Traumatic Brain Injury - Term Paper Example

?Traumatic Brain Injury The Traumatic Brain Injury case study illustrates a diving accident by a 17 yearold Latina girl, Mary, who strikes a sharp blow to her head on the side of the pool. The accident leaves Mary unconscious for three hours in the ICU. The case study fundamentally exemplifies the effects and diagnosis of Traumatic Brain Injury. It shows how a TBI affects a patient physically, socially, emotionally and medically. The case also entails some of the steps followed in the treatment of a TBI. Mary’s disorder is under Axis III since it is a general medical condition and has effects on emotions. TBI potentially directly influences the mental health. It makes her to be particularly susceptible to delusional disorder, depressive episodes and personality disturbances. Thus, a psychiatric follow up is very vital to her and thus she needs rehabilitation and talk therapy (Tsao, 2012). The Diagnostic and Statistical Manual of Mental Disorders labels TBI as an Axis III Disorder. Traumatic Brain Injury is always categorised based on the injury’s severity and could either be mild, moderate or severe. A Glascow Coma Scale could be used to determine this (Markle, 2011). In A Mild Traumatic Brain Injury, brain scans may appear to be normal and sometimes loss of consciousness which does not have to occur for it to be considered a Traumatic Brain Injury (Crowe, 2008). If a concussion occurs in a Mild Traumatic Brain Injury, the patient’s brain functioning may be affected. Symptoms of a Mild Traumatic Brain Injury include headaches, balance problems, difficulty in remembering things, problems with concentration, irritability, nausea and emotional problems including anxiety, mood swings and depression. Though a Mild TBI is difficult to diagnose, a patient could recover within minutes to hours. A Moderate Traumatic Brain Injury on the other hand includes confusion, loss of consciousness from an hour to a day and behavioural problems. There are also mental and physical deficits which could last months or be permanent (Crowe, 2008). One usually makes a positive recovery. It is the population of patients falling between the mild and the severe spectrums. Some patients in this category require intensive care unit whereas some do not need to be hospitalized. The moderate TBI’s symptoms are broad and therefore some may not require lots of attention while some require TBI rehabilitation. Severe TBI is usually a result of significant closed head injuries or most open and penetrating injuries. There is always a considerable residual deficit of the brain function. Though not predictable, the casualties do never recover fully and the treatment programme is usually aggressive in theatres with neurosurgical expertise. The Glascow Coma Scale score above 13 defines Mild TBI, whereas 9-12 defines Moderate TBI and Severe TBI is represented by 3-8. Other forms of determining the severity include AOC which is the Alteration of Consciousness, LOC which is the loss of consciousness and PTA which is the Post traumatic amnesia. Mary’s condition could be said to be Moderate TBI since she recovers consciousness after 3hours and is responsive to the verbal and tactile stimuli. Her score on the glascow coma scale should be between 9-12 since her loss of consciousness was more than 30 minutes and below 24 hours. Her initial level of unconsciousness must have shown severe symptoms score on the Glascow Coma Scale since she could not open the eyes, make any sounds or movements but improved on recovering consciousness (Markle, 2011). Neuropsychological assessment provides useful information to assist a patient, his or her relatives and other health professional to plan for the future. The pre morbid measures of functioning assess the individual’s performance before, during and after the intervention. In Mary’s case a lot of inferential statistical techniques can be used because there are multiple data points for the different phases. The choice of the technique is important as differentiating changes resulting from systematic practice effects and random measurement error from change reflecting general improvement or deterioration are. In most techniques the magnitude of practice effects varies with the nature of the task and is affected by the length of time that has elapsed between test and retest. This makes the expected diminution difficult to estimate but this can somehow be solved by the use of regression to predict scores at retest from scores of initial testing. The extent and nature of retest studies available for a particular test determines the utility of this approach. In our case where we suspect that the extent of recovery is atypical, Mary’s scores on measures of attention or speed of processing could be compared with estimated retest score sample. The measures of intelligence are basically the work forces of neuropsychology assessment. The measures of intelligent include WAIS-III and NAART. The detection and quantification of cognitive impairment may sometimes be difficult since the general population have variable cognitive abilities. Some of the patients may not have had these tests done on them before like in the Mary’s case study which makes it difficult or sometimes impossible to obtain results. This leads the clinician in settling for specific means of pre morbid ability estimations. The above two are the most common since they are relatively unaffected by neurological or psychiatrist disorders. A valid putative measure of pre morbid intelligence