Question:
My last NP results ended with a letter written to W/C. The last question asked by W/C to my NP, was; "What is the alternative to a formal head injury rehabilitation program?"

He concluded his NP evaluation by stating the following:

We would like to give Mr.Rader the opportunity to participate in no more than 4-6 weeks of outpatient cognitive therapy. Teaching Mr.Rader compensatory strategies for memory, daily living responsibilities, etc., "without needing to determine whether the problems are neurological vs. psychiatric in nature. The purpose would be largely to increase his confidence and give him some tools to better manage his thinking and cognitive coping complaints, "but without socially reinforcing him with the idea that he has a chronic brain injury."

After two extensive NP batteries, I'd have thought I would have received a more specific approach to my rehab. With this a recommendation like this, how WOULD a rehab facility approach my case based on this information?? And what's up with the statement about reinforcing the idea that I have a brain injury!!!

Answer: In my experience, there are many individuals who experience both PTSD and brain injury (which is not always mild). I have seen many people who recall brief moments of terror, or when they recovered consciousness, were in a life threatening situation (wrecked car, ambulance, etc). My colleagues and I disagree with the findings of this paper, and are publishing our own experience with several pts with these problems. I believe that the brain injury symptoms must be actively treated and recognized. Certainly, you don't want to panic a patient who is not complaining of cognitive problems, since many pts with TBI do recover well withing the first few months. But I think you need to inform the patient and work with them in their recovery.

Also, have there been any long-term studies of value? I keep hoping to find one, say, where 100 or so people in each of three groups -- mild, moderate and severe injury -- are all followed for 10 years or so -- so that the underlying reasons for "success" or "failure" could be examined.