs. Rehabilitation is done, but I still see a physician to talk. I still can’t manage pain although they said I have reached maximum medical improvement. I don’t believe them. Could they be right? I want to go back to being an accountant.

PAT'S RESPONSE:What don’t you believe? If you’re still having symptoms after 2 ½ years, your physicians are probably right in telling you that you’re likely to have permanent effects of the injury. Getting back to "just the way you were" before the injury is very unlikely. You might continue to see improvements, but after that long post-injury, the improvements are likely to be slow and gradual. If you don’t believe your physicians are exploring all the options, by all means get a second opinion. It never hurts to consult another expert. (Well, it might hurt your wallet if your insurance won’t pay for it.) You might want to consider a specialist in pain management. If you haven’t already done so, consider a neuropsychological evaluation to explore your strengths and weaknesses. Being an accountant is probably one of the most difficult things for a person with brain injury to attempt. It’s a job that requires a good memory, good math skills, sustained attention, organization, stamina and the ability to attend to details. However, if your symptoms are primarily sensitivity to light and sound and balance, maybe the skills you need for accounting are strong enough for you to return to it as a career. If your skills won’t allow you go back to accounting, consult with a vocational rehabilitation expert or consider career counseling to look for options that will fit with your abilities and interests. Only by knowing your strengths and weaknesses and being realistic will you be able to make an informed decision about your future.

DEAR PAT:Hi Pat, I was in an automobile accident in 1983. I sustained a concussion and was in and out of consciousness for the first 3 to 4 days. The doctors at the time showed no real concern. In 1997, after experiencing severe headaches, I was diagnosed with Chiari I malformation and Hydrocephalus. After having 2 separate surgeries to correct the conditions, I still experience the same symptoms. My question is: Is it possible that the Chiari was triggered by the head injury I sustained over 16 years ago? Since being diagnosed I have done a lot of research, and there does seem to be evidence that any "head injury" may be a contributing factor. Any feedback would be greatly appreciated. God Bless you Pat.

PAT'S RESPONSE:It certainly sounds like a complicated case! The Chiari malformation (Also known as Arnold Chiari Malformation) is an anomaly in which the brainstem and cerebellum protrude into the spinal canal. It is congenital (meaning people are born with it). I am unaware of any cases that resulted from injury. It can also be associated with other anomalies such as syringomyelia, spina bifida, and hydrocephalus. Many people experience symptoms beginning in infancy, but in other cases there may not be symptoms until adolescence or adulthood. Symptoms can include vomiting, muscle weakness, problems with arm and leg movements, or cognitive difficulties.

Hyrdrocephalus is an accumulation of cerebrospinal fluid (CSF) in the ventricles in the brain. CSF helps to protect your brain and spinal cord against injury, contains nutrients for your brain, and carries waste products away from surrounding tissues. When CSF is not absorbed as fast as it is produced, it can build up causing the ventricles to enlarge and the pressure inside the head to increase. In your case, hydrocephalus may be associated with the Chiari malformation, although some types of brain injury can cause it as well.

As for your symptoms, it is hard to distinguish what extent your injuries may have contributed to your present symptoms. Although most people recover fully from concussion injuries, there are some people who experience permanent problems. I’m not clear from your question if you have experienced symptoms over the 16 years since your injury or if your symptoms began with your 1997 headaches. If you were not having problems prior to 1997, I would suspect that symptoms are likely unrelated to your concussion 16 years ago since constant or severe headaches are common symptoms of both Chiari malformation and hydrocephalus. There is really no way to know for sure if your brain injury contributed or not.

Also, while surgery is often successful in alleviating symptoms of Chiari malformation, surveys of patient outcomes following surgery show that about 66-80% show improvement. However, that means that up to a third of people following surgery may have continuing symptoms or even deterioration. There is still a lot to be understood about Chiari malformation. It is extremely important that you continue to be followed by physicians who can track your progress. Sometimes hydrocephalus recurs. Please talk to your physician, neurologist, or neuropsychologist about your symptoms and concerns.

For more information about Chiari Malformation, Wake Forest has an excellent list of links with a TON of information. The link to their site: http://isnet.is.wfu.edu/bgsm/surg-sci/ns/chiarisyrinx.html. Good Luck!

DEAR PAT:My mother went in for heart valve surgery a week ago. She is 70 but has had spotless health until this very recent heart valve problem. During surgery, a blood clot went to her brain and caused a blockage. She remains unconscious with occasional slight movements of the limbs. I have been reading everything I can find about coma recovery and stimulation with the hope of waking her up. A lot of what I find refers to stimulation to help coma patients wake up, but I have not been able to find anything that goes into any detail about actual methods. Do you know where I can obtain a more detailed description of coma methods to help people wake up?

PAT'S RESPONSE:There is an article on a website that provides a description of methods for their coma stimulation program. I would caution you that there has been very little independent research on the effect of stimulation on coma recovery. In other words, while it seems promising and the people who use it cite positive results, there hasn’t been a lot of good research to show whether it is really effective or not. The article below cites some statistics for coma recovery with sensory stimulation, but remember that most people emerge from comas anyway. Critics also argue that the types of brain injuries resulting in coma are unlikely to be affected by sensory stimulation, and that most patients who emerge would have emerged with time anyway. Sensory stimulation has also been criticized for fostering family members’ unrealistic hopes for recovery.

A review of the area by Joseph T. Giacino concluded that "It is evident that when existing studies on sensory stimulation are analyzed according to scientific evidence-based parameters, there is very little adequate research concerning the effectiveness of sensory stimulation." He concluded, "At present, sensory stimulation should be considered an option for patient management. This implies it is incumbent upon the clinician to clearly elucidate to family members the high degree of uncertainty associated with this form of treatment."

The website with a description of a sensory stimulation program for coma recovery is:

http://www.comarecovery.org/comarecoveryprogram.htm

The review article citation is:

Giacino, J. T. (1996). Sensory stimulation: Theoretical perspectives and the evidence for effectiveness. NeuroRehabilitation, 6, 69-78.

Any university library should be able to obtain a copy of this article for you through an inter-library loan program if they don’t carry this particular journal.

DEAR PAT:My daughter, Emma, was diagnosed with a medulloblastoma at the age of three. The tumor was removed and she has had radiation and chemotherapy. I want to learn more about how to help her in her academic career, which at this point in time is questionable. She has processing, speech and language problems. At this point, I rely heavily on her special education teachers but they do not have a lot of experience with children with brain injuries like Emma’s. It was suggested that I talk to someone that has dealt with brain injuries to see how we can give Emma the support she needs academically. A psychologist that evaluated Emma suggested that Emma cannot be measured by her peers and that she does not have developmental delays so it would be harder for the special education instructors to help her. Emma will have to figure out how to learn with the guidance of the special education teachers. I feel she will benefit if I could also give her support, but my background is not in education.

PAT'S RESPONSE:Pat knows some doctors with "questionable" academic careers! But that’s not what you mean. Anyway, Emma should have a comprehensive neuropsychological evaluation. I can’t tell from your question how old Emma is or whether the "psychologist" was a neuropsychologist or not. I also can’t tell if the psychologist worked for the school or not. Let me explain the difference. Most clinical child psychologists conduct psychological evaluations that usually consist of an IQ test, and an assessment of behavior or emotional adjustment. Many psychologists also do an achievement test that can help to diagnose learning disabilities. A neuropsychological evaluation may include these types of assessments, but will also examine memory skills, motor skills, attention and concentration, and visual skills. Be sure that when you look for a neuropsychologist, you ask about their training. In many states, any licensed psychologist can claim expertise in neuropsychology, so ask about where they received training and supervision in neuropsychology. This type of evaluation should provide a comprehensive analysis of Emma’s strengths and weakness. In addition, the neuropsychologist should be able to provide specific recommendations to you and Emma’s teachers about how she learns best and what her limitations are likely to be.

Also, if the psychologist is associated with the school, then I would encourage you to get an independent evaluation done. Most school psychologists are outstanding, but they also work for the school. Schools often have a vested interest in keeping their costs down and sometimes don’t like to provide a lot of "extra" services to children who need them. Some schools are better than others. However, public schools are legally required to provide needed accommodations to children with disabilities under the Americans with Disabilities Act (ADA). An independent psychologist or neuropsychologist will be able to help you assess whether the school is providing all the needed accommodations or not.

Finally, yes you should absolutely help Emma as much as possible and give her as much love and support as you can. Talk with all of her teachers regularly about her progress. Talk to Emma about how she is doing. Find out if there are tutors in your area that specialize in working with learning disabled children. Encourage Emma to participate in activities outside of school as well so she can develop other friends and interests. If Emma struggles in school, it will be important for her to have other activities and life experiences she can feel good about to boost self-confidence. It sounds like she has a good parent looking out for her best interests!

To the person looking for an opthamologist for occipital cortical blindness who is associated with a neurosurgery center:

You certainly know what you’re looking for. I don’t know anyone with the particular specialty. However, since I think you were mailing from Colorado, I would suggest you consult the Division of Neurosurgery at the University of Colorado. They might be able to better direct you. Their web address is:

http://www.uchsc.edu/sm/sm/surgery/neurosur/

Pat #14

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: I have written to you before and was very encouraged by what you wrote back. I had a CHI on July 30, 1998, and I'm still trying to figure things out. It's so hard for me to be around people that I don't know for fear that I may seem "strange" to them, etc. Even to be around people that I know, but have not seen me or spoken to me since the accident. I feel so on edge, afraid that they are looking for deficits, or just maybe trying to see what's different. So many people are not at all educated about brain injuries and think that anyone with a brain injury is instantly impaired, or has mental problems. That is true in some cases, but definitely not all. I've been through a lot since all of this happened, and I feel like I've come out of it wiser. I've noticed that the more hardships people have to go through, the more levelheaded they seem to be. Somehow, I have to get over this fear of being around new people. Half the time I feel like I need to explain what happened, when I truly know that it's not necessary. It's so hard to put these tense moments into words. How should I get over this?

PAT'S RESPONSE: I don’t think I’ve met a person with brain injury who didn’t feel this way to some extent. Figuring out what to tell people about an injury or even whether to tell people anything at all can be difficult. Loss of confidence and worrying about making a mistake are also common experiences of people after a brain injury. Many people who were previously comfortable around people become "shy" after the injury. They’re worried about what others think and about making a mistake that will let others know they are "weird."

Pat is glad to hear you already know that explanations aren’t necessary! Your injury is YOUR business. You do get to decide who to tell and who not to tell. Besides, a lot of the time the person who is most likely to notice "deficits" is the person with the brain injury! After all, everyone sometimes forgets things, seems distracted, is emotional, or can’t think of the right word. Obviously if your injury is more noticeable from your appearance, speech, or behavior, this can be more difficult to handle since people will wonder and many will ask. But one of the things about TBI is that the person often looks "healthy." (Although this can have drawbacks too since others may not be as sympathetic or understanding).

As for how to get over the anxiety, there are a few things to try. One is to practice these situations with a friend, family member or therapist. Are there particular types of situations that make you nervous? Are there questions you’re not sure how to answer? Is the flow of the conversation disrupted because of confusion or a memory problem? If you can rehearse these situations, you can build up confidence for life in the real situation. A therapist may be able to help you analyze what aspects of social situations make you uncomfortable and provide relaxation techniques to deal with anxiety. Finally, participation in a support group for brain injury may be helpful. I can guarantee if you go to a group, you will find others dealing with similar issues. Advice and feedback from someone who has been there is often the best thing.

DEAR PAT:My friend had an accident when he was 19. He was hit by a truck and his head was split open. He was pronounced legally dead but was brought back. They put his brain back in his head and sewed him up. They did some tests later on and informed him he only had about 6 years to live because his brain is deteriorating. Well, his 6 years are almost up. He never did any research or anything to find out about this so he doesn't really know if he can be helped. I'm sorry I don't have more info for you to go on. Do you think there is anything medical science can do? Can you tell me more about this condition? And if there is no hope please tell me what is going to happen so I can best be there for him. He just told me this so there's not much time left. Please help.

PAT'S RESPONSE:Pat really can’t tell too much about your friend’s situation from what you wrote. If your friend hasn’t kept up with follow-up medical exams, that is clearly your first step. Without knowing anything specific about your friend’s condition or what may have been causing "deterioration," I really can’t speculate on whether there is anything that can be done. The best thing you can do as his friend is to be sure he is seen by the appropriate doctors, educate yourself about his condition so you can advocate for his treatment, and continue to be the good friend you are. If you can find out any more information about what is causing deterioration, let me know and I will try to give you a more helpful response.

DEAR PAT: My brother sustained head injuries in a car accident on December 22 1998. Unfortunately he was very drunk at the time. It is now 7 months after his accident and he has very slurred speech and a lot of his memory had been wiped off. He cannot remember our sister’s wedding last summer. I am very close to my brother and would like to stimulate him when he is at home. What sort of things would you suggest that I do with him? Will playing scrabble and other board games merely frustrate him or will that help? Please advise.

PAT'S RESPONSE:Certainly it will help to keep your brother busy and playing games that involve memory or problem solving may be very helpful. If you brother is working with rehabilitation professionals, be sure to talk to them and get advice. They will know the details of your brother’s condition and have a sense for his strengths and weaknesses. Most importantly, talk to your brother. He is the only one who can tell you what does or does not frustrate him. Remember to be patient and don’t expect him to get his memory back right away. Depending on his injury, it’s also possible that he won’t ever remember those past events like your sister’s wedding. Keep spending time with him, and encourage him to follow-up regularly with his doctors and to stick to his rehabilitation plan.

DEAR PAT: My 8-year-old daughter was in a car accident about 1 month ago. She had a subdural hematoma with a little bleeding on the brain, but no swelling. The doctors tell us for only being 1 month out of the accident she is doing great. I need to know what I need to look for in the future. Right now she is out of the hospital and in an outpatient rehabilitation center. Can you give me any advise on therapy for at home? Prior to this accident she was an out standing student and we are concerned about her future in school. Any advice would be helpful.

PAT'S RESPONSE:Pat recommends having your daughter evaluated by a neuropsychologist before the school year begins. This will serve as a baseline so you can measure her recovery over time. A neuropsychological evaluation can also help you to evaluate her current strengths and weaknesses and identify any areas that might lead to academic problems. If necessary, the neuropsychologist can help you to work with the school to develop an individual educational plan for your daughter.

