Depression following brain injury or concussion

It’s upsetting to read stories about the death of young people, directly or indirectly, related to brain injury or concussion.Ty Pozzobon’s death following his concussion is certainly a tragedy.

The CBC story discusses the statistical frequency of depression following brain injury. In our practice, we see depression following TBI every day. Frequently I meet survivors and their families shortly after an injury. At that time they are thankful that they or their loved one survived. They praise the medical system and the “miraculous” recovery so far. That’s when I caution about depression and do everything I can to set up a full rehabilitation program. The pattern we often see, as lawyers working with survivors, is that as symptoms persist and survivors don’t recover or get back to “normal” as they hoped, depression sets in. It happens in Merritt, Vancouver and everywhere that people who have persistent post concussion symptoms live.

The risk of suicide is real. Whenever possible, the best plan is to set up a system of service so that survivors can be assisted as they encounter recovery struggles that they did not expect. Perhaps this is worse in brain injury cases because survivors and those around them look “normal” and so desperately want to be “back to normal”. The trajectory of recovery from TBI is different than a broken leg, where there is an expected period of immobility followed by physiotherapy and re-strengthening. We should expect that those recovering from concussion will encounter psychological or psychiatric hurdles. In an ideal world supports to combat the high prevalence of depression following concussion or brain injury would be available for all.

Read CBC article

Awakening from a bad dream……PeaceArch News highlights Harriet Fowler’s story of courage and inspiration

This wonderful lady,  Harriet Fowler, was a client of Brain Injury Law.

“You’re told all these bad things. Doctors always tell you the worst, but the thing you have to remember is to not give up, no matter what doctors tell you.”

Please read the full article about Harriet here http://www.peacearchnews.com/community/280850392.html

and be certain to visit her website: http://harrietrose.org and learn more about her story.

9 Things NOT to Say to Someone with a Brain Injury

This insightful article provides some helpful reminders to those caring for a loved one with a brain injury.

 http://www.brainline.org/content/2012/10/9-things-not-to-say-to-someone-with-a-brain-injury.html

 

A Winner!

We are thrilled to hear that Danielle Benoit, a friend, former client and a very accomplished equestrian, has done very well in the BC Summer Games, earning two gold medals and two silver medals.

Congratulations, Danielle!

 

Meet Harriet Rose Fowler

Harriet is a courageous young woman whose story of recovery is truly inspiring!

Visit her website: http://harrietrose.org and learn more about her story.

Harriet recently completed a manuscript for a book: “You are my Sunshine: The Journey Through my Recovery of  a Traumatic Brain Injury”. She wants to share her story and hopes that it might help others who are dealing with similar challenges.

 

Six reasons to promptly retain a lawyer after a family member suffers a severe brain injury

If the injury is a traumatic brain injury, all of the following reasons are twice as important; patients cannot recover alone, and must rely upon family to look after things while they concentrate on healing.

Read more

Jen’s Story of Recovery

After sustaining a hairline fracture to her femur, Jennifer Weterings was admitted to St. Paul’s Hospital. Within 24 hours she had developed progressive multi-organ failure, due to severe sepsis, secondary to MRSA (Methicillin-resistant Staphylococcus Aureus). Her recovery took five months in hospital – from ICU to GF Strong – and is still continuing today.

On Friday, May 17th, 2013, Jen shared her story of recovery with medical and research staff at Vancouver General Hospital’s Lunch N’ Learn session, sponsored by Webster & Associates.

Read more

“Behavioral Challenges after Brain Injury:” Booklet produced by the Brain Injury Association of America

The Brain Injury Association of America (BIAA) website has a number of useful online resources for individuals and family members affected by traumatic brain injury.

“Behavioral Challenges After Brain Injury” (PDF) is one such resource that informs people with brain injuries, their families, and caregivers about the kinds of behavioral challenges they may face, while also offering practical ways to address these challenges.*

Find this and other great resources on the Brain Injury Association of America website www.biausa.org.

 

*Please note that while some of the materials referenced on biausa.org are intended for an American audience, the material in general is useful and applicable to anyone affected by brain injury.

New technology aims to get TBI survivors back in the driver’s seat

For many people, driving represents freedom and independence. For survivors of traumatic brain injuries driving has been identified as a key component of achieving autonomy and re-integration into the community. Unfortunately, many TBI survivors (and indeed people with various disabilities) have residual cognitive impairments that impact their ability to drive safely and defensively, among other activities. Such impairments can affect:

  • Visual scanning
  • Spatial perception
  • Attention focusing
  • Problem solving
  • Self-awareness of individual shortcomings and driving abilities (anosognosia)

While many technologies help the physically disabled drive, no technology exists to help drivers overcome the above cognitive impairments to enable safe driving… until now.

In recent months, the Shepherd Centre assistive technology team, the Georgia Tech Sonification Laboratory, and Centrafuse™ have collectively developed an in-vehicle assistive technology (IVAT) – an in-dash, touch screen computer system that uses driver interaction and positive reinforcement to improve and sustain behaviours that are known to increase driver safety.

