Abstract
The rehabilitation after a head surgery is a complex process, the success of which is largely dependent on the degree of cooperation between the patient and the therapist. The present paper follows the rehabilitation period of Bobby Robson, a patient who was diagnosed with a brain damage after a car accident. The paper includes interview with Robson and his neurologist, Dr. Milton, tracing the recovery process and providing corresponding support from literature.
Bobby Robson, 36, was admitted to Northwestern Memorial Hospital in Chicago, Illinois, with a brain damage as a result of a car crash. Diagnosed with brain damage, injured tissues and labored oxygen flow, Dr. Milton, a neurologist, appointed a surgery for Robson, who lost consciousness several times after the accident. Robson, who was able to answer a few questions right after the accident, stated “I lost control of the car, and the next thing I saw was the rapidly approaching wall”. An examination of the injury as well as a description of the accident revealed that Robson hit a hard surface with his head. Head injuries are one of the major causes of brain damage, most of which are caused by road accidents, falls, and blast injuries. Head injuries are classified as ‘harm caused on the brain after the head is subjected to severe pressure.
Head Injuries
Head injuries is a serious risk for the population, where studies carried out to determine the number of Americans with head injuries or brain injuries have shown that 1.4 million Americans suffer from head injury every year that is a very disturbing outcome. To accommodate and rehabilitate such cases costs are estimated at around $40 billion. The volume of these prices are credited to behavioral and cognitive changes, still these changes are not properly understood due to DAI being widespread and hard to determine by using standard brain imaging methods. Toward that end, a program known as Traumatic Brain Injury offers an integrated solution and treatment program for patients having traumatic head injuries or diseases. This program deals with individual patient needs, including initial trauma, through physical and medical rehabilitation, behavioral grooming, and community re-entry (Centre for Neuro Skills).
A study conducted on patients who were suffering from diffuse axonal injury (DAI) explained the process of head injuries, where during accidents the victims head is banged on hard surfaces causing the brain to shake violently within the skull. This leads to widespread disconnection of the brain cells and subsequently a condition, which is defined as ‘brain damage’ (Baycrest Centre for Geriatric Care, 1).
An individual with brain injury is left with a number of unyielding impairments that continually interfere during the course of finding and keeping an occupation. These obstacles can be cognitive, that is they involve difficulties with memory, attention, reasoning, communicating, problem solving, etc. They also give rise to physical problems such weakness, vision impairment, sleeping disorder, fatigue, reduced coordination in arms and legs, etc. Brain injury also results into emotional breakdown, vulnerability to depression, increasing anger, or anxiety, and several behavioral problems (Koob et al).
Recovery
For the recovery process in Robson’s case was dependent on the cause of the injury. According to Brown, Lyons, and Rose (2006), the causes of traumatic injury can be classified as follows:
- In trauma; occurs when the brain is shaken violently causing multiple shears across the brain, especially when the brain collides with the skull during impact/period of incident.
- Brain swelling caused by initial injuries can cause secondary brain damage since the skull does not allow expansion/swelling.
- Neuron death due to blood vessel damage due to initial trauma/impact of accident that caused injury.
- Neuron death after brain swelling cause oxygen deficiency cutting off oxygen supply and subsequent neuron death in seconds.
The recovery process, as Robson described, was not easy,
After the surgery, it was like gradually discovering the pain. My main fears were about any consequences that the surgery might have had on my memory or my mental abilities. The pain was usually eased with pain killers and anesthetic procedures. However, I have to talk about memory losses.
Robson’s confusion is understandable, as most patients lack information on the state of their health and abilities, right after the surgery. The role of the staff might be seen in eliminating the risks of patients going to assumptions. Such problem was covered in Morris et al (2005), stating that the fundamental problem encountered during rehabilitation is that patients with brain injury lack awareness about their difficulties or impairments. Additionally, research into this development has often ignored the conditions of those affected by the trauma and do not present an insider’s viewpoint on the process by which a patient with a brain injury educates themselves about their difficulties. In other words, people having less visible, emotional, or behavioral disabilities may find it difficult to convince a VR counselor that they are impaired to qualify for services. Conventional VR system relies on the candidate who is applying for services to be “self-motivated” to work (High et al 31; Malec et al).