With only one month post-injury, probably the best thing you can do for your daughter is to give her a lot of love and reassurance. Most recovery takes place in the first six months post-injury. Don’t expect a 100% recovery by next week or even next month. Keep her involved with rehabilitation and make sure all of the doctors’ recommendations are followed. In terms of specific strategies, I can’t really give any more advice without knowing what areas you are concerned about (attention, memory, behavior, etc.). Good luck. I’ll be hoping your daughter makes a good recovery.

DEAR PAT: My brother had an accident in 1985 when he was run over by a camper type of pickup truck. As a result of this accident, when he was 18 years old, he has lost the use of his left eye, lost most of the use of his right hand, he has a "drop foot", and he tends to think that things happen which, in reality, do not. He seems to feel that he must always prove himself to everyone he comes in contact with, even stating that he tells the governor how to run the state and that the governor takes and uses his advise. He has also become an alcoholic and this amplifies his problems. He has been to several short and long-term programs for alcohol abuse, which seem to help for very short periods of time. He is not able to maintain a job, mostly because he has trouble dealing with people. Through the state welfare program he lives on his own, but this seems to be difficult for him at times because he does not interact with positive role models or peers. We have a large family, all of whom try to offer support and assistance, but he does not seek our help except when he "goes off the deep end". During these times he admits that he needs help, until he has had company for a while. If we offer help when he does not seek it, he becomes defensive and says that we are trying to run his life. Last night he called for help and when my sister, her ex-husband and I responded to his apartment, he was almost like a child who finally got the attention he craved. We talked and together we (he was included in the discussion) decided that he should go to the hospital to talk to a professional about his problems. However, when we got there, he refused to allow the counselor to help him. I realize that he is probably afraid to go to another program because he is not entirely sure that he wants to live the rest of his life without alcohol. He said that he would quit drinking on his own because he "knows that he has to". We finally convinced him to try one more time and he agreed to go to a four-day detox program (inpatient) which he will begin on Monday. My sister and I (along with the counselor) think that the alcohol abuse is secondary to his TBI, but we do not know of any local programs to consider. If you have any suggestions on how we can locate programs for someone with fourteen years of no help with a TBI or anything else we can do, we would be very grateful.

PAT'S RESPONSE:Well, you certainly have a complicated case! So you get an extra-long answer! Unfortunately substance abuse and traumatic brain injury often go together. This is usually because either the person was injured as a result of alcohol or drug use or because the person uses alcohol or drugs to cope with post-injury changes and stress. I believe you have chosen the correct place to start - which is the treatment of the substance abuse. Alcohol often exacerbates or masks other problems and without treatment for his alcohol use, any other mental health treatment (psychotherapy, drug therapies) will have little chance at success. The problem is that most alcohol treatment programs have very little experience working with persons with TBI. Issues related to the brain injury such as adjusting to a disability, behavior problems, memory problems or other neurologically based symptoms will probably not be adequately addressed.

Another concern that your letter brings up is the quality of your brother’s thinking. If he really believes that things happen that haven’t - like giving advice to the governor, this sounds like he may have some psychotic features such as delusional thinking. Even if he is just "telling tall tales" that he knows to be false, this will clearly be problematic in most social relationships. The problem sounds like it may go beyond just alcohol abuse.

In other words, your brother needs three major areas addressed: 1) The consequences of his TBI on his cognitive, emotional and behavioral skills 2) His alcohol abuse and 3) The possibility of a thought disorder or delusional thinking.

As I said, you have already made a good start by helping him to enroll in an alcohol treatment facility. The next step will be to find someone who can do a comprehensive evaluation of your brother and make treatment recommendations. I would suggest looking for a facility such as a university-affiliated hospital or psychiatric hospital that can provide neuropsychological testing, as well as a psychiatric evaluation. Neuropsychological testing can help to evaluate your brother’s cognitive and emotional skills. The psychiatric evaluation is to determine if your brother would benefit from medication. If you can find a facility that can do both, this would be best since both treatment providers would be in the same place and likely would be able to work together. If you can’t find such a place, try to identify a neuropsychologist and psychiatrist and obtain independent evaluations from each. I believe that it is important in complex cases to have a comprehensive evaluation that can be used to guide treatment and provide understanding and recommendations to the patient as well as family members.

Finally, dealing with a family member who has serious mental health or substance abuse problems (or both) is very hard on the family. It affects the quality of life of everyone involved. Many family members are torn between wanting to help their loved one and needing to manage their own busy lives. In addition, the person needing help may not always follow through with treatment and may seem unappreciative. It may be helpful for you to have a family meeting to discuss options for helping your brother. Because you’re dealing with a very complex set of issues, I believe you, your sister, and other family members may benefit from consultation with a psychologist or psychiatrist to develop a plan for dealing with your brother and working on how to respond to when he has a "crisis."

DEAR PAT: Hi, My son is currently 5 months old. He suffered hypoxic injury and cardiac arrest at birth. It took the neonatologist 10 minutes to bring him back to life. Needless to say, they (docs) thought he would have severe TBI. My son has surprised us all by being very alert and appropriate on a cognitive level for his age, however, is suffering from motor delay and possible seizures (video EEG results are currently being reviewed). His first MRI revealed possible basal ganglial damage; his second MRI was negative for injury. Two different MDs read the MRI's and thus I feel this accounts for the difference in findings. My question is what are the detailed responsibilities of the basal ganglia and what clinical symptoms do you see with injury? (athetoid and choreic movements-please define).

PAT'S RESPONSE:The basal ganglia are really several brain structures including the caudate nucleus and the putamen. These structures are involved in the control of both voluntary and autonomic movements. Damage to the basal ganglia most often result in movement disorders, although problems also can arise related to some aspects of attention, memory, learning, or speech production. The specific effects of injury to the basal ganglia will vary depending on the specific site of damage and the extent of damage. Cerebral Palsy (a term referring to a neurologic disorder affecting body movement and muscle coordination) can result from hypoxic or anoxic injury to the basal ganglia during the birth process. Cerebral Palsy is not progressive and must be distinguished from other progressive or genetic neurological conditions. It sounds like you are seeking good medical advice. Continue to be sure your son is followed closely by medical professionals so they can make an early determination if your son has CP or any other motor disorder.

Athetoid Movement - An impairment of the muscle tone (usually in large muscle groups), causing slow, involuntary contractions of the head, limbs, trunk, or neck.

Chorea - A condition of uncontrolled, purposeless, rapid motions that interrupt normal movement.

For more information on cerebral palsy try the following link:

http://www.bissells.com/cp.htm

DEAR PAT:I think what you’re doing here is a wonderful thing. I'm 16 years old and my boyfriend was in a car accident a week ago and in a coma for three days. He has now come out of ICU and he can have visitors. I love to go see him, because he is always so happy to see me. He had some major brain trauma, and is acting like he is 6. I'm not mad at him at all or anything of the sort. I've just become very impatient with this whole waiting process. I've never led onto him that I'm impatient but I can't eat, I can't sleep, and my mind is some where else at work. I would never think about moving on with him in this condition. We were close before his injury, almost too close at 16 sometimes. Could you please tell me how long it usually takes some one to recover and if will ever be the same? If not, what are the chances he will never be the same?

PAT'S RESPONSE:If your boyfriend was in a coma for three days, he likely had a pretty serious injury. If he had "major brain trauma" there is a good bet his recovery process is likely to take a considerable amount of time and rehabilitation. As for whether he will ever be "the same" - Most people have lingering effects of a serious brain injury. Those effects can range from permanent serious disability, to personality change, to memory problems, or in some cases only minor difficulties. It may be that your boyfriend will have essentially the same personality and act the same, but have some minor problems with attention or memory. It may be that he is a very different person both as a result of his injury and the psychological and emotional impact of having sustained a very serious injury and a near-death experience. Only time will tell. Your boyfriend’s doctors are probably the best source of information about his prognosis. Don’t be shy about asking questions.

The main thing is improvement in most cases after a serious brain injury will occur over months, not days. Don’t expect him to "be the same" tomorrow, next week, or even next month. Having someone you care about seriously injured is also hard on you. You might experience feelings of wanting to move on with your life, but feel guilty about breaking up with someone with an injury. You might just want things to get back to "normal" even though that might not be possible – at least for a long time. Talk to your family and friends about how you feel. Consider talking to a counselor – your school probably has a counselor or school psychologist you could talk to for free (At least when school starts). Be patient, show your care and support, and ask his doctors about his condition and prognosis.

DEAR PAT:I am new to the site, looking for information. When I was nine (I Am 37) I suffered a massive head trauma to the back of my skull on the left (near center) part of my head... I was struck by a falling bolder in a Hiking accident... It broke the skull and the bone was pressing down on the skull... It took quite a while to get down off the mountain and I spent 3 days in a coma and the surgeon told my parents I was going to die. He reconstructed the bone and stitched me up and you know I woke up! Now I have never had follow up tests, but I am a real slow reader and I can not type with out looking at the keyboard (and then I am REAL Slow) Often getting letters out of order in words... I have never been able to match Music Notes to finger positions, even though I can play a few instruments by ear, and can read Music... or at least used to try... I have had difficulty with dyslexia my whole life... I cannot remember most people’s names or phone numbers (even the ones I call a lot.) I am an artist and very "right-brained" I wonder if there are programs in my area that might evaluate my damage and perhaps take me on as a patient. I am also interested in possibly participating in Human research projects that might help re-stimulate my damaged memory centers, or even might be interested in using my existing damage to get around the FED limitations to working on "Healthy" tissue. I know this might seem like a lot to ask about, but my request is sincere and I am not having much luck connecting to anywhere.

PAT'S RESPONSE:Are there programs in your area that might evaluate your "damage" or take you on as a patient? In terms of an evaluation, you could certainly arrange to have neuro-imaging done to look for any structural anomalies in the brain. You could also have a neuropsychological evaluation to look at your cognitive strengths and weaknesses. Any rehabilitation program working with people with brain injury should be able to perform these services or refer you to someone who does. Ask your primary care physician for help in finding the resources in your area. As for taking you on as a patient – that would depend entirely on what you might need help with.

I’m afraid I can’t give you much guidance as far as participating in research. That would depend on what kinds of research projects might be run at hospitals or universities near you. The fact that your injury occurred so long ago and occurred while you were a child may also limit how many research studies you could be included in.

DEAR PAT:I read your response to my brother Rusty. He’s in Tierr hospital and is doing O.L. It’s a really great hospital. I think they will help him with a lot with different things. They’re giving him botox shots to help the spasticity in his body it seems to be helping already with his eating. Do you know anything about the botox shots that may help him? He tells us that he feels lonely and lost and that he has lost at life. We asked the doctors to give him Prozac to help with the depression. Mostly he wants and tries to be the way he was. This is a terrible thing to be alive when you can’t function normally. He’s just a shell of what he once was. Its so hard to look at a relative day in day out for weeks and months hoping they come back to have some kind of normal life. Sometimes you wonder why they’ve even lived through this. We’re thankful for his life because some part of him is better than nothing at all, but I know that my brother would not want to stay like he is forever. But I guess there’s no way to tell who’s going to make it. No one should have to experience these things. The saddest part of this whole thing is that people won’t know what kind of person he was or what he had accomplished before this happened.

PAT'S RESPONSE:Botox is a substance produced by a bacteria that blocks the messages between the nerve and the muscle. Interestingly, it’s from a bacteria that in large quantities causes food poisoning! However, this substance allows over-active muscles to relax and return to a more normal state. You mention that your brother is just a "shell" of what he once was – but it sounds like he’s able to communicate and still has his same basic personality. Your brother may have limitations to what he can do, but he sounds like he’s got the kind of love and support from his family that people need to survive this type of tragedy and still live a meaningful life. I’m glad you’re happier with his treatment now, and I’ll be hoping your brother continues to make good progress.

DEAR PAT:I'm a survivor of a six-month coma that was my third near death situation. It's made me a 40-year-old 100% disabled veteran. In my fight for recovery I've come up with the need to get back in shape. Now I'm trying to find out what needs to be got in shape in my head and if there are any mental exercises too. Any guidance will help!

PAT'S RESPONSE:Try the following webpage. This article contains a lot of ideas for ways to "exercise" your brain! And try not to have any more near "near death" situations! Only cats have 9 lives!

http://www.healthgate.com/healthy/man/1998/braingames/index.shtml

DEAR PAT: My husband and I were discussing a segment we saw on 60 Minutes (within the last year or so) about a treatment to head/brain injury (I believe closed head trauma) administered immediately following the trauma - the doctor was from a New York hospital I believe. If I recall correctly, the treatment was opposite from what was traditionally administered in the first 24 or 48 hours following the trauma; immediate reduction of the swelling was not encouraged . . . We would like the name of the doctor and the treatment. Can you recommend how to find out which hospital performs this treatment? Anyway, sketchy info - any help would be appreciated.

PAT'S RESPONSE:Ummm… Well it looks like someone finally stumped Pat!!! If there were a prize for that, you’d win it!

My only suggestion is to contact 60 minutes. Those news magazine shows are always happy to provide you copies of tapes and transcripts, so you might try contacting them. The contact information for 60 minutes follows:

Address:
60 Minutes
524 West 57th St.
New York, New York 10019

Phone:
(212) 975-3247

To order a transcript, call:
(800) 777-TEXT

To order a videotape, call:
(800) 848-3256

Pat #15

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: My wife is currently in a coma resulting from a cardiac/respiratory arrest. She was not breathing for a minimum of 7 minutes, but the time could have been much longer. The doctors are telling me that she is only receiving the most basic of responses from the brain. She experienced seizures during the first 24 hours of her coma. She has been in this coma for 8 days now. Her critical care doctor is asking me to consider signing a "Do Not Resuscitate" form. I do not want to give up until I have exhausted all possible options. I want her back, but also want to adhere to her previously stated wish that she not be made to live in a "vegetative" state. Where or how can I receive information that will help me make this most crucial of decisions?

PAT’S ANSWER: This is one of the most agonizing decisions a person can make. A DNR form essentially means that CPR will not be performed if your wife’s heart stops. It does not mean that medical treatment will not continue and it does not mean that they will stop feeding her or assisting her to breathe. In other words, a DNR form does not constitute "giving up." Many terminally ill patients are asked early on in their illness to consider having a DNR form. I encourage you to meet with her physicians to discuss her prognosis. Consider getting second or third opinions from other experts. Talk with your family, your wife’s family, and clergy. If you and your wife ever discussed these issues, be sure to consider her wishes and values. Also, be sure that YOU talk to someone. Having a critically ill spouse is a terrible thing, and many people try to bear too much on their own.