The use of this type of technology stems from a key observation made by researchers that TBI survivors tend to be better able to remain focused on the driving task in the presence of the evaluator than when driving solo.

In order to replicate the experience of driving with an evaluator, the Shepherd Center team designed a device they called the Electronic Driving Coach (EDC), a three-button box that rests on the driver console. Each of the buttons is labelled to match the three tasks that an individual needs to perform in order to be a safe driver: mirror scanning, speed maintenance, and space monitoring. Every time the individual noticed himself practicing one of these tasks, he or she was to push the corresponding button. The EDC would then give the driver an auditory positive feedback. The researchers found that

“After 3, 6, and 12-month re-evaluations, the individual’s driving skills have been rehabilitated to a much safer level as evidenced by continued evaluations and the discontinuation of traffic violations”

The researchers recognize the limitations posed by the physical in-dash box, and are continuing to evaluate IVAT in both simulators and on-road vehicles with the hope that this technology will not only help TBI survivors, but also other groups of cognitively disabled peoples.

To find out more about driving after a traumatic brain injury, click here.


Read the full, original article here:
“In-Vehicle Assistive Technology (IVAT) for Drivers Who Have Survived a Traumatic Brain Injury” By J. Olsheski, B. Walker, and  J. McCloud

Driving After Traumatic Brain Injury (TBI)

Physical disabilities and cognitive impairment are the main reasons that an individual may be unable to drive after a traumatic brain injury.

Doctors are required to inform the Superintendent of Motor Vehicles that a person has a health condition which impairs their ability to drive. However, this does not mean a person will never drive again. Nonetheless, individuals that have sustained serious traumatic brain injuries (TBIs) should not drive unless their doctor tells them it is safe to do so.

Some of the factors that affect the likelihood that a TBI survivor will eventually be able to drive include:

  • Age (Younger TBI survivors are more likely to recover than older ones.)
  • Mental outlook and effort in recovery
  • Support team, including his or her doctors, therapists, family and friends (strong, reliable support teams aid recovery.)
  • The severity of the primary injury and the resulting complications
  • Whether or not the individual had driving experience before the injury (prior driving experience makes re-learning driving easier.)

Evaluating Individual’s Driving Ability
Determining whether a person with an acquired brain injury can safely drive again involves a number of professionals and assessments, including: medical or neurophysical exams, visual tests, and active driving tests (simulated or on-road).

Getting Back on the Road, in British Columbia
In British Columbia, once the survivor, their doctor, and/or healthcare team are confident in their ability to drive safely, the Office of the Superintendent of Motor Vehicles (OSMV) determines the legality of driving – usually authorized testing is all that is required.

Office of the Superintendent of Motor Vehicles (OSMV)
The OSMV is a BC provincial agency that is in charge of road safety and driver behaviour. The OSMV reviews information from the medical community, law enforcement agencies, and Insurance Corporation of British Columbia (ICBC) licensing when making decisions about a driver’s license.

The Superintendent of Motor Vehicles may require a driver to take a vision test, a functional driving assessment, a medical and/or other evaluation, in order to help determine whether they are able to drive safely. These may include:

  1. Driver Medical Examination (DME)
    The driver’s doctor must conduct a driver medical examination at the request of the OSMV and submit a completed assessment form to the OSMV
  2. Functional Driving Assessment
    The driver may be asked to complete one of these two assessments:
  • Driver Rehab Assessment
    • For persons who are seen as being likely to drive safely again after an illness or injury
    • The goal is to help the individual to get driving again by offering assessments, lessons, strategies and vehicle modification, if necessary
    • This assessment may be the best one for persons with a brain injury
    • Community Therapists
      Unlike other services which are heavily computerized and focus on a rigid “pass/fail” methodology with little or no opportunity for training, the Community Therapists methodology focuses on the assessment of the client’s rehabilitation potential to return to driving. Where appropriate, clients are offered a comprehensive driver rehabilitation program to facilitate a return to this vital daily activity. For more information about Community Therapists, visit their website.
  • DriveABLE
    • Assessment involves an in-clinic perceptual and cognitive assessment and may be followed by an on-road evaluation
    • Rehabilitation and compensatory strategies are not addressed
    • Not appropriate for those with visual or physical impairment
    • Is best for persons with progressive cognitive conditions and impairments
    • For more information about DriveABLE visit their website.

Where can I get a functional driver assessment?

  • For information about driver rehabilitation programs in British Columbia, visit the brainstreams.ca website.
  • Do an OT search through BC Society of Occupational Therapists and select “Driver Rehab Assessment”

How long does the whole process take?
The entire process can take a significant amount of time. The duration depends on the individual’s injury as well as the activity of the groups involved – healthcare team, driver rehab centre, OSMV, licensing.

How much does it cost?

  • You may need to pay for the cost of the assessment yourself. The cost can usually be submitted as a medical expense on your income tax return.
  • If you have a claim against a third party, speak to your lawyer or call Workers Compensation Board if it covers your claim.
  • Functional Driving Assessments centres set their own fees
  • Funding may be available from third-party funders (e.g. ICBC, WorkSafe BC) and extended health plans, or through OSMV.


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