CHAT WITH 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.

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.

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.

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

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