The subject of the case study under consideration is a 17-year-old Latina girl, Mary S, who is delivered to a hospital unconscious with a head bleeding freely as a result of an unsuccessful pool jump from the second floor. She is given PET scans that help to define a number of injuries and the necessity to be placed on precautionary life support.
The level of TBI has to be defined by means of the analysis of the results of three types of tests: the Glasgow Coma Scale, the duration of post-traumatic amnesia, and the duration of the unconscious state (Lezak, Howieson, Bigler, & Tranel, 2012).
As she follows the orders of a neurologist, opens her eyes briefly, moves her fingers, but is not able to speak just moan incoherently, the Glasgow Coma Scale demonstrates the results such as: E3, V2, and M6. The loss of consciousness lasts for about 3 hours.
Amnesia is hard to observe as the girl does not respond verbally for about a day. The next day, she recognizes her parents. The interpretation of these elements proves that Mary has the moderate type of brain injury. The moderate brain injury usually causes brain swelling and bleeding as a result of which a person spends much time sleeping.
At the same time, a person is not in comma and can be aroused (still, it is not recommended) (Brain Trauma Foundation, n.d.).
Taking into account all information got and the evaluation of the DSM-V standards, the following diagnosis may be given: traumatic brain injury with the consequences like adjustment disorder with mixed anxiety and depressed mood (309.28 DSM code), posttraumatic stress disorder (309.81 DSM code), and disorder of written expression (315.2).
A Pre-Morbid Estimation
The estimation of pre-morbid functioning is one of the crucial steps that have to be done as when a TBI case takes place. As a rule, special tests like the NAART or WTAR are used to determine a person’s pre-morbid level of intellectual functioning along with the use of existing records (Strauss, Sherman, & Spreen, 2006).
In the case study under analysis, it is stated that Mary has not passed through full-scale IQ tests, this is why the results of the tests are definite in regards to a particular situation.
The WTAR (Wechsler Test of Adult Reading) on the basis of No-Child Left Behind Testing records is may be used with Mary as she meets its age ranges (16-89 years), speaks English perfectly, and can demonstrate her abilities to pronounce irregular verbs with a clear understanding of what they are all about (Strauss, Sherman, & Spreen, 2006).
The test lasts about 10 minutes during which an examiner presents 50 word cards one by one and gives prompts to a patient on how to pronounce a word. Each correct answer is 1 score for the patient. In case 12 incorrect answers take place, the test has to be stopped.
The peculiar feature of the test is the possibility to compare predicted and actual functioning considering the general intellectual status and the condition of memory. As soon as all 50 cards are shown, the results are evaluated in regards to the age of a patient.
Mary is a 17-year-old girl with a high level of knowledge and abilities to work during classes. Her results are expected to be high indeed as she likes to study and achieve the highest grades in comparison to her fellows.
Assessment of Mary’s Post-Injury Intellectual Ability
The WAIS-IV is the test used on Mary to check out her post-injury intellectual abilities and define the possible deficits between her pre-injury performance and post-injury performance.
The test consists of a number of stages that touches upon the girls’ verbal comprehension, working memory, perceptual reasoning, and processing speed (Strauss, Sherman, & Spreen, 2006).
Mary came to the hospital to take the tests in time and demonstrated her desire to pass through the tests within a short period. She supported eye contact and was eager to answer all questions clearly. During the tests, she stayed calm and focused on the tasks, but she could be easily distracted by outside noise.
Sometimes, it was seen that Mary was at a loss as she could not find out a correct answer as quickly as she used to. She liked to complete tasks before the deadlines, still, the results of the test proved that she could suffer from some deficits.
WAIS-IV scores were as follows:
VC (114): similarities 13, vocabulary 103, information 12;
WM (100): digit span 10, arithmetic 10;
PR (98): block design 10, matrix 910, symbols 11.
In general, full scale IQ was about 105; general ability index was 106.
The evaluation of the tests and Mary’s reaction, it is possible to admit that her TBI associates with such deficits like short-memory problems, processing speed, attention functioning (she is unable not to pay attention to the distracting factors around), and social perception deficit (she wants to control the reactions of people on her behavior, but she cannot do it).