For more information on coma, try the Coma Recovery Association’s website. Their address is: http://www.comarecovery.org

The following website has a nice list of links to resources about DNR forms – including information about legality, ethics etc.: http://www.npg.com/npg/legal/do.not.resuscitate.dnr.htm

DEAR PAT:I have a cousin that just had an accident that resulted in a brain injury. They discovered in doing x-rays that he has calcium deposits, which the doctor said it was not caused by current trauma-is this to be concerned with? What causes calcium deposits in the brain? Can it be reversed? I have been searching for answers on the web for 2 days and have not found anything. Can you help or lead me in the right direction for answers? Thanks.

PAT'S RESPONSE:Pat has a cousin who’s kind of hardheaded. I wonder if… No, actually calcification of the brain can occur from several problems. Most calcium that enters the body is deposited in bones and teeth. Sometimes, calcification can occur through aging. Calcification of the pineal gland for example, sometimes necessitates surgical removal. In other cases, calcification can occur because of brain cancer, vascular problems in the brain, some forms of infection (such as tuberculosis or toxoplasmosis), or a number of other metabolic disorders or problems with the kidneys. As for reversing the disorder, there are some techniques used for removing excess calcium deposits from tissues and joints – some involving diet, others involving medication. Your cousin’s physician should be consulted about treatment issues.

DEAR PAT:My Cousin was 28 years old when she was thrown from a car in an accident and suffered a brain stem injury. She was not expected to live. Yet, she made an almost complete recovery. We were rather happy about here recovery, when she began to fall down a lot. My aunt went with her to the hospital to do some tests, and they discovered numerous brain tumors. They were cancerous, and she has been undergoing chemotherapy for a while now. My whole family has been wondering whether or not the tumors were caused by the accident that happened almost 18 months prior.

PAT'S RESPONSE:Unless your cousin’s accident involved colliding with a truck carrying radioactive waste these are likely two independent events. Pat knows of absolutely no evidence that injury to the brain can later cause cancer in the brain - anymore than breaking a bone will cause cancer in the bone. Of course, anything is possible. However, as in most cases with cancer, there will likely be no way to trace it to a single "cause". Many things increase one’s chances of getting cancer and there are more likely suspects than brain injury. Genetic vulnerability and exposure to cancer causing agents in the environment are two big ones. Keep in mind that at this point, finding out what "caused" the cancer won’t help your cousin. What is important is giving her love and support so she can fight the cancer and hopefully win the battle.

DEAR PAT:Dear Pat: My son has a severe brain injury (he fell 35 ft). He postured a lot in the hospital and now he is in a rehab hospital. They had him on Haldol and also had him on Botox. It stopped the posturing, but now he is no longer on the Haldol and he is starting to posture again. Why would he posture? I am trying to get the Doctors to do something quick before it gets so they can't control it. My son is in a coma yet, he has been in one for 2 1/2 months and they think he is improving, but not while he is posturing. Also he fixes his eyes to the right at a certain time of the day some days. He tracks well and responds to sound. Can you give me any encouragement?

PAT'S RESPONSE:Abnormal posturing is usually a sign of serious Central Nervous System damage. Certainly, a 35-foot fall will cause serious damage. Normally when a muscle contracts, the muscles on the other side of the joint provide resistance to contraction. Abnormal posturing occurs when damage to the CNS prevents the muscles on the other side from acting in opposition. In the case of a prolonged coma, posturing can continue for a long period of time. Obviously, I can’t say anything specific about your son’s case – you should consult with his physician for a prognosis. In general, most people eventually "emerge" from comas. However, it is also true that your son sustained a very severe injury and has been in a coma for an extended period of time. You need to remain optimistic. You also need to be realistic – even if your son emerges from the coma, there will likely be a long rehabilitation process and many long-term changes.

Be sure to talk with your son’s physicians and try to understand the nature and extent of his injuries and get a realistic prognosis. Keep in mind, you also need to take care of yourself and your family. Consider talking to a counselor or clergy. We all need help to get through the bad times.

Pat thought the readers might enjoy this letter from a TBI survivor and an "Ask Pat" fan!

(P.S. Pat just loves fan mail!)
DEAR PAT:I understand that you know everything I need to know and what you don't know isn't worth knowing! My compliments to you for good advice couched in delightful banter. I am a survivor of a very severe TBI who has been blessed with considerable recovery. Persistence and integrity coupled with education and a sense of humor get me through. I also owe a tremendous debt to family, friends, and mentors (it took a while to find the right ones). Be an educated consumer; there are good doctors and there are not so good doctors, shop around for a genuine one - credentials are important, but not a substitute for compassion. Support groups can be an immense source of information and help; be sure it is well facilitated, focused, and viable. The BIA (Pat’s note: BIA = Brain Injury Association) is great! You/I/we are different, just like everybody else - TBI sequelae make you more unique, not diminished. In many cases, TBI doesn't affect IQ to the same degree as it does EQ (emotional intelligence); find alternative ways/coping skills to make up the difference (I'm still working hard on that one 35 years later). Be a skeptical optimist in exploring new information, therapies, and rehabilitation techniques - 1,000 years ago, everyone KNEW the earth was the center of the universe; 500 years ago, everyone KNEW the earth was flat; 100 years ago, the medical profession KNEW malaria was caused by vapors; imagine what they'll know tomorrow.

Pat #16

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: My 29-year-old daughter suffered a TBI injury in February this year. She had a closed head injury and is experiencing left side weakness, and short term memory problems. She is doing a lot better now and making progress in all areas. I've heard it takes a lot of time maybe years. Is that correct? We’re just thankful she is here today and we feel blessed with her recovery, but it has been a lot of stress. If you know of any support groups in San Francisco…she would like to talk to others her age that are going through the same thing so she doesn't feel she is alone out there. Any advice from them would be appreciated. Thanks a lot!

PAT'S RESPONSE:Recovery from brain injury is a long-term process. The fastest recovery takes place about 6-12 months after the injury. Further recovery does occur, but it is more gradual. Many people experience some permanent changes after a serious brain injury. Short-term memory problems often linger, and most people will never get back to 100% of their pre-injury ability. However, there are a number of good strategies that people with brain injuries can use to compensate for memory problems. Many people use note-taking strategies, schedule books, daily planners, or computer calendar programs to help remember appointments, deadlines and "things to do". Some also find a tape recorder helpful to review important conversations (such as with your doctor) or lectures and instructions.

Your idea of a support group is an excellent idea! No one can quite understand the effect of a traumatic injury like someone who has experienced one. You are also right in recognizing that it is very important for persons with brain injury to understand that they are not alone. I can’t recommend a specific support group in California, but if you contact your state chapter of the Brain Injury Association, they can provide you with referrals to a number of resources – including support groups! This organization that helps thousands of persons with brain injury and I’ll bet they can help you and your daughter as well. The contact information for the California branch is below:

Brain Injury Association of CALIFORNIA
President: Claude Munday
Exec Director: N/A

PO Box 160786
Sacramento, CA 95816-0786
Contact: Terry Stimpso
Phone: (916) 442-1710
In State: (800) 457-2443
Fax: (916) 442-7305
E-Mail: [email protected]

DEAR PAT: My brother fell 20 feet and hit his head while at work. This fall has left him in a coma for 55 days now, and all the doctors have been telling us is to wait and hope. My family and I understand that, But Alan started responding to small commands such as - Give a thumbs up, point one finger, or squeeze my hand if your name is Alan. He has even mouthed "Hi," and told them that he was 28. A week later he started having seizures and is back in the TICU. We talked to the doctors and they say that Alan has fluid on the brain again and that the fluids are not draining. They said they would put a shunt in to help the fluids drain, but they said if they put the shunt in Alan still only has a one percent chance of him being Alan again. Now they are telling us that all the little steps that Alan is making are not purposeful. I am totally confused. I don't understand how one minute they are purposeful and now they are not. I will never give up on the power of God, and the strong will that my brother has. Pat if there is any advice that you could give me and my family I would deeply appreciate it. Missing Alan!!!

PAT'S RESPONSE:20 feet is a very long way to fall and survive. As I always tell families who have a loved one in a prolonged coma, the treating physician is the best source of information about the prognosis. He or she best understands the extent of your brother’s injuries and his response to treatment. Be sure to talk with your brother’s physicians and try to understand the nature and extent of his injuries and get a realistic prognosis.

In general, most people eventually "emerge" from comas. However, it is also true that your brother sustained a very severe injury and has been in a coma for an extended period of time. You need to remain optimistic. You also need to be realistic – even if your brother emerges from the coma, there will likely be a long rehabilitation process and many long-term changes. When they say there is only a 1% chance that he will be "…Alan again" they are probably trying to prepare you for long-term consequences. If Alan does emerge from his coma, he is not going to be the brother you had before. Most people who emerge from a prolonged coma after a severe brain injury have significant difficulties related to memory, attention and concentration, motor skills, communication skills, or personality changes. Even if Alan’s improvement is better than anyone expects, he will struggle with some significant changes from this injury.

As for the "purposeful" behavior, this is one of the signs that people look for to assess the level of coma. You are describing purposeful behavior because you saw Alan follow some commands. However, it can be difficult to distinguish between a patient just responding to stimuli and someone actually responding to a command. Even harder to assess are situations where the person is sometimes able to follow commands, but can’t at other times. In Alan’s case, it may also be that he experienced a setback when he had the "fluid" on his brain, and he may need more time to get back to where he can follow commands.

Keep in mind, you also need to take care of yourself and your family. Religious faith often helps through bad times. Consider discussions with clergy, a psychologist or counselor to talk about your feelings and the effect this tragic event has had on your family.

DEAR PAT: I was in a coma for a month and a half from an auto accident. It happened this February. It is hard for me to explain what I am going through. I was working on a Masters degree at Texas Tech after graduating from Louisiana Tech. I am a 36-year-old male I just went to college because after 13 years I finally got out of the Navy. My long-term memory is real good but my short-term memory is bad. I feel like my wife has to put up with another child. I have a quicker temper than I did before the accident and I have a real problem tolerating my kids. I am presently out of rehab and I don't know what to do. Any ideas you have would be greatly appreciated Thank you.

PAT'S RESPONSE: First, I should tell you that what you are experiencing is very common. Short-term memory problems, irritability, and a lower tolerance for stress are among the most frequent symptoms among survivors of brain injury. In addition, people often feel misunderstood by family members – especially if they look healthy on the outside. It is important that you talk to your family. For example, when you say, "I feel like my wife has to put up with another child." – is this how she feels, or is it how you think she feels? Have the two of you discussed the injury’s impact on your relationship?

A therapist with experience working with persons with brain injury can help you to develop ways to manage your anger and frustration. Consider involving your wife in therapy so you can address these problems together. In some cases, there may be medications that can help you better control emotions. You might want to start by keeping what behavior therapists call an ABC diary of the times you get angry. At the end of each day, write down all the things that made you angry using this system:

Antecedent – this is what was happening before you got angry. For example, if you were angry with the kids, what were you doing before you were angry? What led up to the anger? What were you thinking? What were you feeling? (For example, were you thinking about a problem? Were you already upset about something?).

Behavior – this is what you actually did when you were angry. For example, if you were angry because your child misbehaved, what did you do? Did you yell? Curse? Throw things? Hit a wall? What were you thinking about when you were angry?

Consequence – how did things end? How did you calm down again? How long did it take to calm down? Did you accomplish what you wanted to accomplish? (For example, did your children learn what they did wrong and receive appropriate discipline? Did you solve a problem with your wife?) Did you feel better? What was the effect on the people around you? Were they upset? Crying? Avoiding you? It is important to look at the consequences of your anger in order to identify ways to more effectively achieve a desirable outcome.

By keeping a diary like this, you can identify situations that tend to create anger and frustration in your life. There may be ways to avoid some situations that lead to anger and frustration. Are there situations that made you angry that shouldn’t have? Are there situations where your anger is appropriate? You may also identify times of the day, things you’re thinking about, your mood, or something else that contributes to your anger. You might be surprised about what you learn.

You also should keep in mind that everyone gets angry – and sometimes for good reason! How you deal with your anger is very important. Feeling angry is one thing. How you behave is another. It is the behavior that is most important to control. This is especially true with your children. All parents get angry, but good parents maintain enough self control that they don’t curse at, belittle, scream at, or hit their children. Instead they express their anger in a way that both lets the child know what the parent is angry about, teaches a lesson, and reminds the child they are loved even when they do something wrong.

Consider what type of outcome you want when something makes you angry. How can you best accomplish that outcome? Try to figure out ways to express your anger in a way that gets your point across without hurting others. If your anger is especially hard to control, talk to your family about how you would like them to respond when you are angry. For example, should they leave you alone or give you reassurance? What works best for you and your family? Most of the time, when people look at the "C" part of their diary, they find their anger isn’t making things better and they need to find ways to change. Talking with your wife and a therapist about ways to cope will help immensely.

DEAR PAT:I am a first grade teacher with a TBI student in my classroom. I am looking for the best way to teach this student to read. He knows the alphabet and phonetic sounds, however he does not seem to be able to put together the concepts of print to make a word. Can you offer any resources, suggestions? Thank you!

PAT'S RESPONSE:Pat always has suggestions! Some are even good ones! In your case, I can make a few.

First, it will be important for either the school or the parents to see a pediatric neuropsychologist for an evaluation. This would include evaluating a variety of the child’s skills including reasoning, attention, perceptual-motor skills, and basic academic skills. It will be hard for you as the teacher, or for the parents to have a good understanding of the child’s strengths and weaknesses without this type of evaluation. If you can understand the child’s strengths, you will be better able to use those strengths to help the child learn and to compensate for weaknesses. For example, if the child struggles to read, but can absorb information from hearing, that is very important in helping the child acquire academic knowledge. On the other hand, the child may learn better visually, which would be helpful to know as well. In the case you describe, it would be important to know if the child’s difficulty is limited to reading, or if symbolic processing is impaired in a way that will limit written language and math ability as well. So, start with a comprehensive neuropsychological evaluation… but that will take some time to schedule, conduct the evaluation, and receive feedback (this is all provided the parents are open to this course of action).

