Welcome to the TBI-HELP Live Chat

Our Guest is: Dr. Barbara Cicero, Chief of Behavioral Medicine,
 Jamaica Hospital Medical Center
Today's topic is: "Cognitive Deficits Associated with TBI"

[18:29:56] mod: Good Evening Dr. Cicero.
[18:30:40] mod: Thank you for being with us tonight.
[18:43:35] Dr.C: It's my pleasure
[18:44:28] mod: As I understand it, your topic is cognitive effects of TBI. Am I correct?
[18:48:17] Dr.C: yes
[Inserted for clarity]  Rail asks: Do cognitive deficits often increase after the first stages of recovery have passed?
[19:02:55] Dr.C: In general, cognitive deficits do not typically increase over the course of recovery.
[19:03:56] Dr.C: patients will initially show a greater degree of recovery which tends to plateau over time.

[19:04:05] mod: I believe that we have another question that seem quite interesting. [19:04:10] : I have a son that has a TBI and I don't really understand why he sometimes becomes upset or angry...I try to be patient can you explain?
[19:05:18] Dr.C: One of the common problems following TBI is low frustration tolerance.
[19:06:02] Dr.C: This may be due to over stimulation, fatigue or general anger at his situation.

[19:06:41] mod: Rail asks: What are the most common deficits associated with TBI?
[19:07:45] Dr.C: The most common deficits associated with TBI are difficulties with attention;
[19:08:16] Dr.C: concentration, memory, speed of processing, and executive functioning.

[Inserted for clarity] [19:07:18] : Got your answer about low frustration tolerance but why does that happen?
[19:09:23] Dr.C: Patients may become frustrated as a result of the area of the brain which is injured
[19:10:00] Dr.C: Many injuries affect the frontal lobes which have a major role in the regulation and control of behavior.
[Inserted for clarity] [19:09:12] : You said something about leveling off when do you know that happens?
[19:11:00] Dr.C: Leveling off of spontaneous recovery typically occurs within about 12-18 months post injury.
[19:15:04] Dr.C: Once the period for spontaneous recovery has passed, people can still improve via learning or relearning.

[19:11:51] mod: Amanda notes: My son views himself as the same person but the second version.
[19:11:52] Dr.C: Amanda what do you mean by the second version
[Inserted for clarity] [19:13:19] Amanda: He uses his name, lets say John and says he is John #2; [19:14:35] Amanda: He says the original died in a car accident and #2 is here now.
[19:16:17] Dr.C: Amanda, that is not really a bad way to look at it. Many patients talk about how they are not the same person any more
[19:18:52] Dr.C: Amanda, if he is adjusting to his second version than it is a good means of adapting

[Inserted for clarity] [19:15:53] : Why is it tat some days he seems better than others
[19:17:32] Dr.C: A person's cognitive or behavioral functioning can be affected by factors such as fatigue, health.

[19:18:16] mod: Do people ever remember what happened to them?
[19:19:48] Dr.C: The vast majority of people do not remember what happened to them.
[19:21:22] Dr.C: This occurs because the blow to the head tends to disrupt the functioning of the brain and as a result, memory storage does not occur.
[19:22:59] mod: Dr. C. What happens when a person experiences a concussion and is having trouble with their memory?
[19:23:48] Dr.C: People who suffer concussions can exhibit memory deficits.
[19:24:04] mod: Cathy asks: I just logged on as I was passing thru...my husband has a TBI problem and he sometimes finds it hard to remember thing how come?
[19:25:20] Dr.C: Cathy, memory difficulties are extremely common in TBI
[19:27:02] Dr.C: This is because the temporal lobes are vulnerable to injury. The temporal lobes are one of the major areas involved in memory functioning.

[19:27:06] mod: Amanda notes: At this time where there had been short term memory problems there is a vast improvement. After about only 2 wks the new memories are imbedded for use.
[19:29:33] Dr.C: Amanda, I am not sure I understand
[Inserted for clarity] [19:31:59] Amanda continues: The short term memory is improving. Things in the past are there and now it takes only a few days of repetition to make a new memory. The learning process has speeded up. Sometimes new things are learned in a day.

[19:29:10] mod: Cathy asks: Why does he sometimes seem better
[19:29:30] mod: than other times?
[19:30:47] Dr.C: Cathy, cognitive functioning can vary as a result of factors such fatigue, weather, environmental stimulation.
[19:33:08] mod: Cathy replies: I see what you mean ...he seems to
[19:33:28] mod: do better when there are more people around
[19:35:31] Dr.C: Cathy, he seems to benefit from the stimulation. Some TBI patients have difficulty when there are too many people around or if there is too much noise.

[19:31:46] mod: Dr. C. If a person experienced a traumatic brain injury quite sometime ago, such as 5 year, will their memory every be the same?
[19:33:56] Dr.C: given the length of time, it is unlikely that that his memory will spontaneously improve. However, he can still learn compensatory strategies such as the use of a date book or checklist to aid his memory.
[19:36:30] mod: Amanda asks: should neuropsych testing be done every so often as long as there is cognitive improvement?
[19:39:28] Dr.C: Neuropsych testing can be done periodically, particularly if there has been any change in functioning or if the person is being considered for a program e.g., vocational.

[19:42:06] mod: Rocco asks: So this neuro psych. testing that you are talking about what does it show?
[19:42:43] Dr.C: Neuropsych testing assesses a person's cognitive strengths and weaknesses.
[19:43:39] Dr.C: many cognitive functions--attention, concentration, memory, perception, and language
[19:44:41] Dr.C: can be evaluated and based on these results, a treatment plan can be developed.
[19:45:05] mod: Rocco: OK...but how does it do that ?
[19:46:59] Dr.C: Rocco, a series of standardized tests are administered and the person's performance is measured against a comparable group of individuals
[19:46:14] mod: Bob asks: Hi I'm a friend of AmandaLou. I find this very informative. Cognitive deficits are like senior moments but much more often. You do need lists and reminders and lots of patience to help someone with a TBI
[19:49:16] Dr.C: Bob, that is so true. typically, the more structure you provide the better the person will do.
[19:50:59] mod: These here tests are they really good predictors, or can they be sometimes wrong...I'll tell you why because they gave some tests to my father when he got hurt and they said that he had problems thinking but he went back to work ...How come?
[19:53:12] Dr.C: Rocco, some tests are better predictors than others. Also, poor performance on a particular test does not always have significance in terms of the person's ability to function in familiar settings or carry out familiar, well learned activities

[19:52:48] mod: Hi Its PattiSue. Other than structure, routines, lists and such, support is really needed. Someone with a TBI needs all the encouragement they can get to help them strive to get better.
[19:55:44] Dr.C: You are so right. Support, encouragement and understanding are very important in the recovery process

[19:55:29] mod: Rocco notes: So what you are saying is that there could be a problem but because my father is familiar with what he does that's why he does ok?
[19:57:01] Dr.C: Yes, Rocco. TBI patients tend to do well with over learned responses/material

[19:58:25] mod: Dr. Cicero, thank you so much for your very interesting answers and we look forward to having you back in the near future.
[19:59:37] Dr.C: You're welcome I would be happy to come back to your site.
[20:00:04] mod: I want to thank the audience for their participation in this chat session.
[20:00:22] mod: I welcome you all back next week at the same time.