Brain Injury Awareness – Adolescents and their Future
Claire Roantree, Head of Serious Injury at Simpson Millar, has acted for a number of adolescents who have suffered traumatic brain injury and have been left with a degree of cognitive, memory, executive and emotional problems. Often referred to as “the walking wounded”, these brain injury survivors do not show any outward signs of physical disability but the effects of traumatic brain injury can be devastating to them and their family and friends. In this article, Claire explains why it can be extra difficult to determine long term care needs for adolescents and why a good case manager and support team are so important.
Claire says: “I have found that particularly with frontal lobe injury, which occurs at a stage where this part of the brain is still maturing, can have a huge effect on social cognition and emotional development and can impact maturational development in this area significantly.
Often the typical characteristics of frontal brain injury involve a range of executive weaknesses such as difficulty planning and organising activities, difficulty initiating activities, problems with self-regulation of behaviour, intolerance, labile mood, impulsivity, problems with attention control, slow information processing, slow decision making difficulties and poor social cognition. In addition there can be changes to mood, temperament and behaviour and problems with fatigue especially in injuries involving the pre-frontal cortex.
In adolescents, therefore, it can be very difficult to determine how their brain injury is likely to impact studies, work, relationships with family and friends, and ongoing care needs – their future!”
Claire acted for a young man aged 18 who was knocked over by a driver of a vehicle when walking home one evening. He suffered a severe traumatic brain injury
resulting in post-contusional damage in both inferior frontal regions and both anterior temporal regions. He suffered all of the above characteristics. His type of injury suggested that his maturational development will have been delayed possibly by as much as 10 years. This was exacerbated by a pre-existing history of developmental dyslexia.
He was unable to return to his pre-accident employment and the likelihood was that he faced an uncertain future on the labour market and despite his strong work ethic he was unlikely to work full time or in regular and consistent employment. Additionally, like most 18 year olds, he lived at home with his parents and relied heavily on his mother to support him.
In order to determine his long term care needs Claire set up a trial of independent living for 12 months supported by a Case Manager, Support Worker, Neuro Occupational Therapist, Neuropsychologist and Vocational Specialist. The main aim was to determine his ability to carry out daily living tasks whilst living in his own accommodation without the support of his family, set goals and strategies to enable him to live independently and identify what his long term care and case management needs will be.
His main difficulties were planning and organising a weekly shopping list, carrying out his weekly shopping, setting and managing a monthly budget, and managing correspondence and paperwork.
With the help of the Neuro OT, he was able to use his iPhone and iPad to organise his finances, pay bills, plan his weekly shopping and set himself reminders for appointments and ad hoc work.
Simple things that we take for granted proved challenging for example doing the weekly shopping. He found that he was quickly overwhelmed by the amount of information and supermarket offers, leaving him unable to make a decision and ultimately walking out of the supermarket in frustration not having bought anything.
Telephone calls with utility providers were extremely difficult because he was unable to answer any unexpected questions and if conversations went on for longer than 5 minutes, he lost track of what had been said and what information was required of him due to memory issues.
The trial of independent living was a challenge but he recognised and acknowledged that the strategies and techniques taught to him by the Neuro OT, the ability for him and his family to learn about his brain injury and gain a better understanding of his behaviour, and the prompting and structure provided by the Support Worker were all absolutely invaluable in enabling him to live independently.Claire says: “The trial of independent living for adolescents and young adults is a practical and insightful way of enabling brain injury survivors and their family and friends to better understand the nature of their brain injury and how to cope with hidden disabilities which will remain with them for the rest of their lives. Rehabilitation, support from a Case Manager and Support Worker, practical advice from a Neuro OT, and education and emotional support from a Neuropsychologist are all fundamental in ensuring that brain injury survivors reach their maximum potential and are supported in the long term to cope with their difficulties and increase their independence.
Clients often describe how they just want to be normal again and not be treated differently. Good and effective rehabilitation gives them the best chance of a “normal” and independent life.”