It will also be important to talk with the special education instructors or other learning disability experts in your school or area. In many cases the techniques to teach a child with an "acquired learning disability" will be similar or identical to teaching a child born with a learning disability. For example, "multisensory teaching" is often used to teach dyslexic children. Using this approach, students may be asked to not only look at the symbol and say the sound, but also to trace or write the letter to see how it "feels." In the meantime, it sounds like the child is lucky to have a caring, concerned and creative teacher. Keep trying new things with this child. For example, if he is very visual, some computer software for young learners might help him to practice basic reading skills. Continue to encourage the child and be sure to have frequent discussions with the parents about your concerns.

More information on dyslexia can be found at:

http://www.interdys.org

DEAR PAT: I am a graduate student in speech language pathology and want to do a thesis on "teachers knowledge of educational and behavioral concerns of children that have suffered traumatic brain injury." I have searched the web and can't seem to find any such study. Would you know of one? Or would you have any information on this topic.

PAT'S RESPONSE:Graduate student? Glutton for punishment huh? Well, welcome to the club. I would say that your first problem is searching the web. The old fashioned search for library books may be the best starting place. If you really want to search for studies, you are better served searching scientific databases such as PsycInfo or Medline. Your university librarian should be able to help you. These databases usually contain studies conducted in peer reviewed journals. If you’re just using a search engine (like Yahoo, Lycos, or Hotbot) to search webpages, you’ll always be at a disadvantage. For example, many peer-reviewed journals (This means other scientists have looked at the paper to be sure it meets scientific standards) do not publish the results on the web (or else why would libraries need to buy the journals?). You will also have a very difficult time verifying the source or quality of any study that just appears on a website. In fact, someone could just completely make up a study and how would you know? Although the web contains lots of websites that provide good, balanced information (like this one!), there are others that are not as good and it’s sometimes hard to tell the difference – especially if you’re researching a topic you’re just beginning to learn about.

[Pat now steps off the soapbox] OK. As for your question about studies… the study listed below seems to directly address your topic. (Pat just read the abstract and can’t comment on the quality or thoroughness of the study).

Title: Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study.
Authors: Farmer,Janet E.; Johnson Gerard,Mary
Journal:Rehabilitation-Psychology. 1997 Win; Vol 42(4): 273-286

Second, the book described below addresses your topic, as well.

TI: Students with acquired brain injury: The school's response.
AU: Glang,-Ann(Ed);Singer,-George-H.-S.(Ed);Todis,-Bonnie (Ed)
PB: Baltimore, MD, USA: Paul H. Brookes Publishing Co. (1997). xvii, 400 pp.

DEAR PAT:I had a car wreck due to a seizure and I had a contra coup brain injury. Since I came home from the hospital I noticed that my smell and taste is not the way I remember them. I can't stand the smells of cooking food and other things. They smell and taste horrid! I have lost 40 pounds from 180 to 140. How long will this last and is it brain related?

PAT'S RESPONSE:It is very likely brain related. Although less common than many symptoms of brain injury such as memory problems or headaches, many persons with brain injury do report altered taste and smell. It also can occur with some forms of brain tumor or after brain surgery. As for how long it will last - it could get better gradually, or it could take longer or even be permanent. Like many things with brain injury, the rate and amount of recovery vary greatly. I know that doesn’t help much, but your physicians are really the only ones who can give you specific information about your prognosis. You might consider seeing a nutritionist if your weight loss continues. You need to maintain a certain caloric intake and balance of nutrients to be healthy. If eating is difficult, it will be important to make sure you are eating the right things to maintain your health. You may also consider eating foods with mild taste and smell. (Stay away from that Limburger cheese!)

DEAR PAT:My nephew sustained a severe brain injury three weeks ago. It seemed as if he was recovering but this has stopped. At the same time, he continually spikes high fevers. Could these fevers be deteriorating his recovery?

PAT'S RESPONSE:Fevers are the body’s way to fight infection. Talk to your nephew’s physicians about the source of the infections or if there is some other reason he has a fever. Infections can occur after a serious injury because the body’s immune system is weakened, or because bacteria enters the body through an open wound. Only three weeks after a severe brain injury is really too early to evaluate recovery. Ups and downs often occur. Keep supporting your nephew and remain optimistic. Don’t be shy about asking his doctors questions. They have the best understanding of his current medical situation and prognosis.

Here’s another e-mail from one of Pat’s fans!

Pat, I suffered a closed head injury five years ago. I am now studying speech pathology and plan to work with TBI victims. Although I do not have a question, I do want to say that you are right on the money on so much of your advice. I think it's great that you take the time to help people find an answer to so many questions. Because of people like you I beat the odds and have even been accepted to grad school five years after being told I would not return to college. Thanks for believing in us and taking the time to show the way. R.C.M

Pat #17

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: Do you know of any resources available for obtaining a specialized wheelchair for a low-level brain injured patient with no access to financial resources?

PAT'S RESPONSE: Finding money for specialized equipment is often very difficult. Wheelchairs often range from around $1000 for a basic model to more than $10,000 for more specialized power models. There are a few options for financial assistance that you might explore. First, carefully check the patient’s insurance policy. Some policies pay for necessary medical equipment such as wheelchairs or other specialized healthcare equipment. Contact your state’s Department of Rehabilitation Services to find out if your state offers financial assistance for such situations. If that is not an option - churches, community groups (Rotary or Kiwanis clubs) or other charities may be willing to help you raise money. Often, people are willing to help if you just ask! If other people have suggestions that Pat hasn’t thought of, send your ideas!

DEAR PAT:I am an avid reader of your articles since my brother became a survivor 7 months ago. He had water around his heart (pericardial sac) that was misdiagnosed as pneumonia. He went into cardiac arrest at the hospital and the residents did open heart massage for 20 minutes. He is now totally dependent on his wife who also cares for their two small children. I am there daily and on the Internet nightly, looking for all information. My question is - Where can I look for similar cases as ours to sue the hospital and doctors? The expenses are enormous to keep him at home. This is our only recourse, we are involved with the Mayo Clinic now. That is a blessing, but now my family is considering bankruptcy. My brother is 51 years old. We celebrated his birthday in ICU while he was on life support. Life’s not always fair, but we need to find out if others had this happen and what is our legal recourse. I did go to an attorney who is waiting for records from the hospital. I had to give him $5,000 just to review the case, non-refundable. I have learned that what needs to be done, I must look into myself. Where can I go to review other lawsuits?

PAT'S RESPONSE:I’m very sorry for this tragedy in your family. Your story shows how brain injury and illness affect entire families, not just the patient. As my readers know, cardiac arrest can result in brain damage from lack of oxygen to the brain – and this sounds like the case with your brother.

As for your question about malpractice – it’s hard to comment on the specifics of your situation. Pat is not a lawyer or a cardiac or respiratory specialist. I do know that fluid in the pericardial sac is often the result of viral or bacterial infections such as pneumonia. Pat isn’t qualified to assess whether your brother’s treatment conformed to standards of practice or if the physicians failed to identify the pericardial fluid when they should have… Consultation with a specialist in cardiac or respiratory illness may provide some answers for you.

There are some other resources on the Internet that you have probably located with your Internet savvy! There are many legal and medical websites that may better address your malpractice questions. I am concerned that you gave an attorney $5000 of non-refundable money just to "review" the case. Many attorneys offer free initial consultations and free legal aid is available for people who do not have the ability to pay attorneys’ fees. It is important to find out if you have a good case before you spend large amounts of money – especially if your family is having financial problems. It is important to weigh the financial risks of bringing a lawsuit against the potential benefits of a settlement or successful suit. I hope that you will find justice and that your family will successfully adjust to this terrible tragedy.

DEAR PAT: I am a long-term care Administrator. Our facility is attempting to deal with a 74-year-old woman with a brain tumor, which is growing and causing aggressive behavior towards other residents. I am unable to find a facility in our area of Southern Wisconsin that would be appropriate for discharge. Where can I access a list of such facilities?

PAT'S RESPONSE:It is often very difficult to find placement for violent or aggressive patients. Such patients require extra resources, are stressful for staff, and can create dangers for both staff and other patients. Other facilities that do accept aggressive patients may limit the number they accept due to staffing and other concerns. In your case, it sounds like your facility is in a difficult predicament with this woman. I would make a couple of suggestions in the short-term. First, work closely with her family and physicians (consider a psychiatric consult) to identify medications that may help to decrease aggressive behavior and to make this woman comfortable. Second, be sure your staff is trained in the proper way to restrain aggressive elderly patients. Consider consulting a psychologist to develop a behavior modification plan. Even with cognitive impairments, many people are still responsive to behavior modification techniques. Finally, try to identify when this woman is becoming agitated and develop a plan for dealing with her aggressive behavior that protects her, your other patients, and your staff. It sounds like a tall order – and it is. (Probably why you’re having such a hard time finding an alternative placement). For your facility, it sounds like it’s only a short-term solution until you can find a more appropriate placement.

I don’t know if I can be of much help to you in Wisconsin. About all I can suggest is that if you haven’t already done so, you might want to contact the Wisconsin Department of Health and Family Services. On their website, they provide contact information for people who should be able to help you identify good nursing home or mental health facilities for this woman. You may also want to look into facilities specializing in Alzheimer’s, as they often have to deal with unusual behaviors.

Their website for adult resources in Wisconsin is:

http://www.dhfs.state.wi.us/reg_licens/adults.htm

Many rehabilitation professionals have been concerned for years about a lack of resources of aggressive patients – and too many end up in inappropriate placements. Unfortunately, the problems of placing neurologically impaired, aggressive, elderly patients are only likely to increase as the population ages.

DEAR PAT: I am looking for any information on help for a person with traumatic brain injury who has aggressive, violent episodes. The individual is now 39, was 6 when accident occurred. He is falling through the system, difficult placement due to behaviors. But behaviors are not all the time. There is a great person trapped. Would like to be able to offer parents hope. Also are there any support groups for the parents of traumatic brain injury?

PAT'S RESPONSE:If you read the question right before yours, you know that you are not alone in experiencing problems finding an appropriate placement for persons whose neurological problems lead to aggressive or violent behavior. Unfortunately for this gentleman, he’s very young and appropriate placements may be even harder to find. There are many persons with brain injury in the criminal justice system because of their inability to control their impulses. If he is a danger to others, it is extremely important that he follow the treatment recommendations of his doctors very closely. A few suggestions –

1. Be sure he is properly medicated and closely followed by a psychiatrist who has expertise in working with persons with brain injury and/or managing violent behavior.
2. Talk to a psychologist or other behavior management expert about what the family can do to set up a good environment for this man. Encourage him to participate in psychotherapy with a neuropsychologist or other therapist specializing in brain injury rehabilitation. Support groups are also helpful for many persons with brain injury – it’s often easier to talk to others who have "been through it."
3. Try to identify what triggers the "violent episodes." Is he having seizures that contribute? Do "episodes" occur when he is overwhelmed, stressed, or fatigued? Does alcohol and/or drug use contribute? Identifying situations likely to bring on aggressive behavior can help to avoid the situation in the first place.
4. Consider if there are emotional or psychological factors that contribute. Frustration, depression, or anxiety can contribute to angry and aggressive feelings.

Although persons with brain injury often have more difficulty controlling violent or aggressive impulses, this doesn’t mean it’s impossible. It also does not excuse violence or hurting others. If the person knows right from wrong and is cognizant of the problem, it is his responsibility to follow treatment guidelines, accept responsibility for his actions, and work to modify his own behavior or avoid situations likely to cause "outbursts."

Finally, yes there are support groups for family members of persons with traumatic brain injury. Many patient groups also welcome family members. Contact your state’s Brain Injury Association chapter or visit http://www.biausa.org for more information – including contact information for the state chapters.

DEAR PAT: My daughter suffered a severe closed head injury and is 17 months post injury. Her short-term memory is impacted greatly. She has an IEP and is in the normal classroom with learning support. However 2 classes are very auditory and try as we may the instructors will not make the courses visual. Are there resources available to make subjects visual? How can we access them?

PAT'S RESPONSE:It would be helpful to know which two subjects you are concerned about. Some classes are easier to teach "visually" than others are. It would also be helpful to know if your daughter’s reading skills are impaired, or if her limitations only extend to information she hears. If your daughter’s difficulties are limited to problems learning from a lecture format, it will be important to supplement her learning with information presented in class with outside readings as well as information presented visually in the form of graphs, charts, or diagrams.

Your daughter may also benefit from tape recording lectures for later review at home (you may be able to help supplement these lectures with visual information). Hands-on learning, demonstrations or watching educational videos/documentaries may also be helpful. Finally, many subjects can be supplemented with educational software that provide multi-media learning opportunities.

DEAR PAT: My father was recently in an automobile accident where he suffered brain trauma, I have many concerns. He is very lucky to have lived because his BAL was three times the legal limit. From this accident, he suffered three skull fractures and two hematomas, one on each side of the brain. He was never in a comatose state. It is 2 1/2 weeks later and he talking to people and is even remembering things from the past. He now has a very short attention span and occasionally has childish spells. I am wondering what type of behavior is typical for people who have suffered basilar and occipital fractures, and what role his hematomas may play a part in his recovery. I must also add that there have been a series of CT and the hematomas have gone down, the doctors expect them to take care of themselves, although later it may be necessary to drain them. Do you have any advice? Thank you!

PAT'S RESPONSE:Hematomas are blood clotting in tissue. I’m sure your father’s physicians will monitor these closely. As you noted, surgery is sometimes required to remove the clots. As for "typical behavior," it is very difficulty to predict brain injury outcome from skull fractures, or points of impact. The reason is that in high-speed traumas such as motor vehicle accidents, the brain can sustain multiple impacts as the person (and the brain) bounces around during accident. The brain often rebounds inside the skull creating injuries opposite the point of impact. In addition, diffuse injuries can occur because of rotational forces. Alcohol use at the time of injury further complicates the picture. Research has shown the persons who are intoxicated at the time of a brain injury are likely to have more problematic post-injury symptoms. Hopefully your father will beat the odds in this regard. To sum up, behavior is just very difficult to predict based on a CT or a MRI. As frustrating as it may be, there usually isn’t much to do, but "wait and see."

Probably the best advice is to be patient and remember that recovery from brain injury is a long-term process. You will have a better sense for how your father’s recovery is going after about six to twelve months. It is important that he follow all his doctors' treatment recommendations and that he refrain from alcohol use (which limits recovery). You may also want to consider having a neuropsychological examination done to establish a baseline against which you can measure future recovery.

DEAR PAT:I’m trying to find information, research, and written information on recreational activities or after-school activities for teens with brain injury. That is, not focused strictly on academics. There is life after school, and it doesn't have to be filled up with more and more educational tutoring/homework. My eyes are getting sore from finding so little on this subject, aside from a couple of general articles. Any bright ideas?

