The Long Term Consequences of a Severe Traumatic Brain Injury: A Ten-Year Follow Up Study in Cognition, Behavior, and Encephalomacia

Kimberly Hutchinson, Student, School of Psychology; Thomas DuVall, Student, School of Psychology; Burton Ashworth, Student, School of Psychology; Lawrence Dilks, Clinical Neuropsychologist, Counseling Services of SWLA; Lisa Hubbard, Student, School of Psychology; Jacqueline Bourassa, Student, McNeese State University

DB is a 27-year-old male who was struck by an eighteen-wheeled tractor-trailer while riding his bicycle in 2002. He was comatose for three weeks post-accident and later placed in a physical rehabilitation facility for a period of two months. A 2002 neuropsychological evaluation concluded the client possessed a moderate cognitive impairment. After his discharge home he experienced personality change, left hemiparesis, limited mobility, acid reflux, depression, anxiety, difficulty with anger management, chronic pain, disinhibit ion, and an impairment in executive functions. Over the last ten years the client became involved with substance abuse, was arrested for petty crimes, had unstable social relationships and experienced financial hardship as a consequence of an inability to maintain employment. Ten years post injury a follow-up neuropsychological evaluation was ordered to assess the client’s overall condition.

DB presented as a right handed, overweight, below average height individual who offered a mild left hemiparesis, inconsistent dysfluency, a shuffling gait and limited fine motor abilities. Speech was pressured with poor prosity. The client’s mother denied any premorbid handicaps. The client was administered 24 standardized tests over an seven hour period assessing skills in cognitive ability, executive functions, memory, language, adaptive behavior, sensory/perceptual, motor, personality and effort. After completing the appropriate releases the client was escorted to an assessment room and evaluated by two psychologists. Scoring was according to standardized methods. There were no unusual events that might have invalidated the assessment.

The results were consistent with an individual who possesses a global impairment with specific limitations in executive functions, impulse control and language ability. Sensory abilities were well preserved. As a consequence of the evaluation the DB acquired the following diagnosis: Cognitive Disorder, Pain Disorder, Personality Change (secondary to TBI), Major Depressive Disorder, Sleep Disorder, and Polysubstance Dependence. His GAF was 45 at the time of assessment. The client’s impairments were evident immediately following the accident without any periods of remission. Though the cognitive impairments were regarded as significant it was recommended that management of chronic pain and addressing the sleep disorder be give highest priority as it was felt interventions for functional recovery would make little progress until insomnia and pain were brought under control. It was further recommended the client be admitted to a long-term care facility for cognitively impaired individuals and a guardian be appointed for medical and financial matters.