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Answers to your personal questions from someone who
cares........ 
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 Answer: 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.
- Bicycle accident at age 6
- Fall and blow at age 8
- Fall and blow at age 10
- Car accident at age 19
- Car accident at age 28
- Hockey accident at age 29
The first one resulted in stitches and the 6th one with a loss of memory
of the day it happened. I have had headaches for several years and then they
went away. The last car accident restarted them. I am now seeing a
psychiatrist that is helping me deal with my emotional difficulties such as
memory, anger and social skills. I am on a diet that includes fatty acids to
help heal my brain. Am I going about things correctly or should I be doing
more? After the last accident my wife left me due to my behavior. Thanks for
the information as it is helping me understand me.
PAT'S RESPONSE: Are you Evel Kneivel’s long lost son? Seriously,
I don’t know if you’re just unlucky or if you have tended to be someone
who is impulsive or likes risks. The fact that you were injured playing
hockey, after all of your other injuries, suggests that you probably
like excitement and physical activity. However, in choosing your
activities, it is important to understand that having multiple brain
injuries is a serious problem. If you pay attention to sports, you know
this has become a major issue among professional football players. Many
ex-players now talk about the serious problems they have experienced
after their football careers because of multiple concussions. Certainly,
you should remain as physically active as possible, but you might want
to choose sports and activities with less chance of head injury. Also,
be sure to drive carefully and defensively. Otherwise, it sounds like
you are working hard to understand the effects the injuries have had on
your behavior, and to move forward with your life. I’m certainly sorry
to hear about your marriage and hope you will find happiness with
someone in the future. Please continue working with your psychiatrist as
it sounds like it is really helping you. Consider contacting the Brain
Injury Association and locating a brain injury support group. Talking to
other survivors is often very helpful. You’re to be commended for
working very hard at recovery, and I suspect things will continue to
improve with time.
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