Rehabilitation Psychology. Vol 53(2), May 2008, 180-190.

Abstract

Objective: To understand how traumatic brain injury (TBI) affects parent-child interactions acutely following injury. Participants: Young children hospitalized for TBI (n = 80) and orthopedic injuries (OI; n = 113). Method: Raters coded videotaped interactions during free play and structured tasks for parental warmth/responsiveness and negativity and child warmth, behavior regulation, and cooperation. Raters also counted parental directives, critical/restricting statements, and scaffolds. Results: Parents of children with TBI exhibited less warm responsiveness and made more directive statements during a structured task than parents in the OI group. Children with TBI displayed less behavior regulation than children with OI. Parental warm responsiveness was more strongly related to child cooperativeness in the OI group than in the TBI group. Child behavior also mediated group differences in parental responsiveness and directiveness. TBI accounted for as much variance in parental behaviors as or more than did sociodemographic factors. Conclusion: TBI-related changes in child behavior may negatively influence parent-child interactions and disrupt the reciprocity between parent and child. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

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They don’t know published classifications for brain injury severity.

They still believe the Glascow Coma Scale predicts brain damage.  Well, Natasha Richardson was coherent and appeared fine just before she died from a brain injury so, clearly the old way of thinking is wrong.

Do not fear asking about the science.
What is the apoe allele?

Does the brain go into hyper or hypo-metabolism after injury?
Draw me a brain cell (Believe me, when one doctor described it as an “umbrella” or a “Left shoe” even I was amazed at the depth of ignorance.

Which  is heavier, grey or white matter of the brain?
Describe a brain injury to me on a cellular level.

Bad DME’s don’t know the science and are too lazy to learn it.

This is your backyard, not theirs.  Why? Because when you try a TBI case, you learn the science and the medicine and  probably know it better than they do.

When they go down the “it’s only mild and should be healed by now” road, show them the studies to the contrary. For example:
“Doctor, are you aware of the actual published statistics on depression due to “mild” traumatic brain injury?

“No”

“Before you claim some other cause of the spontaneously developed depression right after brain trauma, might you want to know the probabilities?”

(Either way he loses. Either he says “no” and looks like he doesn’t want to keep up with the science or facts or he admits he doesn’t ‘have the background to make the conclusion)

“What are the odds of a 42 year old man spontaneously developing depression vs it being due to a brain injury?  Let’s look at probabilities.  If the DSM tells us that men have a risk of developing Major Depressive Disorder in 5- l0% of the population. [i] If you then say my client has been alive as an adult 7,665 days and his life expectancy is 30 more years or 10,950 more days and there is a 5-l0% chance over the sum total of his life as an adult (l8,675 days) that he will develop Major Depression, then over l8675 days there is a 5-l0% chance of developing this, correct? So, if we take the days of his adult life and  divide the potential by those days, on any given day he has a  l in l86,l50 chance of developing depression at most.

Since my client experienced depression immediately after the accident, and we know that even mild TBI increases the risk of depression such that there is an l8% probability of developing a psychiatric diagnosis within  l year post injury,[ii] that means on a given day post injury my client has a l in  15 chance of developing a psychiatric disorder due to a brain injury. (365 divided by 24)   Then, there is a l in  l86,l50 chance my client randomly develops major depression vs a l in l5 chance it’s due to a traumatic brain injury, right? That means that the brain injury is l2,4l0 times more likely to be the cause, right?

[ii] Levin, H, McCauley, S et cal, Predicting Depression Following Mild Traumatic Brain Injury, Arch Gen Psych/vol 62, May 2005  at 523.

Psychological Assessment. Vol 8(4), Dec 1996, 422-427.

Abstract

The underlying structure of the Postconcussion Syndrome Questionnaire (PCS) was evaluated in a large sample of medical and psychiatric patients. Three potentially viable models were generated using exploratory factor analysis with half of the sample. The other half evaluated the 3-, 4-, and 5-factor models using confirmatory factor analytic procedures. The factor analyses generated compelling data for a 5-factor model for the PCS questionnaire. However, internal consistency for each of the factors argued in favor of the 3-factor model. Balancing internal consistency, confirmatory factor analyses, and parsimony resulted in endorsement of a 4-factor solution for the PCS questionnaire for this sample. The factors are best described as clusters of psychological, somatic, cognitive, and infrequent complaints. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

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American Journal of Orthopsychiatry. Vol 71(2), Apr 2001, 245-251.

Abstract

This article synthesizes information about brain injuries so as to help therapists understand these patients and treat them more effectively. It describes physical/cognitive and emotional features of mild brain injuries; discusses the difficulty of assessment; emphasizes the importance of family involvement; and, finally, reviews group and individual therapeutic interventions. Family involvement and group work are described as beneficial for these patients. Individual psychotherapy is indicated for those who have a more realistic perception of their skill level, can adjust to a new self, and are able to manage emotional reactions. Therapists must understand the physical, cognitive, and psychological effects of a brain injury so that they can empathize with their patients even when there is no definitive proof of injury. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

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