Welcome to the TBI-HELP Live Chat

Today's topic is: "Longer Term Recovery Issues in Traumatic Brain Injuries"

Our Guest is: Dr. Thomas Kaplan, Director, Mid-Hudson Valley UCP

Tonight's Topic Summary:

Focusing on a broad spectrum of the emotional family responsibilities and vocational issues that are often problematic for TBI victims and their families.

[19:02:05] Mod: Hello! Tonight we are very happy to have Dr. Thomas Kaplan as our guest speaker. His topic for tonight is longer term recovery issues in traumatic brain injuries.
[19:02:29] Mod: Rail: How helpful are TBI support groups and how can they help?
[19:04:24] Dr.Kaplan: In general, these types of support groups ca be extremely useful. Though all Tbis are rather unique, it is important for people who have suffered from this syndrome to share their experiences with others in an ongoing fashion. They therefore reduce the social isolation that many tbis experience and frequently allow for the initiation of a renewed social life.
[19:07:07] Mod: Neen: Hello, I need to know if educational resources are available for my 20 year old daughter?
[19:07:41] Dr.Kaplan: I will need to know more about her circumstances. At what age was she injured and what is her current level of functioning?
[19:08:51] Mod: Mary: After being in a long term care facility can the TBI person come home?
[19:10:01] Dr.Kaplan: Mary, the answer is yes. Given a sufficiently structured home environment and management of acute behavioral problems, return home can be an option. These issues are usually rather difficult to generalize about though, again, perhaps some additional particulars would assist in clarifying the situation.
[19:11:40] Mod: Neen: Kandle, was injured at 15, is now in Restore Rehab in Atlanta and has short term memory deficits, but is very smart.
[19:12:36] Dr.Kaplan: Neen, we need to know what is keeping her in a long term facility at this point. Is Kandle able to control her behaviors, for example?
[19:14:21] Mod: Neen: Dr. Kaplan, I am in need of making a structured home for kandle, I am looking for her to be home March 2004 she is in Restore for behavioral problems that are better?
[19:16:38] Dr.Kaplan: Generally speaking, the need for a longer term care facility is mandated by the need to manage these problematic behaviors. These can be often of either an aggressive or sexually disinhibited nature. Both types of problems reflect the disinhibition of impulses due to damage, typically, of the frontal lobe. Before you bring her home, you need to be comfortable with the notion that you will be able to prevent her from hurting herself or others.
[19:17:59] Mod: neen: No she is not able to control her outbursts which can involve hurting herself and others, however she has improved greatly, she does come home for visits and does wonderful.
[19:18:32] Dr.Kaplan: This is certainly a good sign that she has successful home visits. You should have a backup plan if she should begin to lose control of herself within the home.
[19:19:00] Mod: Rail: Is longer term psychotherapy helpful in TBI for behavioral issues?
[19:21:07] Dr.Kaplan: I believe that longer term psychotherapy is very important for these issues. Very often the road to recovery and stabilization is a long one with a lot of bumps. These problems that are encountered along the way can either serve to destabilize the TBI victim and undermine their adjustment or can be used as learning experiences that will aid in their future emotional growth and stability.
[19:22:18] Mod: Why haven't I made the same progress as other TBI survivors?
[19:24:46] Dr.Kaplan: While it is important to share your experiences with other TBI victims, it is probably unfair to compare yourself to others. Each injury is unique, each person to whom the injury occurred was unique, and their current living circumstances often differ greatly. Each tbi survivor needs to set his own individual goals that reflect these factors and allow for successful treatment.
[19:25:14] Mod: Mary: my husband is 39 and was hit Nov 24, 2000 and was in a coma for 5 month's and is in a long term care facility but they do not give him much attention in the training of his behavior. Can we do anything to help?
[19:25:48] Dr.Kaplan: Mary please clarify. What do you mean, they don't do much in training his behavior?
[19:28:24] Mod: Mary: They do not help him to better control his anger and also they leave him in the hallway and do not help him when he is aggravated. How can I help him to become calmer?
[19:31:13] Dr.Kaplan: Well, that's a tough one Mary. They are the ones who are present when these events are occurring, and it is going to be hard for you to implement a treatment program that is not supported by the facility. Your job is probably to demand an effective treatment program that addresses these issues in a positive and constructive manner. This can usually done through the case manager who should be serving as an advocate for the tbi victim. If you are not satisfied by the case manager's response, then you need to move up through the hierarchy of the facility until your complaints are listened to.
[19:31:54] Mod: Susan: Isn't the attutude and expectations of a TBI staff a sort of guiding factor to progress. As a a TBI staff a sort of guiding factor to progress. As a teacher I know that if I have high expectations fir my students and treat them as if they WILL succeed they do. How can you help to see that a positive attitude is kept up at facilities such a day centers where burn out is so common?
