Week of August 22, 2001
According to the Center for Disease Control, every year, 50,000 people die of traumatic brain injury in the United States, and another 230,000 are hospitalized for traumatic brain injury and survive. One out of three of those survivors will experience the onset of permanent disability. In this show, traumatic brain injury survivor Richard Roe shares his story with us. We interview neurosurgeons Dr. Ross Bullock and Dr. Randy Chesnut about why the brain is so vulnerable to this sort of injury, and what can be done to minimize the damage and to regain previous levels of functioning. Neuropsychologist Dr. George Carnevale, of New Jersey's Kessler Institute, fields calls from survivors and their families, and discusses the impact of an injury on a survivor's personality, short term memory, and thinking. He also discusses rehabilitation strategies for the survivor, and the need for the survivor's family to get adequate support. Filmmaker Daniel Yoon, who survived a traumatic brain injury and went on to write, direct, and star in the autobiographical "Post Concussion," contributes a commentary that brings to life the textbook case of a nineteenth century traumatic brain injury survivor named Phineas P. Gage. And commentator John Hockenberry muses on our discomfort with the gray areas of gray matter.
In an introductory essay, Dr. Fred Goodwin, host of "The Infinite Mind," honors Katharine Graham, former Chairman of the Board of the Washington Post Company. Mrs. Graham died in July, 2001 from a head injury she sustained when she slipped on a concrete walkway. Dr. Goodwin recalls Katherine Graham's involvement in destigmatizing and demystifying mental illness when she made public the cause of her husband's death, a suicide linked to his manic-depression. Destigmatizing and demystifying mental illness is also what "The Infinite Mind" tries to do with its shows. While Phil Graham's manic-depression points to the human brain's vulnerability to internal chemical disruption, Katharine Graham's death of a head injury points also to the brain's vulnerability to external trauma. Today, concludes Dr. Goodwin, we try to shed light on and destigmatize traumatic brain injury.
The show begins with an interview with Richard Roe, who was working as a stone mason in upstate New York when he fell off a scaffolding and plummeted thirty feet, landing head first on a pile of rocks. The fall damaged his frontal lobe and temporal cortex, impairing his ability to see things on his left side, his short term memory, and his spatial perception. Going back to work after the accident, he learned he could no longer build anything straight, because of the spatial perception problems. Impairment to his short term memory made it hard for him to perform everyday tasks around the house. For instance, if he was cooking he would be apt to forget what ingredients he had already added to a recipe. Two years after the accident, he and his wife separated. He only got better, Roe says, when he started to accept himself as he was. Paradoxically, says Roe, when he lowered his expectations for himself, he found he could perform better. Today, he feels his level of functioning is very close to what it was before the accident, with his biggest lingering problem being difficulty in visual tracking, which makes sustained reading a challenge. He compares himself after his injury to a performer taking over a part in a musical that had long been played by someone everybody loved, and how it was hard for him at first because everyone hated the new him and wanted the star to return. Now that he and the people around him accept him for who he is today, his life is better and he is happier.
Richard Roe today works as a counselor and a professional astrologer. He can be e-mailed at: alphaastrologer@aol.com Or write to PO Box 3660, Poughkeepsie, NY 12603.
In the show's first interview, Dr. Goodwin interviews brain surgeons Dr. Ross Bullock and Dr. Randy Chesnut. Dr. Bullock is the Chairman of the Section of Neurotrauma of the American Association of Neurological Surgeons. Dr. Randy Chesnut is Director of Neurotrauma and Critical Care at Oregon Health Sciences University in Portland. Dr. Chesnut explains that the severity of a traumatic brain injury is gauged by how long someone is in a coma, but that even an injury classified as "mild," can bring far-reaching consequences. In severe cases, a survivor may be unable to regain control of basic functions like walking or talking. Some of the problems associated with mild traumatic brain injury can include problems with short term memory, organization, and ability to focus. Psychological problems that form in reaction to even a minimal loss of functioning can often be greater than the neurological problems. Dr. Bullock points out that the injury caused by many traumas, for instance, the skull's impact with a hard surface, result in diffuse injury of brain cells throughout the entire brain. While it's now been proven that even brains of older people can regenerate new brain cells, Dr. Bullock says we need to learn more about how we can encourage the generation of new brain cells through stem cell research and research into the chemicals in the brain that encourage the growth of new cells. He also finds hope in the use of drugs developed to help patients with Alzheimer's overcome cognitive problems, but says there needs to be more research in their applicability to traumatic brain injury. Dr. Chesnut stresses the importance of early intervention and rehabilitation efforts, a team approach to treatment and rehabilitation, and the clear necessity for long-term, post-acute care.
