Creating a "Plan B" for Life After a Brain Injury
If I want to look at a patient who I've been able to monitor from beginning to--I won't say end, because the end has yet to be determined. I guess, looking at a gentleman who had a career established-- had worked in a career for a very long time, well-established, and was injured at work falling down a set of stairs, and originally when we started seeing him, he had a lot of behavioral--explosive behavior issues, couldn't remember much of anything. Speech had been impaired. Reading abilities had been impaired. He was having a lot of difficulty trying to figure out what he could do. His anticipation was, "Well, I'll do a little rehab." "I'll be able to go back to work in a couple months." As the time went by, watching him become more and more aware of, number 1, that he's not going to be able to go back to work at the job that he worked before, but also coming to terms with where some of his problems are. This is a gentleman who actually worked very hard in therapy. He was a delight to work with because you would say stuff, and he would come back and say, "I thought about what you said and did all my homework." [laughs] So it was really good in that sense, and the challenge then became-- you know--we did a lot of cognitive rehabilitation in terms of just addressing memory and teaching him to use a PDA and teaching him some problem-solving skills. But the challenge then really became helping him understand, okay, now what can I do with my life? What is it safe for me to do? What is it not safe for me to do? When do I have to acquire some assistance? Those are the long-term issues that really challenge people. You know--learning to manage money. They learn very quickly to count money to go to the grocery store to buy bread, but then you start talking about, okay, are you paying your mortgage? Are you paying the bills? What has happened with your retirement account? Understanding all of that and how it fits, because since it's not so immediate that's the kind of stuff that people have a lot of difficulty managing. Learning to travel. One of the therapeutic tasks with him has been learning to maneuver the public transportation system--how to get from point A to point B. For a while he was very restricted to "I can go one stop in either direction from my house, and that is the sum total of my world." So, what if you need to change Metros? What if you want to travel to the Midwest? How are you learning to do those kinds of things? So the challenge has really become--when people get past the immediate rehab--the challenge really becomes being able to live an independent life. You can learn a lot of tasks that get you through the day, but what makes most of our lives rich is being able to explore, do new things, learn a new skill, travel somewhere, meet new people. And those are the kinds of things that are very difficult for rehab to address because you can't do so much of that in an office. There's only so much travel you can do around my office-- you know--so getting people to be able to interact with the world. And--you know--the guy at the train station or the cashier at the airport have no training in brain injury, so if someone can't clearly explain what it is that they want and what they need and why they're having trouble, teaching the individual with the brain injury, "How do you interact then with the rest of the public, who doesn't understand the problems that you have?" It requires a lot of intensive work, a lot of nailbiting on our part because we're letting them venture out, and we worry always about is he ready? Is he not ready? In the back of our heads there is always the liability issue as you're looking for the headlines splashed--you know--"Therapist let client go to such and such a place." You know--you worry. But--in the same way as when you're raising children, you have to kind of know where they are and know where the next step is and let them go, let them explore, let them live their lives. That's what brings people back to full recovery is then being able to then live their lives.
Coming to terms with a different life after a TBI can be challenging, but finally, perhaps, a relief.
Posted on BrainLine February 2, 2011.
Dr. Celeste Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center. She has a long history of providing cognitive psychotherapy and developing residential behavioral management programs for children and adults.
Produced by Victoria Tilney McDonough and Brian King, BrainLine.