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 and well established and was injured at work falling down a set of stairs, originally when we started seeing him, he had a lot of behavioral explosive behavior kind of issues, couldn't remember much of anything, speech had been impaired, reading abilities had been impaired, and 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." And as the time went by, watching him become more and more aware of, number one, 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 could say stuff, and he'd come back and say, "I thought about what you said "and did all my homework." [laughs] So it was really good in that sense. 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. 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 don't 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." It was like, "Okay, what if you need to change Metros, "what if you want to travel to the Midwest?"-- learning to deal with those kinds of things. So 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 it's 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. So getting people to be able to interact with the world, and 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 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 kind of intensive work, a lot of nail biting 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 head there's always the liability issues. You're looking for the headline splash, "Therapist Let Client Go So-and-So "to Such and Such a Place," and you worry. But in the same way, when you're raising children, you have to kind of know where they are, know where their next step is, and let them go, let them explore, let them live their lives because that's what brings people back to full recovery is being able to then live their lives.
A neuropsychologist talks about working with people with TBI -- from basic cognitive rehab to strategies for successfully navigating the world.
Posted on BrainLine February 7, 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.