must possess adequate reliability, have adequate criterion validity and be largely impervious to the effects of psychiatric or neurological disorders. The NART is basically a single word reading test with 50 items graded difficulty. Since NART requires only oral reading of short single words it makes minimal demands on current cognitive capacity. This is basically the best test for Mary since it depends on prior ability to read irregular words that a girl of her age must have the knowledge of pronouncing them. The NART has a test-retest reliability, inter-rater reliability and high internal consistency. Earlier tests of the NART reliability have been generally positive. Most research on its ability in the estimation of pre morbid ability use scores of IQ tests as the variable of the criterion. The Wechsler Test of Adult Reading (WTAR) is also based on the rationale of reading single irregular words. It has considerable potential as the NART’s alternative. It however has a rather modest research base at present due to its space limitations. There are cases however that NART is inappropriate and WTAR becomes a significant alternative (Fundukian & Wilson, 2008). WAIS IV (Wechsler Adult Intelligence Scale) is essentially designed for older adolescents and adults. It has four index scores which represent the components of intelligence. These are Pr4ocessing Speed Index (PSI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI) and Verbal Comprehension Index (VCI). It is generally made up of 10 core subtests and 5 supplemental ones. The four index scores make the Full Scale IQ (FSIQ) while the VCI and the PRI make up the General Ability Index (GAI). The advantages of the indexes over the individual subtests are having superior reliability. This is because the reliability of a composite will always exceed that of its individual components if they are correlated with each other. In Mary’s case, taking the WAIS IV tests will help the clinician to understand how much the TBI affected her (Wechsler, Psychological Corporation, & Pearson Education, Inc., 2008). The next test that Mary should take is the Wechsler Individual Achievement Test (WIAT-II). This is fundamentally an assessment of academic achievements of children, adolescents, high school and college students and adults. It comprises of four basic scales which are reading, writing, math and oral language. These scales have a total of 9 subtest scores. An improved version of the WIAT will include sentence composition and essay composition. The test whose mean score is a hundred takes 45-90 minutes to administer with consideration to the age of the participant. It is however difficult to assess all components of achievements since academic achievements could be conceptualised in a variety of ways (Gillard et al., 2013). The assessment of cognitive speed on the other hand will help determine why Mary can not keep up in class. An example of these assessments is the PASAT which basically a 10-15 minutes test including practice sessions, which assesses auditory information processing flexibility and speed and calculation abilities. This 60 questions test will help the clinician to know how much affected Mary is since it has demonstrated high split half reliability. It should however be administered 3 to 4 times before the assessment to improve familiarity of the task since a patient will display poorer performance when first tested (Granacher, 2008). The other assessments of cognitive speed include Digit Symbol and Trail Making tests. The Digit Symbol consists of digit symbol pairs followed by a list of digits. The patient should write down the corresponding symbol as fast as possible under each digit. The correct correspondence is measured. The Trail Making Test on the other hand consists of two parts A and B, in which the patient should connect a set of 25 dots accurately as fast as possible. This provides the clinician in knowing about the patient’s visual search speed, mental flexibility, executive functioning and speed of processing (Granacher, 2008). Mary should have a hormone assessment as part of the routine care. This is because in TBI survivors, neuroendocrine abnormalities occur with a high frequency and could have significance with respect to recovery and rehabilitation. She should also closely follow the prescription of the psychopharmacological drugs offered and attend the talk therapy for the better and faster recovery. This is a slightly complex issue and appropriate reappraisal of the patient on a regular basis as she takes the above tests, will facilitate a more concise diagnostic formulation (Tsao, 2012). References Crowe, S. F. (2008). The behavioral and emotional complications of traumatic brain injury. New York: Taylor & Francis. Fundukian, L. J., & Wilson, J. (2008). The Gale encyclopedia of mental health. Detroit: Thomson Gale. Gillard, A., Cassidy, J. W., Lash, M., Billings, J. A., & Denton, G. L. (2013). Traumatic brain injury. Detroit: Gale Cengage Learning. Granacher, R. P. (2008). Traumatic brain injury: Methods for clinical and forensic neuropsychiatric assessment. Boca Raton: CRC Press/Taylor & Francis Group. Markle, S. (2011). Wounded brains: True survival stories. Minneapolis: Lerner Publications. Tsao, J. W. (2012). Traumatic brain injury: A clinician's guide to diagnosis, management, and rehabilitation. New York: Springer. Wechsler, D., Psychological Corporation., & Pearson Education, Inc. (2008). WAIS-IV: Wechsler adult intelligence scale. San Antonio, Tex: Psychological Corp. Read More