PAT'S RESPONSE:The answer to this really depends on how severe the child’s injury is and what the symptoms are. In most cases, persons with mild to moderate brain injury deficits can participate in social or recreational activities with non-injured people. Activities such as scouts, church groups, or art classes will provide opportunities for socializing and community participation regardless of ability level. In addition, the child may have talents that are unaffected by injury – such as music that provide enjoyable outlets. Many teens enjoy finding activities where they are not necessarily labeled as "brain injured." Obviously, contact sports such as football, basketball, or soccer should only be considered with a doctor’s permission due to the risk of re-injury. If the person’s injury was serious it may be better to avoid such sports entirely.

If the child has more severe symptoms or has behavior problems, you may want to explore some other alternatives. Hospitals that serve children and adolescents may have support groups for teens with brain injury – and some of these may also have social and recreational activities. There may be groups for teens with learning disabilities (or physical disabilities). Remember, in many cases, brain injury is a kind of acquired learning disability and many activities, groups, and interventions may be useful with children with brain injuries.

DEAR PAT:Dear Pat: I am a graduate student who suffered a mild TBI from a sports concussion 2.5 years ago. I have concentration deficits and experience problems reading and writing at the level of a graduate student. I am determined to finish my degree but I am behind schedule and meeting opposition from my advisor and graduate department. A neuropsychologist told me there is nothing I can do except spend extra time to get my work done. Are there rehab programs that address deficits in high functioning individuals? I would very much like to find solutions to my problems.

PAT'S RESPONSE: Most rehabilitation programs are more focused on helping people with more severe deficits. As a graduate student, you’re sort of doing the equivalent of professional sports for the brain. It requires very high level cognitive skills such as attention, communication, and memory. Knowing your strengths and weaknesses is very important. Attention problems can often be compensated for with a number of behavior interventions, which you have probably already discussed with your neuropsychologist. Reading and writing will depend on what the specific problems are. For example, if it takes you longer to write due to motor skills, you might consider voice recognition word processing software. On the other hand, if the issues are reading comprehension and/or organization of writing, your neuropsychologist may be right. It may just take more time and effort and/or some tutoring to compensate.

You may also qualify for some accommodations from your graduate school under the Americans with Disabilities Act. For example, you might get extended time for test taking, be able to test in isolation, or have a tutor provided. If you think something like this might be helpful, talk to your school’s student disabilities department about this.

There are also two very important questions you will need to ask yourself – and they’re very hard questions -

1. Are going to be able to function at a high level in your chosen field? For example, if you are going into a field that requires a great deal of reading and writing at a high level, you need to ask yourself if you can compensate. Can you learn to compensate for your disability and function as well as your peers? Are compensations you receive in school (extra time, tutoring) reasonable for an employer to provide in the workplace? You also need to consider the cost of making a mistake due to inattention or misreading something. In some fields, the mistakes can be corrected with minimal cost (other than perhaps embarrassment) but in some fields (such as health care) mistakes can cause significant harm.
2. Will it be worth the extra effort and energy needed to compensate for your injury related deficits? For example, if it takes you extra time to compensate for your deficits, you need to be prepared to spend that extra time to get the job done. In other words, what might take 40 hours per week for a non-injured person may take 50 hours for you. You might be able to do the exact same job, but if you have to read and write as part of your job, it may take you longer to do the same amount of work.

If you believe you can do it and you’re willing to put in the effort and energy, then the best thing you can do is to devote the time and energy needed to complete your degree. Continue working with your neuropsychologist and continue to explore options and compensatory strategies. If attention problems are significant concern, talk with your physician about the risks and benefits of a medication trial. Another option to talk to your neuropsychologist about is whether taking some time off might be helpful. Sometimes stress can limit recovery from an injury, and perhaps you would benefit from a year away from school to allow further recovery and to assess your options.

If you decide the answer to either of the two questions is "no", then you need to consider other career options. Talk with your neuropsychologist about your strengths and consider career counseling to assess job options that play to your strengths!

You sound like a hard-working and dedicated person and I’m sure there is a lot of success in your future!

DEAR PAT: It seems like most of your questions are related to severe head injuries. What about the minor ones? I’ve had a headache daily now for over 4 months since being injured. Any advice?

PAT'S RESPONSE: If I had a daily headache for four months, I wouldn’t call that minor! First, you need to talk to your physicians about your headache. They may be able to recommend some medications to cope with the headache. You may also want to consider behavioral techniques such as relaxation training or biofeedback to help you cope with pain. Other things I would advise include avoidance of high stress situations and getting plenty of sleep each night. Stress and insufficient sleep can both limit recovery after a brain injury. Consult with a physiatrist, neuropsychologist or pain management specialist (or all three) to get a better sense for your specific prognosis!

DEAR PAT: My husband fell 100+ feet in a plane crash in April 1999. He sustained a severe brain injury and is still struggling with attention and memory. Also, within the past three weeks he has recurring smells of cigarette smoke when no one is smoking. He is under the care of several doctors, but wonder if you have any info on the smoking smell. Thank you – his wife.

PAT'S RESPONSE:Pat certainly hasn’t encountered this symptom before! It’s probably impossible to know for sure what’s causing it. It’s possible that he is experiencing a mild hallucination (probably on a par with hearing someone call your name when no one is there). It could also be that his injury has triggered an association with the part of his brain responsible for storing "cigarette smell" in his memory. Perhaps there is an odor in the environment that his nose detects, but his brain mislabels as "cigarette smoke." Sometimes patient who experience seizures smell an odor before a seizure (although you don’t mention seizures). Pat’s open to other explanations if someone can suggest one.

This problem could actually be serious if your husband believes there is a fire in the home – or conversely if he fails to respond to a smell of smoke because he believes it is just "in his head." You may want to check the smoke detectors in your home to be sure they are working – just in case! Unfortunately, I’m unaware of any specific treatments other than to wait and see if this is a temporary symptom.

DEAR PAT: I was very impressed with this site. I found it helpful and informative as well as emotional. Thanks a lot. Here is my question: My sister suffered a TBI almost a year ago. She has had a great recovery, so far. She is now back to work and functioning quite well. Now she is having a problem admitting that the TBI has had that much of an effect on her life. She is in denial, she is a much different person because of the injury but won't admit it. It has been really hard all of the family. I have suggested therapy but she doesn't see that there is a problem. I have come to terms with the fact that I can't have my sister "back" the way she once was but I want to establish a new relationship her but I don't know how. If you can help – thanks so much. If not -thanks for listening.

PAT'S RESPONSE:Thank you for your kind comments. Pat just loves compliments. Onto your question! After a brain injury, people often seem "different" to family and friends. This can be due both to effects of the injury on personality and behavior as well as the emotional impact of surviving a traumatic event. It sounds like in many ways your sister has been a remarkable success story if she is back at work and functioning well. Because I’m not sure what the "differences" are, it’s hard to offer any concrete advice. One thing I can tell you is that many survivors of brain injury often become tired of having people tell them they are "different" (even if they are different). If your sister is functioning well, it may be that you and your family need to consider if there are ways you can accept her differences in a positive way. For example, if "differences" mean a different likes and dislikes, different attitudes, or different ways of doing things, it may just take time to "get used to" your "new" sister. On the other hand, if "differences" include irritable mood, low frustration tolerance, or angry and aggressive behavior, you can certainly talk to your sister about this and encourage her to seek counseling (or even consider family counseling with your sister). However, you must remember that she is entitled to make decisions about her life – including decisions about whether to seek help or not. The only exception to this would be if she is danger to herself or others (then you can ask a judge to intervene). If her behavior makes it uncomfortable for you or other family members to be around her, you may have to think about limiting your interactions to only include those that are brief and pleasant.

Somehow, I’ll bet a sister as concerned and devoted as you will find a way to work things out!

DEAR PAT:I am an instructional aide at an elementary school. I have just been assigned to work with a second grader who is near drowning victim. I don't know a lot about the child other than the parent's refusal to allow him special services from school because that would label him special ed. At this point, the teachers and school are trying to deal with the parents and in the meantime I have this sweet boy for two 30 min. sessions a week. I need some kind of direction as to how to work with him. At times he is somewhat alert and he knows some letter sounds but seems to be unable to put letter sounds and shapes together to form a word. At other times he is drifting and unfocused. His eyes rolling back in his head. He seems to have short or very little retention of what we are working on. He is on a modified curriculum. Help! What can I do for this child with such short and limited time frames?

PAT'S RESPONSE:I wish every child could have educators who were as dedicated and passionate! Unfortunately, it will be very difficult – if not impossible – to get this child the help he needs if the parents are uncooperative. It sounds like this child needs to have a comprehensive neuropsychological examination to assess his strengths and weaknesses. It is difficult to develop an appropriate and realistic educational plan without knowing a child’s capabilities. If he is in 2nd grade and only knows "some letter sounds" and is yet to form words – he’s clearly very delayed. Without knowing the extent of brain damage or his level of skill, it’s impossible to know what approach will work best or even if he will be capable of learning in a "mainstream" academic environment. In the meantime, you may want to consult with the special educational coordinator at your school (if you haven’t already). You may want to try to adapt multi-modal learning strategies and other techniques used to teach learning disabled students. However, even with that, two 30 minute sessions a week aren’t very much for a child with such significant learning delays.

I certainly understand the parents’ desire not to have their child "labeled." Emotionally, parents often have difficulty adjusting to the fact that a previously "normal" child now has impairments of disabilities as the result of an injury. It is certainly important for school personnel to be understanding and sympathetic to the parents. However, I wonder if the parents are aware of the child’s deficits in the classroom. I don’t know what kind of relationship the parents have with the school at this point, but it might be helpful to invite the parents to observe the class. If this child is noticeably far behind the other children, seeing it with their own eyes may help them decide something must be done.

Talking with the parents about all the options should be considered. For example, if they are concerned about "labeling" the child as "learning disabled" because they believe he will eventually recover – perhaps they could be provided with a label such as "Other Health Impaired." It may also help to explain the children who receive services are periodically re-evaluated and if he no longer shows learning problems at a future date, services could be stopped and he would no longer have a "special education" classification. Finally, the parents could be encouraged to seek an independent neuropsychological evaluation (it may be paid for by their insurance). This would provide them with confidential feedback about their child and his needs. Although the school could not receive a copy of the report without the parents’ consent – at least they could hear from a neutral expert how their child is doing and what his educational needs are. Maybe after hearing the facts, they would change their minds about placement options.

On the other hand, if the parents continue to resist services, tension between the parents and school may increase. Although there are options the school can pursue at that point to force the issue, it’s beneficial for everyone involved (especially the child) for this to be resolved cooperatively.

Pat #18

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

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 http://www.tbims.org. 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.

Pat #19

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: Six weeks ago my son was in a boat accident. His two friends were killed and he received severe brain trauma and other physical injuries. There were questions as to whether he would live. He did, and he opened his eye approximately 1 1/2 weeks later. We were told that if he lived, he would have little quality to his life. Two weeks ago my son was transferred to a skilled nursing care facility. We were told he would be able to transfer to a rehab program in 2 to 4 weeks. He made it in 12 days. My son is coming along physically though there is permanent physical damage. He repeats things, and has made some comments on his own. We are told he is now in stage 4 of six stages. He has become very agitated. I could tell when I talked to my daughter-in-law last night that she is very stressed. She is only 26 and has much to deal with. My questions is, what is this stage four? Can my son become stuck in it and never make further progress? What is the next step after this aggressive stage? One thing I have learned is that the only thing certain about brain injury is that nothing is certain. This makes it very difficult to ask questions because I have been told doctors give the worst scenario so that family won't be disappointed. I've also noticed that the SICU perspective and the rehab perspective is different. It was the doctor at SICU that was so negative about my son's recovery prospects. I'm so happy to find this site. This situation breeds loneliness and isolation. I must put on a happy face for the benefit of elderly parents, etc. Thanks so much.

PAT'S RESPONSE: Boating accidents are an increasingly common problem and I'm sorry to hear about your son's tragedy. I doubt the doctors were intentionally providing the "worst scenario." However, they do want to provide a realistic picture of a person's risks. Sometimes people beat the odds, but the doctors need to be honest and tell patients and family members when the odds aren't good. In your case, it sounds like your son is doing better than expected.

I'm not sure which "stages" you are referring to. People have come up with several ways to rate recovery from coma or traumatic brain injury. One of the most commonly used scales is the Rancho scale which includes eight stages.

Understanding the eight Rancho Levels can be helpful to track patients following traumatic brain injury. The levels and descriptions are listed below. Keep in mind that some people may plateau at a certain level and there is no way to accurately predict how fast someone will progress or where they may plateau.

The Rancho levels:

I. No Response

Patient appears to be in a deep sleep and is unresponsive to stimuli.

II. Generalized Response

Patient reacts inconsistently and non-purposefully to stimuli in a non-specific manner. Reflexes are limited and often the same, regardless of stimuli presented.

III. Localized Response

Patient responses are specific but inconsistent, and are directly related to the type of stimulus presented, such as turning head toward a sound or focusing on a presented object. He or she may follow Simple commands in an inconsistent and delayed manner.

IV. Confused-Agitated

The patient is in a heightened state of activity and severely confused, disoriented, and unaware of present events. Behavior is frequently bizarre and inappropriate to his immediate environment. Patients are unable to perform self-care. If not physically disabled, they may perform automatic motor activities such as sitting, reaching and walking as part of the agitated state, but not necessarily as a purposeful act.

V. Confused-Inappropriate, Non-Agitated

Patient appears alert and responds to simple commands. More complex commands, however, produce responses that are non-purposeful and random. The patient may show some agitated behavior, but it is in response to external stimuli rather than confusion or distress. The patient is highly distractible and generally has difficulty in learning new information. He or she can manage self-care activities with assistance. Memory is impaired and verbalization is often inappropriate.

VI. Confused-Appropriate

Patients show goal-directed behavior, but rely on cues for direction. They can relearn old skills such as activities of daily living, but memory problems interfere with new learning. Awareness of self or others begins to re-emerge.

VII. Automatic Appropriate

The patient goes through a daily routine automatically, but this is robot-like with appropriate behavior. He or she will have some recall of activities and superficial awareness of his or her condition. The patient requires at least minimal supervision because judgment, problem solving, and planning skills are impaired.

VIII. Purposeful - Appropriate

Patient is alert and oriented, and is able to recall and integrate past and recent events. He or she can learn new activities and continue in home and living skills, though deficits in stress tolerance, judgment, abstract reasoning, social, emotional, and intellectual capacities may persist.