Dr. Milton’s position on Robson’s fears was twofold. On the one hand, Dr. Milton stated that the surgery itself went well, where post surgery examination revealed no complications. On the other hand, the case of Robson’s memory losses might require further examination.
We should understand that the rehabilitation is a sensitive period. Several conditions are temporary, and accordingly, I try to calm patients down. At the same time, I should comprehensively test all brain functions at this period. In Robson’s case, magnetic resonance imaging (MRI) was done for part of the testing.
Observation is an essential procedure during post-surgery periods, specifically in head injuries, where observation might indicate damages. Accordingly, the usage of MRI in order to assess brain activity is a common procedure (Baycrest Centre for Geriatric Care). Such procedure is performed to measure the ability to tackle mentally challenged tasks. Such tasks involve the control and manipulation of brain memory. Such level of cognitive operation is very important to help an organization realize full employee productivity. It is also essential in maintaining daily tasks especially when resolving commonplace organization and problem as explained by Brown (Brown et al 937-946).
Rehabilitation
For a period of 5 weeks after the surgery, Robson’s emotional condition was gradually improving. Several discussion sessions were held in order to assess Robson’s needs and fears. The approach widely used in such case by expert neurosurgeons is Interpretative Phenomenological Approach (IPA), which allows learning more about patient’s conditions, views, and hopes as they recover. Robson’s views on emotional state was not good in first sessions,
It is like gathering pieces together. The headaches are gone, although I still cannot remember all things about the accident. I think there is still something wrong with that.
A couple of sessions later, Robson’s mood started to gradually change, where being around family members, along with the treatments showed positive results. As more information was gathered through the sessions on the experience of the patient, the rehabilitation process improved. The insight from direct observation and interviews provide ideal clinical and rehabilitation settings. It also helps the set up of appropriate alternative interventions to treatment and rehabilitation. According to Eames & Wood, Twenty-four patients with severe brain injury who had disturbed behaviors preventing rehabilitation were used as cohorts to determine outcomes. Many neurosurgeons do the same to get result. The cohorts were under care in ordinary settings and provided treatment in a typical token economy (Eames & Wood, 613-619). A long-term follow-up study to observe behavioral trends in ‘post brain injury’ treatment period shows that post-traumatic behavior disorders are prevalent and can be treated. Eames and Wood propose lengthy rehabilitation and advice that it can have surprisingly good effects (Eames & Wood, 613-619). Doctors doing research on post-traumatic conditions single out psychiatric implications as commonplace outcomes. Reekum, Cohen, and Wong point out that traumatic brain injury (TBI) may cause psychiatric illness (Reekum, Cohen & Wong, 315-327). This evidence proves that there is a strong association between TBI and mood and anxiety disorders in posttraumatic brain injury and post rehabilitation periods (Reekum, Cohen & Wong, 315-327).
Dr. Milton comments on the rehabilitation and post-rehabilitation periods were largely positive. He admitted that a few problems existed at the start of the period, mainly related to diagnosis. As Dr. stated,
Diagnostics can be problematic when measuring brain damage right after the accident. Examining Robson, the main problem can be seen in vague descriptions of his state. General discomfort is common right after a brain surgery. The problem was to identify problems, which can be evident during examination and the rehabilitation period.
The statement of Dr. Milton largely conforms to the opinions on post-injury problems. According to Rice-Oxley and Turner-Stokes, both doctors in leading neurosurgical centers, the problems posed by conditions and the lack of diagnostic specifics as guides to what to measure when diagnosing range of brain damage after injury is a pitfall. However, this is now cushioned inside robust evidence for the effectiveness of rehabilitation of brain-injury cohorts (Rice-Oxley & Turner-Stokes, 7-24). Rice-Oxley and Turner-Stokes provide insight about how Meta analysis demonstrates clearly that stroke units, a procedural measure during treatment and rehabilitation of brain injury. Strokes units are believed to provide much better outcomes than general management of the process in a medical ward, though this applies only in a survival level, discharge destination, and reliance on assistance circumstances (Rice-Oxley & Turner-Stokes, 7-24).
