Case Study

Client History: L.L., a 52 year-old male, struck a deer while riding his motorcycle at 55 mph. EMS personnel found him confused and in pain. Though he was wearing a helmet, subsequent evaluation revealed a closed head injury, fractures to the left rib and left scapula, and a compression fracture of T-10 and T-11. L.L. completed a brief acute hospital stay and transferred to NeuroRestorative® Specialty Services at The University of Texas Health Center at Tyler for post-acute brain injury rehabilitation.

Treatment Focus: Prior to his accident, L.L. lived alone and independently, with no external support system available. Though significant, his ambulation and basic ADLs deficits stemmed primarily from peripheral injuries, which were already healing well. In contrast, his emotional, behavioral and cognitive impairments showed no appreciable progress during his acute stay. Upon admission to our program he required twentyfour hour, intensive supervision. He was disoriented to time and place, with profound deficits in attention, concentration, memory and problem solving. Furthermore, he recognized no impairments and remained fixated on leaving the unit to ride his motorcycle.

The case manager assigned one-to-one supervision to L.L. to maximize efforts at reorientation, and to maintain his safety and presence in the facility. Behavioral staff tracked improvements in orientation, safety, and judgment, incorporating those goals with other restorative therapies that included physical and occupational therapy, speech language pathology, and therapeutic recreation. In conjunction with L.L.’s growing awareness, the therapy team targeted functional skills most important to him, i.e. basic, modified independence in the home. The therapy team’s focus progressed to full independence, with return to work and driving as his discharge goal.

Outcome: L.L. was discharged home independently, with no further therapies required. He returned to work, initially on light duty and eventually to full job responsibilities, including heavy equipment operation. He did return to driving, and riding his motorcycle.

Case Study

Client History: J.W., a 17 year-old female, was an unrestrained driver in a head-on motor vehicle accident. She sustained a depressed right skull fracture, cerebral contusion, and right frontal hematoma. She underwent emergent tracheostomy, and surgery to elevate the depressed skull fracture and evacuate the hematoma. After her acute hospital stay she transferred to us for postacute brain injury rehabilitation.

Treatment Focus: Upon admission, J.W. displayed behavioral issues in the form of noncompliance, poor adjustment to her limitations and diminished interaction. Problems with attention, concentration, memory and problemsolving were all significant obstacles to independence as well. Auditory and reading comprehension was poor and precluded a return to school. Finally, though ambulation and transfers were acceptable, her endurance was so poor that she was essentially dependent. In addition to the post-traumatic deficits, J.W. had premorbid issues with depression, asthma, migraines, and insomnia – each of which complicated her recovery.

Inpatient treatment consisting of behavior analysis, physical and occupational therapy, speech language pathology and therapeutic recreation focused on her functional deficits. J.W. improved quickly and soon transitioned to our Day Treatment program. The diminished structure and increased demands of home, however, proved difficult. Her cognitive deficits were more apparent, exacerbating her depression and leading to suicidal ideations. She chose to continue the program as an inpatient. Over the next several weeks the treatment team collaborated with her teachers, obtaining weekly assignments for use in therapies. The Program Case Manager and Clinical Director made two visits to J.W.’s school to help with teacher education and to establish a reasonable program for her reintegration into the regular classroom. There was also considerable time spent in family education to address her premorbid problems with depression.

Outcome: After three months J.W. was discharged home and to school fulltime. Her GPA for her remaining year was better than it was prior to her injury. J.W. has since graduated and will soon enter college.