DEAR PAT: Two and a half years ago, my best friend from childhood sustained a severe brain injury to her brainstem. All of her motor skills were affected and although she has been in Rehab for the past two and a half years, her Rehab team decided to stop therapy for a while due to a plateau in her recovery. As with all brainstem injuries, her motor skills were affected. She has no use of her left arm, and her right arm has significant tremors, interfering with functional tasks. She has made significant gains in her trunk and legs, however, her goal of walking has not been obtained (yet). Her speech was also significantly impaired, but she does speak and can communicate her needs. The remarkable thing throughout all of this, is that her mental status and intelligence were hardly affected by her injury. She has minimal short-term memory loss, and she does process things slower than usual. My question to you is, now that therapy has decided to take a break, do you have any suggestions of other activities or treatment strategies that the family could look into? Any info would be very helpful. I would hate to see a healthy mind and healing body be forgotten in the midst of health care that wants immediate results. Her family is very involved and willing to try anything.

PAT'S RESPONSE: I'm glad to hear your friend has so many people that care and show her love and support. Probably one of the best things you can do is to continue to be such a great friend - social support and companionship are very helpful. As for continued rehabilitation, it may be helpful, but based on the length of time post-injury, improvements will likely be slow and gradual. Some people find that persons with balance or motor problems can build strength by exercising in a swimming pool (although consult with her physician first!). Playing video or board games that emphasize memory and/or motor skills can be helpful and fun. Talk with her physician and/or a physical therapist about activities that will help to build strength and maintain good health.

The best thing to do now is to focus on your friend's strengths. From what you wrote, she has made tremendous progress over the past 2-1/2 years! Encourage her to set goals and to develop her interests and hobbies. Work with her to identify things she can do and enjoys doing. What can she do to help her feel more involved and productive? Since you say she communicates well, talk with her about what she would like to do. What future goals does she have? How can those goals be achieved? Let your friend guide you into what activities she would like. With friends like you, I know she's in good hands.

DEAR PAT: My son's Social Security Disability was cancelled 3 years ago because they state he is able to work. However, he has not been able to secure a job on his own and what work he has had was through employment agencies. Even though these are supposed to be open to full time employment at the job sites, he is always told he is no longer needed. The longest he was kept was 10 days. He always works when told to report but I suppose he is inappropriate in someway. We need advise in securing SSI or other financial support. He wants and needs to be independent.

PAT'S RESPONSE:

1. Talk with his physician about his condition and prognosis. In order to qualify for SSDI, you will need a doctor to describe the patient's problems and state that he is unable to work.
2. Talk to your son or his former employers. Finding out why he cannot hold a job is essential for determining if this is due to a disability, behavior problem, or some other reason.
3. Investigate the possibility of having your son evaluated by a psychologist, psychiatrist, or neuropsychologist. Documenting behavior problems may help to qualify for SSDI - but more importantly may suggest some treatment options to help him improve his behavior and allow him to keep a job.
4. Contact your state's Department of Rehabilitative Services. Most of these programs include return-to-work training and supportive employment services to help people successfully re-enter the work force. Perhaps they can suggest some programs that may be able to help your son.
5. Contact your state's chapter of the Brain Injury Association and ask if they have any information to assist people in your son's situation. Also, you may find some useful advice in the FAQ section of this website.

DEAR PAT: My 26-year-old son was involved in a motor vehicle accident on 11/7/99. He was rear-ended while at a complete stop and suffered a serious head injury that required over a dozen stitches. Since that time he has had many ailments, headaches, huge swollen glands, viral attacks, but the latest is the most upsetting. He is experiencing severe joint pain. It started in his left ankle, then his right, both knees, now his right wrist and elbow. When he awakens, he can not walk or function until he has taken aspirin or pain medication. He has seen a neurologist who says all is well. Now he is scheduled to see a rheumatologist since my family doctor thinks he has rheumatoid arthritis. I think this is trauma related and here is why. Prior to the accident, Jeff was running 10 to 20 miles daily. He held two jobs, one at a fitness center where he was a licensed personal trainer, certified spinning instructor, etc. The other job is as a track coach at a private boys' school. He had been training seriously for the Boston Marathon for over a year and had planned to compete in the Philadelphia marathon on November, 1999. He has lost his job at the gym since he is unable to perform. He is becoming very depressed as am I since I can not seem to help him in any way. I do believe that this is related to the accident and/or head trauma. Do you have any similar case histories or anywhere to direct me for help? Thank you for your time.
PAT'S RESPONSE: Hm... Sounds like a complex case. I'm not sure I can be of very much help since arthritis and diagnosis of joint pain are not within my area of expertise. I can tell you that it is more common to have musculo-skeletal pain after a traumatic injury - such as pain in the muscles of the neck and back.
Keep in mind that just because two things occur at about the same time doesn't mean that one caused the other. In other words, if he developed arthritis, it could have been independent of his accident and only a coincidence. Below is a link to a site with LOTS of links and information about arthritis. You can read about suspected causes of arthritis (including the possibility of infections or genetic factors) as well as current research and treatments.
http://www.pslgroup.com/ARTHRITIS.HTM#Disease

DEAR PAT: My son of 16 1/2 months died of a traumatic head injury. His whole brain was swollen and the cause of death was subdural hematoma, cerebral edema, and blunt impact to the brain. I was not home with my child. My husband was home and is now in jail. I can not put my son's death to rest because I do not know how any of this happened. The prosecutors told me it was from slamming or shaking. My husband told me he fell out of the crib and later on fell off the couch. I don't know what to think. I miss my little boy and little boys of his age shouldn't have this happen to them, they are so pure. Is there any information you can give me that might ease my mind on what might have happened?

PAT'S RESPONSE: I'm sorry for your loss. Nothing is more tragic and heartbreaking than the death of a child. Unfortunately, I'm afraid I can't ease your mind very much. It is questionable that those types of injuries would occur from the minor falls your husband described. Even if he is telling the truth, one has to consider whether your son was being properly monitored by adults if he can sustain two serious falls within a short period of time. However, this may also be a case of child abuse or Shaken Baby Syndrome. The doctors that examined your child should be able to determine if his injuries are consistent with falling. Injuries from child abuse are usually quite different from those sustained "accidentally" and the medical evidence will probably hold the answer to your questions. Please see Pat Column #11 for more detail on Shaken Baby Syndrome (Click the "Archives" link at the bottom of this page).

DEAR PAT: My grandfather recently experienced a massive hemorrhagic stroke, from which the doctors predicted that he would not survive. He was in a coma for almost two weeks and much to everyone's surprise "woke up" one day. He was transferred to an acute care traumatic brain injury cognitive rehab in New York and has made great progress. At this point, he is able to recognize family and friends, nod yes or no to questions and even attempt to speak. He needs cognitive, physical, occupational and speech therapy. He is going to be discharged from the acute care facility and we were advised to find a long-term care traumatic brain injury certified facility to have him transferred to. I have done some exploring for facilities in New York and New Jersey but seem to have hit roadblocks with each potential facility I find. Is there a resource I can use for a listing of appropriate and available facilities in the area. Thank you very much for your help.

PAT'S RESPONSE: It's not clear to me if you are looking for a rehabilitation hospital. This is a medical facility that will provide rehabilitative therapies such as physical, occupational, and speech therapy. If this is what you are looking for, please see the answer to the next question.

On the other hand, if by "long-term" you are looking more for residential facility that can also provide medical care, you may want to explore the following websites:

This is a website with long-term care information for New Jersey. It contains a locator for long-term care sites in the state.

http://www.njahcf.org

A similar site for New York

http://www.nyshfa.org

This is the website for a national organization of long-term health care facilities.

http://www.ahca.org

DEAR PAT: My brother is 45, 4 years post-injury. He is in a 1/2-day outpatient program for the past 3 years. This has been great, but I feel that he needs much more at this point in time. The usual resources (voc. rehab) have not had much else to offer. Are there any intensive in-patient rehab facilities in the eastern U.S. for people that are a few years post-injury, that concentrate on vocational issues and moving past the "typical" outpatient rehab services?

PAT'S RESPONSE: It's very unusual for a person to be admitted to an inpatient facility several years after discharge without some type of deterioration. Certainly if you can afford the costs, you can probably find a facility willing to admit your brother and provide intensive services. However, keep in mind that 4 years post-injury, further improvement is likely to be gradual. In addition, it is unclear whether a person will actually benefit from intensive therapies that many years post-injury. In some cases, too much therapy can leave patients stressed and fatigued, possibly even slowing further recovery. My advice is to talk these issues over with your brother and other family members. If your brother agrees that he would like more intensive therapy on an inpatient basis, you may want to investigate full-day treatment programs or having in-home therapies before you consider the very expensive option of an inpatient placement.

As for locating rehabilitation facilities, the following links may be helpful -

A checklist of questions to ask when looking for a Rehabilitation Center

http://www.headinjury.com/rehabfind2.htm#questions

A listing of some rehabilitation sites in the United States (This is far from exhaustive, but might be a good starting point).

http://www.headinjury.com/rehabfacility.htm#topofpage

Rehabilitation facilities should be accredited by either CARF or JCAHO (but not necessarily both).

To check on a facility's accreditation with JCAHO, visit their website at:

http://www.jcaho.org

For a list of CARF accredited rehabilitation facilities, contact CARF at:

CARF
4891 E. Grant Road
Tucson, AZ 85712
Voice/TDD (520) 325-1044
Fax (520) 318-1129

DEAR PAT: After a person has been injured in a car accident and suffers a traumatic brain injury, who determines they are "of sound mind" to sign any kind of legal papers? To ask for a divorce? When is that determined? At what point is it discussed? I'm referring to my brother who suffered a closed head TBI nine months ago. He has been home from the hospital for five months and his wife treats him with zero respect. She constantly talks down to him and I'm afraid of how she treats him when I'm not around. He begs me to take him away from her. I don't know what to do. I think he is "of sound mind" now. Thank you for your excellent work. I don't know how I would have survived without you during these last few months.

PAT'S RESPONSE: You need a sound mind to get divorced? You sure don't need one to get married! Actually, you are asking a legal question. You should consult an attorney for more specific information and I can only make general comments. Decisions about someone's competence for making legal decisions (like divorce) would likely be made by a judge, although judges often decide to follow the guidance of a medical or mental health professional who may do an evaluation. Competency is usually task specific. That means that you are neither "competent" nor "incompetent." Instead, you may be competent to do some things, but not others. For example, a person could have the capacity to decide his or her medical care, but not to make financial decisions. It sounds weird, but people could have a deficit in a specific area (like math or reading) that would affect their ability to make some kinds of decisions but not others. In most cases, the individual determining "competence" will attempt to determine if the person understands the issues and alternatives in making a decision for that specific issue (in your brother's case, divorce).

Probably the place to start is simply for you or your brother to make a phone call to a divorce attorney. He or she will be able to guide you through the laws and procedures of initiating divorce in your state. It may be that competency will not even be an issue if either your brother's wife agrees to the divorce, or if your brother is capable of making an informed decision.

A final note. If you believe that "zero respect" crosses the line into verbal or physical abuse, there are other avenues to pursue. Spousal abuse is against the law regardless of gender. Contact an attorney or social services for more assistance.

DEAR PAT: My husband had a traumatic brain injury in 1996. He has responded very well to therapy. He walks with a walker, speech is somewhat impaired, however, we can understand him. He is still incontinent and gets very frustrated about this. Is there something that we can try to help this situation?

PAT'S RESPONSE: Incontinence is a frustrating and embarrassing problem. Your husband should consult his physician to determine the cause of the incontinence (for example, is it due to lack of muscle control, lack of sensation, or some other reason). Your physician may be able to recommend some medications that can help. There are millions of Americans who suffer from incontinence, and many use adult diapers or protective underwear to help with this problem. Try to be supportive and understanding. Ask your husband's doctor to talk with him about this problem. Counseling may help him to deal with his frustration and to understand that incontinence is a very common difficulty affecting millions of Americans.

DEAR PAT: I'm glad to see so many people being able to ask you for help, but I didn't see many about TBI in children... Do you know of an educational program or summer camp or something specifically for head injured children?

PAT'S RESPONSE: There are rehabilitation programs specifically for children with brain injury. Programs and support groups may be available through a local children's hospital. Call and find out if they offer any outpatient programs for children with brain injury or if they can refer you to someone who does. You can also contact the Brain Injury Association and ask for help locating resources.

If you've read Pat's column before, you know that existing programs for "special needs" children (e.g. learning disability) can sometimes be modified in a way to assist a child with brain injury. Talk to people involved with these groups in your community and find out if they can be modified to assist a child with brain injury.

The Brain Injury Association
105 North Alfred Street
Alexandria, VA 22314
Phone: 703-236-6000 Fax: 703-236-6001

http://www.biausa.org

DEAR PAT: My brother died from anoxia due to an accident last year after living in a vegetative state for 3 months. Although at first in an ER, he was later transferred to a long-term care facility. I was shocked to see how many young people were there. My questions arise out of sheer curiosity: how many young adults nationwide live in a persistent vegetative state? what percent of them recover? How many facilities exist nationwide that care for young adults in vegetative state?

PAT'S RESPONSE: These are excellent questions. Estimates I have seen indicate that between 10,000-25,000 people exist in a vegetative state in the United States. Exact numbers are hard to determine because of disagreement about diagnosis, the relative rarity of the condition, and the fact that people with brain injury may "progress" out of a vegetative state. I am unaware of any statistics on the number of facilities that care for patients in a "vegetative state." Partly, this would depend upon whether you included trauma hospitals, or whether you are only considering long-term facilities of patients in persistent vegetative states.

For more information (probably more than you really want) - check out this website:

http://www.comarecovery.org/pvs.htm

DEAR PAT: My 18 year old sister was involved in a serious car accident on December 21, 2024 and sustained serious head injuries. She was not breathing on arrival at hospital and was put on life support for 2 days. Three weeks down the track she still has Post-Traumatic amnesia, but not seriously. She can remember most things long term, although without a lot of emotion as we lost our mother in a car accident in October 99. She is still in rehab now although insists stubbornly all the time that she wants to go home, and has to go back to work. I feel that she used work as a means to cope with mums death but what the family is finding difficult is that before the accident she was a loving, caring person but now she doesn't care how others feel, ignores visitors and constantly tells us that no-one visits. She says that we are just family and have to be there even though we have been with her everyday, with a loss of money and time etc. I love her dearly and am at a loss as to how to find the sister she was. Is there anything I can do apart from going crazy?