[19:35:21] Dr.Kaplan: I agree with you that the therapists expectations are a crucial component to recovery. I think that the best way to maintain morale and encourage positive treatment planning is to spend sufficient in supervision on each individual case. Since each case is unique, this is the only legitimate way to proceed anyway. But it is important to maintain a vision of yourself as a helper of individuals rather than as an employee or a student in a nursing home. The only way to do this is to take the time to understand each human you are dealing with. time
[19:36:06] Mod: Neomutant: I am KathleenK, I am Neomutants mother. I realize how difficult it is to try to sooth a TBI person. Sometimes I want to cry because I get so frustrated at senseless arguments and nasty comments. But that is when I realize that I am very lucky Neo can speak at all.
[19:39:06] Dr.Kaplan: As we work with those we love, we eventually realize that they will never again be who they were before, especially when the injuries are very incapacitating. Just as the TBI victim must think about starting a new life, we as parents must think about becoming good parents to a very different child than the one we used to know. In this context, we count different blessings, and go on from there.
[19:40:02] Mod: Neen:Is is normal for me, the mother, to experience extreme depression?
[19:42:39] Dr.Kaplan: Neen, my last answer reflects the enormous adjustment that many parents need to go through. This process not only sometimes involves grieving for the loss of someone who we treasured and now at times does not appear to be there. It also involves the difficult process of dealing with problematic attitudes and behaviors that may cause depression in and of themselves. Support groups for parents are often an important way to cope with many of these very understandable feelings of depression, anger, and the resulting guilt.
[19:43:11] Mod: Neomutant: What should I do if I feel that my son is becoming depressed? I do not believe that I have the right to tell a doctor to medicate my son. Or do I?
[19:47:48] Dr.Kaplan: This is a difficult question, and it is understandable that you would feel conflicted about it. Depression is a debilitating condition, and when combined with a tbi, can totally rob a person of their ability to function in a useful way. If your son is truly depressed, he should receive some help, either in counseling and/or with medication. To deny him this assistance is, in my view, wrong. A good psychiatrist, especially one who is familiar with TBI, will assist you in determining if in fact your son is depressed, and whether he would benefit from a trial of medication. It would not really be your call, not totally anyway.
[19:50:36] Mod: Neomutant: Where do I begin to find day programs to involve my son in. He is high performing but without a doubt has short term memory and visions of grandeur. He needs to be occupied during the day but I do not believe he could obtain employment? Susan: Back to a vocational issue. Why is it so difficult to find learning programs that are not juvenile and how can we as family members get those who work at centers etc. to adapt them more for adult use. Its as if they feel they brain injured has no ability to see its below their level. Any suggestions?
[19:54:29] Dr.Kaplan: Finding good programs is not always easy, even in major metropolitan centers. Very often, the reputation of the facility is less important though than the individuals who are there to make a significant investment in your loved one. Names of programs in your area should be available from the local or state chapter of the Brain Injury Association. Typically, it pays to visit these facilities and interview the actual staff members who will be working with your relative before you send him there. Meeting with these therapists after the treatment has begun, and at regular intervals can also be an effective way to stimulate motivation in their treatment and recovery. Though the tendency is to look to these caregivers as capable and giving professionals, they will probably respond positively to supportive contacts and positive feedback from the family.
[19:55:35] Mod: Neomutant: I suppose I just want my son to experience a day filled with normal experiences. Instead of being angry all the time. I think if he had a plan during the day or a place to go it might take some of the anger away. I think that when he sees his psychiatrist he lies. I think he claims everything is good and that he is happy. Then he screams out the car window if someone gets in his way. Or he will kick doors if he is angry at the pets making too much noise.
[19:59:19] Dr.Kaplan: If your son is not telling all to his psychiatrist, this is not at all unusual. Many tbi patients, especially those with memory problems, respond to their immediate environment and are not really able to understand the nature or purpose of the therapeutic process, except on a rather concrete level. Other patients wish to look good for their own reasons. If the family is relying on the psychiatrist to help manage a difficult situation that he is not being made aware of, then the family needs to find a way to communicate the relevant information to the doctor, and then get the issue addressed. But just wanting a normal day filled with normal experiences may be asking too much. If normalcy is not possible, then the next goal should be to optimize a day, make it better, improve the quality of his life. If you as a parent shoot too high, you will be vulnerable to a serious depression, and this will do nothing for your brain injured child.
[20:01:53] Mod: I see that our time is up. I would like to thank our audience for participating and I would like to thank Dr. Kaplan for providing us with a very informative chat session. Good night all and stay safe!