Rice-Oxley and Turner-Stokes project that the advantages of the approach include the fact that out of every 100 patients treated four deaths are avoided. On the same level, two institutional admissions are avoided (Rice-Oxley & Turner-Stokes, 7-24). These benefits are because of good-quality acute management during and after treatment. In addition, the coordinated input of an efficient multidisciplinary team plays a pivotal role in making the results very effective (Rice-Oxley & Turner-Stokes, 7-24). Therapy programs commonly observed as rehabilitative measures provide clinicians an overview that rehabilitation programs are of greater benefit and are effective solutions for brain damage recovery (Rice-Oxley & Turner-Stokes, 7-24).
On the keys to success working with patients, Dr. Milton outlined the importance of information during that period. Cooperation during such period is essential, and in that regard, considering the situation, the responsibility lies also on the patient as much as on the therapist. He followed,
Lacking information is like working through a keyhole behind a closed door. It takes time the patient’s condition allows to give us the key to that door.
The importance of information is also outlined in Denton (2008), when discussing the applicability of the therapeutic approaches in stimulating memory resurfaces. Denton argues that every chunk of information (as observed earlier) is an essential stimulus. It will open a door somewhere in the brain that will eventually lead to something one may be conversant with. It takes time, if in rehabilitative conditions, encouragement and mentoring can significantly bring quality recovery (Denton 173-178). Therapeutic approaches work well as the posttraumatic stage ends. Mapping out specific areas of weakness and engaging compelling strategies like lessons, assuming very comfortable positions, and relaxing are essential in making recovery very possible and smooth. Many patients confess that relaxing and self-deep thinking has provided very significant progress in recovering memory and fully regaining one’s mental health.
Conclusion
It can be concluded that the rehabilitation period in the case of Bobby Robson was successful. The report outlined critical periods during and after the rehabilitation. Many expert neurologists insist that comprehensive rehabilitation is very essential in making recovery a success. The recovery process is aimed at correcting certain problems that come along with the head injury.
Works Cited
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Denton, Gail. Brainlash: Maximize Your Recovery from Mild Brain Injury . 3. 1. New York: Demos Medical Publishing, 2008. 173-178. Print.
Eames, P, and R Wood. “Rehabilitation after severe brain injury: a follow-up study of a behavior modification approach..”Journal of Neurology, Neurosurgery, and Psychiatry with Practical Neurology 48.7 (1985): 613-619. Web.
High, Walter, Angelle Sander, and Margaret Struchen. Rehabilitation for traumatic brain injury. New York: Oxford University Press, 2005.
Koob, A.; Colby, J.; and Richard B.. “Behavioral recovery from traumatic brain injury after membrane reconstruction using polyethylene glycol”. Journal of Biological Engineering. 2.9 (2008). Web.
Malec, James, and Rachel Scanlan. “Employment after Traumatic Brain Injury”. Brain Injury Association of America. Brain Injury Association of America, 2004. Web.
Morris, Paul et al. “Patients’ views on outcome following head injury: a qualitative study.”BMC Family Practice 6.30 (2005): 5-40. Web.
Reekum, Robert, Tammy Cohen, and Jenny Wong. “Can Traumatic Brain Injury Cause Psychiatric Disorders?.” Journal Neuropsychiatry Clinical Neuroscience 12. (2000): 316-327. Web.
Rice-Oxley, Margaret, and Lynne Turner-Stokes. “Effectiveness of brain injury rehabilitation.” Clinical Rehabilitation 13.1 (1999): 7-24. Web.
Santa Clara Valley Medical Center. “Traumatic Brain Injury”. Santa Clara Valley Medical Center. Santa Clara Valley Medical Center, 2008. Web.