PAT'S RESPONSE: Well, please don't go crazy. That won't help anyone. Probably the most important thing to remember is that your sister's brain injury is probably affecting her behavior. Neurophysiological changes after injury can results in symptoms such as difficulty controlling emotions (or showing no emotion), altered perceptions, difficulty with memory, or distorted sense of time. For example, even though you visited yesterday, it may seem like a much longer time to her. In addition, she has had a serious, traumatic event and this can cause a strong emotional reaction. She is likely reacting to her trauma, wondering about her future, and frightened that her life may never again be "normal." Also, she may be grieving now both for your mother and for parts of herself she's afraid are gone. Try to remember not to take the behavior personally, and just remember that this is a normal part of her injury. Also, if she was just injured on December 21, 1999, she has a VERY recent injury. Brain injury recovery is a long-term process, and it is unrealistic to expect her "back to normal" in just a few weeks. Be patient and give it some time.

Pat has one last piece of advice! Don't expect your sister to be grateful for your "lost time and money." Being a member of a family is sometimes about making sacrifices. Just ask yourself if your sister would do the same for you if roles were reversed. From what you describe about her before the injury, it sounds like she would.

DEAR PAT: I have a niece, 18 years old, who lives in Cali, Colombia. Last October she was in a very bad car accident, and was in a coma for over 2 months. She woke up 4 weeks ago. Her recovery so far has been extraordinary, she can walk with help, can talk, and understand things pretty well, she has no short memory, and has some tremors in the left hand and head, she takes medication for it. I was very glad to see your site as I will e-mail my sister so she can access it too. A question I have is this, In Colombia they have no access to any rehabilitation centers or programs as we do in the States. She has been told to come to the States for further help. (She received physical therapy, and they have consulted with various specialists.) All recommend for her to come here. Because they don't have insurance, all have to be pay by cash, my sister is not rich, but the prizes for the services in the States are astronomical. Do you know of any organization, or entity that could help with some financial assistance? I want to thank you for the help you have given and the amount of information this web site offers.

PAT'S RESPONSE:I would start by contacting the Brain Injury Association and asking if they have any ideas or if they can offer some help. Try contacting charity organizations such as the Red Cross, United Way, or religious organizations to see if they might be willing to provide funds. States have provisions for indigent care, so you might find out if your niece would qualify in your state (contact a state funded hospital - such as a teaching hospital at a University). You might also ask your own religious group (church, temple) for help. I wish I could give you better advice. I hope things work out for her!

DEAR PAT: My son had a car accident in Aug of 1994. He has a Traumatic Brain Injury with short-term memory loss and a speech deficit. We are trying to find him a job and the Department of Rehabilitative Services has been very helpful, but we are hitting brick walls right now. As soon as an employer finds out he has a deficit they say, "We'll call you!" We live in Chester, Virginia and I am trying to find a place where he can get out and see other people other than our family! Do you know of anyone available in the area or who I can ask in the area? Thank you for your help!

PAT'S RESPONSE: Pat has several ideas for you! A visit to a chapter of the Brain Injury Association of Virginia (in Richmond, 355-5748) can be a helpful source of support and education. There are also brain injury support groups in the Richmond, Virginia area. The Brain Injury Association will be able to provide you with contact information (I know there are groups that meet at Sheltering Arms Rehabilitation Hospital in Richmond). If you believe individual and/or family counseling might help, you could try contacting the Department of Physical Medicine and Rehabilitation at VCU at 828-9055 (They maintain this website). They offer counseling services on an outpatient basis and have experiencing in working with people struggling with return-to-work issues.

DEAR PAT: I have made friends with some people who have brain injury and live in a nursing home. The home is privately owned and for profit. Staff turnover is non-stop, and it appears that the residents, who are confined to one hallway with a locked door, are not getting opportunities for community integration and vocational services. What can I do? I volunteer at the home and have become friends with many of the residents. They tell me that they feel trapped, that they would like to move out in an assisted living situation, and that they would like to work and get out in the community more often. The case managers seem uninformed regarding the opportunities and when I inquire, they tell me that I can not meddle due to confidentiality issues. However, the residents have trouble remembering to ask questions and advocate for themselves. Many of them do not have any concerned family member involved. I am really frustrated and I want to help, but I don't know where to go for the help!

PAT'S RESPONSE: You sound like a really good person who is trying to give to others. And you work for free? Can we clone you?

One thing you could look into is whether you could locate a church or civic group to organize volunteers to spend extra time with the people at this home. You may even be able to organize an outing if you can get the permission of the facility. Try to find an ally among the case managers or staff. If you can find someone with some authority that also would like to increase the opportunities for community involvement, you will probably make some progress.

Although you have good intentions, also keep in mind that you do not have access to medical/psychiatric records. Many patients in nursing homes may have significant cognitive deficits that are not evident to a lay person. Seizures, high risk for stroke, or other health complications may require intensive observation and low stress levels. Some patients may have periods where they are alert and aware, but may also have episodes of confusion or delirium. Some may even be prone to aggressive or violent outbursts if frustrated, frightened, or overwhelmed. Remember that nursing homes are very controlled environments with regular routines. Pat has seen patients that look "OK" in nursing homes, but were completely unable to function outside of a very controlled environment. Without access to medical records, it's impossible to know the medical or psychiatric issues involved.

Nursing homes are usually overseen by state agencies and/or accredited by outside agencies. You might want to research your nursing home's affiliation. If you believe that patients' rights are being violated, you could contact one of these agencies and make a formal complaint.

DEAR PAT: My mother had a seizure, and was found to have a large mass last month. An MRI was not helpful because the swelling was so great, they cannot see what is inside. She doesn't have insurance, so she was sent home from the hospital and ordered another MRI three weeks later. The swelling had remained the same, but with a new pocket in a new location. She has an appointment to see a neurosurgeon next month. No angiogram was done, and besides the MRIs she has not seen a doctor since being released from the hospital. Worse, her doctor does not return our calls when we have concerns. I am concerned that she is not getting proper care because of her lack of insurance. She was in a car accident in October, and it is possible that this is a related injury from that incident. What will happen to my mom if this swelling continues to increase? Are there other diagnostic tests to see what it could be? I am afraid for her, and I don't think this case is being treated with the appropriate urgency. Am I overreacting, or is this normal for brain injuries?

PAT'S RESPONSE: The person with the most information about your mother is her doctor. Pat certainly can't comment on the specifics of your case. If your mother has a "mass" (often a tumor or growth), a few weeks may not make much difference to her physical health. In fact, sometimes "growths" are evaluated over a period of months to see if they are growing or not. Also, if it is a growth, it is unlikely to be associated with her accident. My advice is to wait and see what the neurosurgeon says. Carefully monitor your mother, and if you see any further seizures or witness changes in her behavior (such as disorientation or confusion), take her to the Emergency Room.

As for returning your phone calls, doctors should always communicate with patients and family members. However, remember that medical information is confidential and is not to be released to anyone but the patient. Some doctors follow this more strictly than others, and laws may vary from state-to-state. However, if the doctor is not returning calls or providing adequate explanation of your mother's condition to her - then change doctors. It is essential that patients feel comfortable with their physicians and physicians have a clear responsibility to keep patients fully informed of their medical condition.

Pat #20

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: My sister (she's in her mid-20's) had a traumatic brain injury during a car accident almost one year ago. She's been home from the hospital for several months and is doing a lot better. She continues to have weakness on the right side of her body and some memory problems, though. Also, her confidence seems low. I wonder if she'll ever get back to being like she was before the accident. How long does it take to get better after a severe brain injury? What can I do to help her? Thanks, Pat!

PAT'S RESPONSE: Bravo and keep up the good work! It sounds like you care a lot about your sister and want the very best for her. Now that she has been home for a while, you have a chance to look toward the future. Help her anticipate new challenges that may surface. Provide support and encouragement when they do. A little "sisterly love" goes a long way.

In response to your question about recovery time, the short answer is, "It depends." Recovery from brain injury--as you are learning first hand--is usually a long-term process. People may recover quite rapidly in the first six months to a year after their injuries. Then, people tend to find the rate of recovery slows down. The good news is that most individuals continue to recover for some time, just at a more gradual pace than before. Others find their physical or cognitive problems seem to linger on indefinitely. Your sister is far from the "indefinite" phase of recovery. Her problems with motor weakness and forgetfulness may continue to improve. It depends on a number of factors including her own individual strengths (supportive family, motivation, young age) or challenges (severity of brain damage, access to rehabilitation resources), whether this will be the case.

Never stop working toward improvement! Recovery depends on what you do to help it along. To make the most of her progress, your sister should keep regular visits with doctors and specialists trained in rehabilitation (e.g., physical and occupational therapists, neuropsychologists, and physiatrists). Talking to other people about her condition may help renew confidence lost after the accident. Rehabilitation counselors and support groups offer a caring environment for guidance and education about surviving brain injury. Strategies to overcome and/or adjust to memory problems can be developed with the help of a rehabilitation psychologist. Many people find talking with others that have survived brain injuries helps them better manage their own adjustment. Go to a support group for family members of survivors, kind sister, and take advantage of the companionship and understanding you too deserve.
DEAR PAT: My life is in a rut. I do the same thing every day and see the same few people. Life is so dull and lacks luster. Plus, it's been three years since I had a head injury and I haven't been out on a date since. At first, I was too busy getting well to worry about dating. I didn't know what the future had in store for me. Over time, I've found that I don't have as much in common with the people I used to have as good friends. I'm trying to think of ways to meet new people (maybe even someone special) and to find different activities that are more in line with who I am today. Help!

PAT'S RESPONSE: Could this be a case of the "winter blahs" or something more terminal like "love sickness?" Either way, you are not alone. We all experience times in our lives that seem a little too familiar and routine. Are you ready to make some changes, shake off the snow, crawl out of hibernation, etc.? If so, read on…

First, give yourself some credit for taking the time to get better after your injury. Reliable schedules and familiar people make the recovery time easier for most people. Second, Pat suggests you take stock in your life. What other areas may need a make-over (besides your love life)? When was the last time you picked up a new hobby, tried a different sport, took a class, or went to the library and browsed the aisles? These types of activities not only improve the "inner" you, but also increase your exposure to new ideas and people. When you broaden your range of interests, you increase the chances others will be interested in you! Third, you may want to consider ways to accentuate your outward appearance as well. Ask yourself (and answer) these types of questions to see where you could improve your "people skills."

* Would others consider you a warm and friendly person?
* Are you a good listener and show interest in the other person during conversations?
* Do you make the most of your appearance (neat haircut, clean clothes, big smile)?

If you're kind to yourself, cultivate new interests, and appear approachable, you are well on your way to being a good friend to yourself and someone else. Good Luck!

Pat #21

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: My life is in a rut. I do the same thing every day and see the same few people. Life is so dull and lacks luster. Plus, it's been three years since I had a head injury and I haven't been out on a date since. At first, I was too busy getting well to worry about dating. I didn't know what the future had in store for me. Over time, I've found that I don't have as much in common with the people I used to have as good friends. I'm trying to think of ways to meet new people (maybe even someone special) and to find different activities that are more in line with who I am today. Help!

PAT'S RESPONSE: Could this be a case of the "winter blahs" or something more terminal like "love sickness?" Either way, you are not alone. We all experience times in our lives that seem a little too familiar and routine. Are you ready to make some changes, shake off the snow, crawl out of hibernation, etc.? If so, read on…

First, give yourself some credit for taking the time to get better after your injury. Reliable schedules and familiar people make the recovery time easier for most people. Second, Pat suggests you take stock in your life. What other areas may need a make-over (besides your love life)? When was the last time you picked up a new hobby, tried a different sport, took a class, or went to the library and browsed the aisles? These types of activities not only improve the "inner" you, but also increase your exposure to new ideas and people. When you broaden your range of interests, you increase the chances others will be interested in you! Third, you may want to consider ways to accentuate your outward appearance as well. Ask yourself (and answer) these types of questions to see where you could improve your "people skills."

* Would others consider you a warm and friendly person?
* Are you a good listener and show interest in the other person during conversations?
* Do you make the most of your appearance (neat haircut, clean clothes, big smile)?

If you're kind to yourself, cultivate new interests, and appear approachable, you are well on your way to being a good friend to yourself and someone else. Good Luck!

Pat #22

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: I’ve recently re-entered the dating scene after 4 years of absence. I had a brain injury in 1998 and lost my girlfriend soon after. It really hurt that she didn’t stay with me. I was pretty mad and had a hard time trusting people for a while. I’m completely over her now, but I am afraid of dating someone new. I don’t think anyone would really want me because of my head injury. I get embarrassed easily and can’t think of the right words to say all the time. I don’t want them to think I’m dumb, so I usually avoid being around a lot of people.

After many weeks of pestering me, my older brother finally talked me into going on a date with a family friend. I thought the date went great. We went out to dinner and then to a bar, partying until 2 a.m. I told her all about my ex-girlfriend, how she left me high and dry after the accident, and how long it’s been since I’ve been out on a date. We talked for hours about my brain injury and what I went through getting better. I took her home, but she wouldn’t give me a goodnight kiss. When I tried to call her the next day, she wouldn’t even talk to me. I left messages, but she hasn’t returned my phone calls. What do I do now? Dating Dud

PAT’S RESPONSE: Sounds like you two had quite a night! Without being a fly on the wall (or in your soup), it’s hard for me to guess what went wrong on your dinner date. I do know that you are not the only person to have ever felt confused after a date. Years of reading letters from brain injury survivors about this topic have certainly been educational for me. Dating can be a complicated process for anyone, but it may be especially hard for someone recovering from a brain injury. Let me share with you some ideas from “Pat’s Secrets of Dating after a Brain Injury.”

q Get in shape.

§ Taking up two theatre seats won’t impress her.

q Before you ask for a first date, find out what the other person likes to do.

§ Does he or she like to go on picnics, see movies, or play golf?

§ Have a set plan when you ask someone out if your date doesn’t have a preference. You might say, “Do you want to go to the movies with me on Friday?”

q No matter what your friends say, hygiene is important.

§ Go beyond basic cleanliness (bathing, brushing teeth and hair). Try ironing your clothes, getting a haircut, and trimming your nails.

§ Your date may not tell you if you’ve got poor hygiene, but a second date is not likely.

q Watch your temper.