You can write to Dr. Randy Chesnut at Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd., Portland, Oregon, 97201L472. E-mail: chesnutr@ohsu.edu
You can write to Dr. Ross Bullock at:Medical College of Virginia Box 980, Richmond, VA, 23298. E-mail: Robulloc@hsb.bcu.edu
After a brief break, we resume with a look into a classic, textbook case of traumatic brain injury, the case of nineteenth century railroad worker. When The Infinite Mind wanted a commentary on the case, we turned to filmmaker Daniel Yoon. In 1848 a hardworking young man by the name of Phineas Gage entered the annals of medical history when he survived a horrible accident that drove an iron spike through his head, obliterating part of his frontal cortex. While he could still function after the accident, his demeanor changed. No longer the sober, hardworking young railroad foreman he had been, he now swore profusely, drank, and got into fights. Flash forward almost 150 years later to Berkeley, California, where another hardworking young man, Daniel Yoon, is crossing the street and is struck by a car, sustaining a concussion. Unable to return to his work as a management consultant, Daniel Yoon instead decided to make a movie about his experience. The result is the surprisingly funny "Post Concussion," which Daniel Yoon wrote, directed, starred in, and even shot. Admitting that he first found the story of Phineas Gage funny, Yoon imagines scenes from a potential film about Gage called "Post Three Foot Iron Spike Through the Head," for instance, a scene in which it's suggested that Gage was the originator of the phrase "I need that like I need a hole in the head." After reviewing the facts of the case, Daniel Yoon concludes that it wasn't so funny after all, and probably not at all funny to Gage. He also says that nineteenth century physicians drew misinformed and faulty conclusions from the case. "Sadly, the case of Phineas Gage would not be the last time the details of a patient's history would be disregarded in order to protect the interests of powerful medical institutions," says Yoon.
"Post Concussion" has been a hit at festivals with audiences and critics alike, and won the prestigious Taos Land Grant award at the Taos Talking Picture Festival. To learn more "Post Concussion," upcoming screenings, or about filmmaker Daniel Yoon, click here for Bluewater Films.
Click here to learn more about Phineas Gage.
Next is an interview with Dr. George Carnevale, a neuropsychologist at New Jersey's Kessler Institute. Dr. Carnevale gives an overview of the cognitive and personality changes that a traumatic brain injury survivor can face. He explains that the impact of the injury on the survivor's family can also be profound, particularly if the survivor had been the primary breadwinner of the family, or integral to its functioning. A listener from Oregon calls in with a question. Explaining that she is the wife of a survivor who got his injury in Vietnam, she says her husband has not always been able to play a parental role to their children, particularly after they entered their teen years. Dr. Carnevale advises that she and he go to a counselor together, so that the counselor can offer third-party feedback to her husband about what is appropriate and inappropriate behavior around their children. He also suggests that she be open with her children so that they understand "It's not that Dad is being mean, it's related to the injury to his brain." At Kessler, he tells her, they are working on developing a model for long-term, whole family care, that would provide advice and intervention to families and traumatic brain injury survivors as needed. A traumatic brain injury survivor, also in Oregon, calls in with a question about how to deal with the chronic fatigue he suffers from, which he connects with the injury he sustained four years ago. The caller explains he is no longer able to work and is in almost constant pain. Dr. Carnevale suggests that often depression is a component of the problems survivors face, and advises him to seek a neuropsychologist in his area with who he can work on an extended basis. Concluding the interview, Dr. Carnevale mentions that close to seventy percent of all traumatic brain injuries seen in emergency rooms are connected with alcohol consumption, and stresses the importance of preventative measures, including responsible drinking and use of seat-belts in automobiles and helmets in sports.
To reach Dr. Carnevale, write to: Kessler Institute for Rehabilitation, 240 Central Avenue East Orange, NJ 07018. E-mail: gcarnevale@kessler-rehab.com. Click here to learn more about Kessler Institute for Rehabilitation.
Concluding the show, John Hockenberry comments on our discomfort with the many shades of gray that attend traumatic brain injuries. He recalls the case of a Texas woman who survived a traumatic brain injury and went on to sue the party responsible for the accident. Her family thought she was being unreasonable when she began to question the integrity of the lawyer who was representing her, seeing her suspicion as a faulty judgment possibly related to her injury. A few months later, when they had become more familiar with the lawyer's modus operandi, they changed their tune. It seems the TBI survivor had made a good call in the first place. An injury can impair some cognitive functions, but that doesn't mean the survivor's judgment can be dismissed. In this case, it may have even been sharpened in that the impairment to her inhibitions may have made it more likely for this survivor to find fault and question authority than her more conventional and trusting personality before the injury.
For more information about traumatic brain injuries, including how to find a support group for TBI survivors and family members, contact the Brain Injury Association of America by clicking here. You may call their family help line at 800-444-6443 or e-mail the family helpline at mailto:familyhelpline@biausa.org.
For an online support group for TBI survivors and their families, check out TBI Chat.
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