Magazine article Clinical Psychiatry News

A Personal Look at Brain Injury

Magazine article Clinical Psychiatry News

A Personal Look at Brain Injury

Article excerpt

I am a forensic psychiatrist who often examines and treats patients who have suffered traumatic brain injury. As such, I'm often called upon to use quality of life measurements to quantify the extent of a patient's disability for litigation and compensation claims.

I'm also a survivor of traumatic brain injury (TBI) who is intimately aware of the difficulty of applying the quality of life concept to this condition.

Recently, I reviewed the quality of life literature and found that many studies used questionnaires of fairly low levels of sophistication and fairly high levels of rigidity. They all reflected the inherent difficulty of applying simple measures to complex and difficult-to-define issues, especially in a diverse and wide-ranging condition.

Despite the lack of useful measures and good current literature, quality of life is a concept around which insights and observations about TBI can be bundled and that can still be used in a general way to measure rehabilitation outcomes. Clinicians, however, need to know several things about patients with TBI.

Factors such as the severity and the location of the trauma, of course, are ultimately involved in rehabilitation outcomes and, thus, the patient's eventual quality of life. The extent of other damage; the quality of care; the resources of self, family, and community; adaptability; and the insurance and legal systems all contribute to the outcome.

Sheer good or bad fortune cannot be overlooked, either, and certainly the more money, skill, love, and patience that go into the mourning, stabilization, and rebuilding processes, the better the likely outcome. Still, much depends on what we have left relative to what we started with. Likewise, much depends on intangible factors such as spirituality, flexibility, and the availability of options.

The range of impairment is great in TBI. If, however, we focus more on the subgroup of the mildly traumatic brain injured--people like me who walk and talk and often work--I can offer some insight.

First of all, the life of a person with a mild brain injury often has an uncanny peacefulness. Cognition has an intense focus, although it doesn't feel intense.

It's like walking with blinders: What's not in front of you isn't there. Thus, if you start off at an angle instead of straight ahead, you follow your original path often--without awareness of or compensation for the deviation. This leads both to an unrealistic comfort and many shocking surprises. Potential crises often are attended to only after they become full-blown crises.

With rising demands, other dysfunctions appear, such as irritability, overreaction, panic, exhaustion, and collapse.

Brain-injured people cannot tell you all with which they struggle, certainly not on a questionnaire that asks for simple answers about quality of life. Actually, most of the time we forget how bad it feels when it feels bad. If you get us when we're on a straight path, our memory deficits serve us well and we tend to minimize the panic and brain jams we've experienced.

There are problems along the path, too: a peculiar type of fatigue that comes on rapidly and overwhelms. …

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