The comparison of her pre-injury and post-injury performance proves that the girl has some problems with the perception of the world around and the inabilities to complete the functions she used to complete. She is upset and even angry with her inabilities to memorize simple facts mentioned recently.
Assessments of Cognitive Speed
Several tests, which are more sensitive, are used in order to determine why Mary cannot keep up in class.
These are Trails A&B, the PASAT, and Digit Symbol. As Mary was diagnosed with TBI, the tests under consideration should help to define the reasons of why she cannot concentrate on the details, be more attentive, and memorize information. The purpose of the Trail Making Test is to prove the presence of brain injury.
Mary has to connect the 25 numbers chaotically distributed on a page. She begins properly, still, in several seconds, she starts making mistakes and stop completing the test. She does not want to continue. The part B of the test (the alternation between numbers and letters) helps to check out Mary’s visual motor abilities and visual spatial abilities.
The results are the same: the girl does not want to finish the test due to her inabilities to focus on the task. She does not meet time limits as well. It proves the presence of TBI as well as the consequences such as anxiety and written expression.
The PASAT test causes a number of problems as the use of a tape and the necessity to follow certain rules in a definite period of time make Mary dissatisfied and angry because of her inabilities to meet time deadlines and requirements of the test.
Several attempts are made to re-start the test, still, it also serves as a proof of a traumatic brain injury that causes a number of problems with cognition and behavior in general.
Finally, the Digit Symbol test, that requires attention and time, calms Mary down and provides her with a chance to complete the task properly meeting all the standards. It shows that her cognition may undergo some improvements in case special conditions are provided.
Recommendations for Accommodations and Rehabilitation
The effects of brain injury turn out to be catastrophic for Mary. She refuses to attend school and talk to her parents about the problems that really bother her. Her injury harms her cognitive skills, memory, and concentration abilities. The results of these deficits are problems with reasoning and even vocabulary.
She cannot keep up in class and suffers from fatigue and anxiety. This is why some accommodations in classrooms and rehabilitation at home are necessary for Mary.
Accommodations can be as follows:
- Provide with additional time for various class assignments;
- Support Mary with some teacher’s notes;
- Give her oral and written instructions;
- Allow her using notebook to check her spelling and grammar in cases of emergency;
- Reduce the rubric expectations in regards to the quality of the work done.
Still, it is necessary to admit one fact – Mary may not want to be provided with special terms of education. This is why it is better to offer her some time for rehabilitation at home and use medical support to overcome the challenges of TBI.
Rehabilitation details:
- Cognitive therapy focuses on the improvement of cognitive skills that can be relearned. It is possible due to certain repetitive activities, support of a professional, and clear explanations.
- Occupational therapy may be provided by advanced nurses and followed according to a properly developed health plan in a hospital.
- Neuropsychological tests should be considered on a regular basis as they can show the results of the therapies used.
As soon as these hints are taken into consideration by Mary and her parents, she has all chances to get recovered and achieve appropriate results within a short period of time.
A Prognosis
Mary’s case is a tragic development of the events that cannot be predicted but may be improved.
As soon as she is diagnosed with TBI with a number of consequences influencing the girl’s cognitive development, memory, and behavior, the test assessments, and evaluation of her reactions by the professional neurologists prove that Mary suffers from long-term TBI effects.
She is in need of professional help and appropriate treatment at home as well as in a hospital. She has to be treated by an expert in order to re-develop her skills and be able to gain control over her emotions and inabilities. Mary has to be ready that she cannot perform all the activities at the same level as she used to.
She needs to be supported by her family and her friends.
In case these suggestions are followed, a prognosis of her recovery may be rather positive. Of course, people suffer from some problems after their TBIs. They need time and understanding.
Mary’s status in a society she lives in should help her to find the required portion of support and continue living according to her ordinary style of life soon.
Reference List
Brain Trauma Foundation. (n.d.). Facts about traumatic brain injury. Web.
Lezak, D., Howieson, D.B., Bigler, E.D., & Tranel, D. (2012). Neuropsychological assessment. New York, NY: The Oxford University Press.
Strauss, E., Sherman, E.M., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary. New York, NY: Oxford University Press.