§ Nothing turns a date off worse than yelling at the waiter.

q Keep your hands to yourself.

§ Don’t assume it’s okay; Ask before you touch.

q Don’t talk too much about yourself.

§ Encourage your date to talk about his or her interests, life experiences, etc.

§ Look for social clues to change the topic (poor eye contact, yawning, waving down the waiter for the check).

q Think before you speak.

§ You won’t impress her by accurately guessing her real weight or age.

§ Don’t tell everyone stories about your underwear.

§ She won’t be impressed by stories about how drunk you got.

§ Don’t talk about sex on the first (and probably the second and third) date.

q Don’t get your date drunk.

§ You’ll probably get drunker.

q Good manners are always appreciated.

§ Don’t make noise when you eat.

§ Say “Please” and “Thank you.”

§ If you invite someone out on a date, you should expect to pay.

Remember, dating can be complex with many “rules” to make things go more smoothly. Next time you ask someone out for a date, choose a person you are truly interested in knowing better. Good luck on all your future dating adventures!

Pat #23

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: Since my brain injury 2 years ago, I have had many problems that will not go away. I feel depressed and angry most of the time. I get very impatient with people. It’s difficult for me to concentrate and I’m often forgetful. I couldn’t keep up at work and I lost my job 6 months ago. Since then, I haven’t felt like being around people much at all. The only people I have to talk to are my children. Even they don’t understand what I’m going through. They keep telling me to “get over it” and find another job. So far, I haven’t been able to do either one of those things. I feel too sad and irritable to even think about working. I finally broke down and told my doctor about how I’ve been feeling lately. She started me on Prozac last month. I feel a little better, but I’m still having a pretty hard time. What else can I do to start feeling better? Are there people out there who will believe that my problems are not imaginary?
---“All in my head” in Hanover

PAT’S RESPONSE: You may be surprised to find out your symptoms are not so unusual. Problems like the ones you describe are quite common after a brain injury in fact. Many people recovering from brain trauma notice changes in their emotions and thinking. You’ve taken good first steps to reach out and find others who do understand what it’s like to survive a brain injury.

From the letter you wrote, your doctor seems to believe that your problems are real and that they deserve treatment. Depression after a brain injury is an all too common difficulty. Reactions to loss and life changes, or changes in brain chemistry, or both may account for post-injury depression. There are many medications for depression and other emotional problems that may be helpful for you. Keep your doctor informed about how the medication is (or is not) helping. Be willing to try different medications if necessary.

If you find that medications aren’t helping enough, you may want to think about other kinds of treatment or support. Many people find individual and group therapy, for example, helps during the short and long-term phases of recovery. Your doctor may know a rehabilitation specialist in your area who provides counseling for people after a brain injury. Joining a group for survivors of brain injury is another great idea. You are likely to find the support, guidance, and advice of other people with similar experiences very helpful.

There is a community of survivors, family members and friends, and treatment professionals that will not dismiss your concerns. The Brain Injury Association of Virginia (804-335-5748 or toll free 1-800-334-8443) is a wonderful organization to contact. They are an excellent source of information about treatment specialists, programs, services, and support groups in your area.

Pat #24

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: Our 26-year-old daughter was badly hurt in a motorcycle accident 3 years ago. She broke a leg and both arms, had bruises from head to toe, and had a massive brain hemorrhage. There was a time when we didn’t think she would make it. Luckily, she had great surgeons that literally saved her life. We were filled with hope during her quick physical recovery. What has been most difficult has been watching her mental struggle with the effects of a brain injury. Even after all this time, she still forgets everyday things, has trouble keeping up with conversations, and gets tired so fast.

Since she was discharged from the hospital and finished treatment, my husband and I have been taking care of her at home. We love our daughter very much and would do anything to help her get better. I have noticed, though, that her temper is much shorter since the accident. She argues with my husband about everything. In her defense, my husband likes to tell her what to do and how to do things. I think he has a hard time letting her make her own decisions and mistakes. I know my daughter is growing more angry and resentful about the way she is being treated. What can I do, Pat, to keep the peace at home between my daughter and husband?

PAT’S RESPONSE: Wanting the members of your family to be happy and to get along is a natural response. I bet your motherly instincts about conflicts between your daughter and husband are right on target. The trick, however, is to avoid being the target! In other words, when family members argue, some unlucky person may find herself caught in the middle. During stressful times, you may also feel extra pressure to help everyone in the family get along.

Realizing that your family has been through a series of stressful events since your daughter was injured is important. First, you and your husband were faced with the possibility that she may not survive the accident. Second, you were concerned about her mental recovery once her physical health was restored. Lastly, you have seen signs of lingering cognitive and emotional problems that are worrisome.

You and your husband may also be under stress because of the responsibilities of taking care of your daughter. Assuming she was living on her own before the accident, you and your husband had probably just gotten used to having an “empty nest” when she moved back home. Having an adult child in the home after a period of absence would be a significant change for any couple. Also, the strain of caregiving should not be overlooked. Relatives providing care to persons with brain injury may find the responsibility rewarding but burdensome. Adjusting to these life-altering changes is understandably difficult for your family.

Following a brain injury, survivors are more vulnerable to stress of daily hassles as well as major life changes. That’s one reason why people with brain injury often have trouble controlling frustration and anger. There are a number of constructive ways to cope with anger problems that survivors and their families have shared with me over the years. To help your daughter increase her self-control, try the following ideas other survivors and their families have found helpful:

* Encourage her to be positive and sensitive to others’ feelings. Remind her to explain herself calmly. Doing so will make it easier for others to understand and help.
* Help your daughter remember that controlling anger will improve relationships with family and friends.
* Encourage your daughter and husband to take a “time out” and try to relax when angry feelings start to build. Helpful strategies include breathing deeply and slowly or counting to ten before speaking or acting.
* Identify trouble situations, people, and places that bring out your daughter’s anger. Make a plan to deal with trouble situations and practice the plan ahead of time.
* Be a good role model and encourage your husband to do the same. Teach good anger management skills by using them yourself.

Patients and families may need additional help during especially stressful times. Talking to extended family members, friends, or professionals can benefit families with complex and challenging issues as the ones you have described. For example, you may consider asking others for help in caregiving. A short break or chance for respite often makes it easier for family caregivers to cope over the long term. You may also wish to contact the Brain Injury Association of America (BIAA). BIAA offers a telephone helpline for families (1-800-444-6443) as a nationwide source of information and referral services. For emotional support, participating in a local support group for persons with brain injury and their families is another possibility. The Brain Injury Association of Virginia (BIAV; 804-355-5748 or 1-800-334-8443) provides information about support groups and other useful services for survivors of brain injury and families.

If you are seeking individualized help, you may wish to consider counseling for yourself or your family. BIAV has a list of mental health professionals with brain injury experience throughout Virginia offering individual and family counseling. Another source of treatment may be found in the Department of Physical Medicine and Rehabilitation at Virginia Commonwealth University (VCU). The family support program at VCU provides education, counseling, and referral services addressing the unique needs of persons with brain injury and their families. Laura Taylor may be contacted to learn more about this program and to see if you are interested in participating (phone: 804-828-3703/1-866-286-6904 or email: [email protected]).

Pat #25

Meridian Tech Group, Inc — Tue, 26 Apr 2025 05:00:00 GMT

DEAR PAT: I was injured in an automobile accident almost 20 years ago. Way back then, little attention was paid to my head injury and the orthopedic surgeon was mostly interested in fixing my broken bones. About 10 years ago, I began noticing head-injury related symptoms as they became more annoying and painful with age. I’ve been to an ENT [Ear, Nose and Throat doctor] for tinnitus [ringing in ears] (she gave me sinus medication), a neurosurgeon for advice about tingling and crawling sensations in my left side (he said that removing cervical spine bone spurs would not solve the problem), an orthopedic surgeon for arthroscopy on my left knee (this helped a little, but my leg still hurts), a neuropsychologist (she has identified logical and reasoning issues that seem related to frontal lobe injury), and a psychologist (he thinks I have a personality disorder). In the last several months, I’ve seen a neurologist who thought I had MS [multiple sclerosis], but now that he has decided that I don’t have MS, he doesn’t know what’s wrong with me.

Taking matters into my own hands, I’ve gone back to the hospital that treated me after my accident to retrieve old records. After much back and forth, I was able to sweet-talk someone into finding the microfilm. I read through the records and discovered that I had an open wound in the frontal area and that x-rays showed a soft tissue injury in the parietal region. Could the parietal region injury be to blame for the pain in my left side, which includes inability to discriminate temperature and pressure, surface tingling and burning, zapping sensations that feel like weak electrical shocks especially in my foot and hand, maddening tinnitus and increasing weakness in my left arm and leg?

PAT’S RESPONSE: I doubt that 007 could have done much better retrieving the microfilm from your medical records! All joking aside, active participation in your medical care is vital for survivors of brain injury. Brain injuries generally result in complex problems requiring help from a number of professionals such as physiatrists (doctors of physical medicine and rehabilitation) and other “neuro” specialists (neurosurgeons, neuropsychiatrists, and neuropsychologists). As you have experienced first-hand, even medical professionals may have difficulty knowing exactly what is going wrong with an individual coming to them for help.

An important first-step is seeking out advice about symptoms and recovery from a treatment professional with expertise in helping people with brain injury. Your local chapter of the Brain Injury Association of America (Phone: 800-444-6443 or E-mail: [email protected]) can provide you with a list of rehabilitation specialists in your area. Offering education, support, and referral services for individuals with brain injury and their family members are primary functions of Brain Injury Associations around the country.

People with brain injury sometimes feel strange sensations on their skin or notice other physical changes. Paresthesia is a term describing abnormal skin sensations such as burning, prickling, itching, or tingling usually felt in the hands, arms, legs, or feet with no apparent physical cause. Injury to the brain’s parietal lobe or sensory pathways may result in paresthesia. Other medical conditions such as MS, stroke, diabetes, and rheumatoid arthritis have also been known to cause paresthesia according to the National Institute of Neurological Disorders and Stroke (NINDS). For more information about neurological and medical conditions associated with paresthesia, you may contact NINDS directly (301-496-5924) or visit their web site (www.ninds.nih.gov).

The appropriate treatment for paresthesia depends on accurate diagnosis of the underlying medical cause. Doctors base their diagnosis on a number of factors like a patient’s complete medical history, physical examination, and laboratory tests. A comprehensive evaluation by a physician with experience treating persons with head injury may be beneficial. You may also benefit from speaking with other survivors of brain injury and their families about ways they have found relief from brain injury-related symptoms. The Brain Injury Association of American is an excellent source of information about support groups in your area. If you have internet access, their web site is www.biausa.org. You will also find links to local Brain Injury Association chapters through the site.

Pat #26

Meridian Tech Group, Inc — Mon, 11 Apr 2025 05:00:00 GMT

DEAR PAT: I have a friend who had a serious brain injury last year. She fell off the horse she was riding and was knocked completely out. I'm glad I was riding with her that day so I could go find help. We got her to the hospital right away. They said she was in a coma from her injury. She spent several weeks at the hospital and slowly got better. When she went home, we threw a big party for her, but it didn't seem to cheer her up much. It's been months since the injury, and she still seems sad all the time. Whenever I ask her to do things with me, she puts me off mostly. I have to insist before she'll even go out to see a movie or eat lunch with me. This isn't like her at all to be so isolated and down.

What can I do to help my friend when she won't even talk to me about what's wrong?

PAT’S RESPONSE: After brain injury, people often have a hard time dealing with life changes that may follow like seeing different doctors, going to physical therapy appointments, being unable to drive, or missing work. Changes in brain functioning after an injury may also play a role in emotional difficulties. The physical wounds of a brain injury often heal much more quickly than the emotional ones. You are a good friend to notice that she needs help feeling better. Despite your best efforts to cheer her up, sometimes it takes help from professionals to start feeling positive again after brain injury.

The Brain Injury Association of Virginia (BIAV), located in Richmond, has information about services for persons with brain injury. The friendly staff at BIAV would be happy to share their resources for persons after brain injury. For example, BIAV has a list of local brain injury service providers (doctors, psychologists, and counselors), information about support group meetings, educational materials about brain injury, and other resources in the community. You and your friend may consider attending a support group to learn about coping with brain injury first hand from people with brain injury and their family members or friends. Perhaps, you can invite your friend for an early supper then go to a support group together!

To learn more about support groups in Virginia for survivors of brain injury and their family members or friends, contact BIAV by phone (804-355-5748 or toll free 800-334-8443), e-mail ([email protected]), or send a letter to the address listed below:
Brain Injury Association of Virginia
3212 Cutshaw Avenue, Suite 315
Richmond, VA 23230
Toll free: (800) 334-8443
Internet: www.biav.net

For people with brain injuries having a difficult time adjusting, there are a number of studies going on at Virginia Commonwealth University (VCU) Medical Center in Richmond which may be helpful. There are two studies which may be of interest to your friend. One study helps identify symptoms of depression after brain injury. The other study provides treatment to persons with severe depression following brain injury. To learn more about options for people with brain injury to volunteer in a study (or two), read on!

In one study, researchers are trying to figure out the best way to identify emotional changes after brain injury. People volunteering for the study will talk with someone about emotional changes they've noticed since their injury. A short test of mental functioning will also be given. They will be interviewed on two occasions -- once as soon as a visit can be scheduled, then again three months later. If a serious emotional problem is found or the person is interested in treatment, options that may help him or her feel better will be discussed. People without clear signs of emotional difficulties after brain injury can also volunteer for the study if they like.

Another study at VCU Medical Center hopes to find out whether medication for depression helps people with brain injury feel better. The survivor will be seen by a doctor and research staff every one or two weeks for three months while on medication to check the person's response. Volunteers are not charged any fees to take part in these studies. To learn more about these research projects, you, a family member, or another friend may call Jenny Marwitz (804-828-3704 or toll free at 866-296-6904). Your local chapter of the Brain Injury Association of America (toll free at 800-444-6443 or internet www.biausa.org) may provide information about ongoing studies or support services for persons with brain injury in your area. Contact information for other national organizations with information about brain injury research and recovery are provided below:

National Institute on Disability and Rehabilitation Research (NIDRR)
400 Maryland Avenue, S.W.
Washington, DC 20202-7100
(202) 245-7640
TTY: (202) 245-7316
www.tbindc.org

National Institute of Neurological Disorders and Stroke (NINDS)
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424 or (301) 496-5751
TTY: (301) 468-5981
www.ninds.nih.gov