Head Injury

A Practical Guide

Trevor Powell

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351687881
• Edition: 2
• Topic: Education
• Subtopic: Inclusive Education

This popular and bestselling book has been brought up to date with the latest information on caring for someone with a head injury. Newly published, it includes an additional chapter on long term emotional adjustment, plus extended sections on other types of brain injury, returning to work, anger management and improving insight and awareness. This book is the ultimate guide to the hidden psychological, social, behavioural and emotional problems caused by head injury for professionals, families and carers. Practical, down-to-earth and written in a jargon-free style, it addresses the medical problems, rehabilitation and adjustment of individuals and families to the realities of life after head injury. Containing personal experiences, factual information and research and specific guidance and practical advice on ways of dealing with difficulties connected with head injury, this new and updated version will be an essential addition to the resources of all professionals working with people with a head injury.

CHAPTER 1

Information about Head Injury: Setting the Scene

Introduction

A head injury can happen to anyone. It does not matter who you are or what you do. This injury can range from a bump on the head, which leaves minimal long-term consequences, to a catastrophic injury which irrevocably alters the whole pattern of a person’s life. These injuries happen in a matter of seconds. Anyone who has had a head injury has a different story to tell, in terms of both the injury and of the residual problems and outcome. No two stories are alike. What most have in common is that individuals and families confront intolerable difficulties, which necessitate plumbing the depths of their own resources and emotions. The personal qualities of love, fortitude, patience, faith and courage are severely tested, often highlighting the indomitable nature of the human spirit.

This book is meant to be a guide, offering some help for those whose life has been affected by head injury, and for those who work with people who have suffered head injury. There are no magical cures or short cuts; rather there is a long, difficult journey towards coping. Understanding more about that journey, and the potential pitfalls, and sharing the experiences of others who have trodden that road before, can surely only help. Before embarking on our journey, let us set the scene by telling seven very brief stories, to give a picture of the variety of different types of injury, and the varied after-effects and degrees of recovery.

Seven Stories

Paul, a 30-year-old painter and decorator, fell from scaffolding and sustained a severe injury. Two years later he still has not returned to work and spends most of his time at home. He plays on his home computer but often has to ask his nine-year-old daughter for help in getting into the programme. He looks perfectly well, but has severe memory problems, finds it very difficult to learn anything new, and is very moody and quick to anger. He refers to himself as one of the ‘walking wounded’.

Neil used to love messing about with motorbikes. His injury occurred when he was knocked off his bike by a lorry. He has now lost his job because of problems with memory, organizing and planning. He also has a lowered tolerance of frustration. Last week, for the first time, he tried to work on his bike, taking it apart and cleaning it, but he became so frustrated when he was unable to reassemble it that he flew into a rage and smashed up his beloved machine with a hammer.

Peggy fell backwards onto concrete when a large dog jumped up at her. The doctors at the local hospital told her to go home and rest in bed for a day. Three months later she still had enormous difficulty coping with her job as an executive because of excessive tiredness and poor concentration. It was only after 12 months that she felt that she was “back to her old self’.

Geofge was involved in a fight outside a night club, where he was hit on the head with a hammer. He now works as a gardener and plays darts for his local pub team, but he finds it impossible to add up the scores in the way he used to.

Sarah was planning to go to art school. She accepted a lift from a friend who had been drinking after a party and found herself in hospital for six months. She can still paint from her wheelchair but her tremor means that she cannot draw a straight line. Although she still enjoys going to galleries she invariably forgets where she has been and what she has seen.

William was just 18 when he was involved in a serious road traffic accident. He spent two weeks in intensive care. His mother, sitting at his bedside, was told, ‘It’s touch and go and, if he survives, don’t expect too much. He might be a vegetable.’ Three years later William has just successfully completed the first year of a university degree course in archaeology and, amazingly, appears to have few residual symptoms.

Jonathan banged his head in a school rugby match. For the last 10 years he has worked, but has never managed to hold down a job for more than six months. His expectations are unrealistic and he does not recognize and accept a number of his problems. Because of his frustration, he has developed a serious drinking problem. He is now living and working in a Christian community.

Letter from a Parent

Let us consider a letter written by a father whose 19-year-old son had a head injury, in order to highlight, firstly, how a head injury can affect the whole family, and secondly how it can be gieady misunderstood, even by professionals. This ‘open letter’ was written as a plea to all those concerned, and captures a number of common themes which will arise throughout this book. The letter was entided, The Lucky Ones’.

To whom it may concern

Our plea to the medical world is that although you see us as the lucky ones we still need help and understanding. You see, it does not feel lucky to have a head injury or to have a relative who has one. We appreciate that many people die or have serious brain damage as a result of road accidents, but our experience is of one of ‘the lucky ones’ who needs understanding and guidance - things which we have found to be generally lacking.

To family and friends we would say that, although outwardly ‘the lucky one’ appears well, inside so much is wrong. Understanding, love, time, patience and gentle encouragement are all needed in large measures.

‘The lucky one’ does not feel lucky, nor does the family hit by shock struggling to look after him. Confusion, sadness and desperation are all felt by ‘the lucky one’ who feels different from the way he felt before the accident, but does not know why. The family is also confused, frightened and unsure how to help.

Life for the injured is harder than usual - a real struggle in fact as he tries to sort out his thoughts, agonisingly slowly, and remembering even little day-to-day things is sometimes impossible; but he looks so normal that no one understands or seems to care. He is expected to act and think the way he did before the accident, but he just can’t. On top of that he feels so utterly exhausted. Everything is such hard work. Due to the confusion and inability to cope, friends shy away until he is left on his own. He longs for their understanding but he looks so normal and when he says he is having trouble with his memory, people reply, ‘So do I, I am always forgetting things’, or if he says he is exhausted he receives the reply, ‘Oh yes, I feel tired all the time too.’ But it’s different for the head- injured, who eventually says nothing about his memory or exhaustion, and retreats into himself. Of course his injury does not show like a broken leg in plaster - people make allowances for anyone in that condition. He is not seeking sympathy or pity, only understanding or at least some attempt to understand, so that people might realise why he acts the way he does. He can’t put into words the way he feels, but he knows he does not feel right. He is afraid of being left alone in case he can’t cope, he panics in crowds, and is afraid to travel on the road - after all it was a road accident that made him feel the way he does; but to the world he is a ‘lucky one’.

He finds new tasks difficult to accomplish. He remembers things learnt before the accident, but learning new things and remembering things he is told is virtually impossible. Likewise, making decisions, even simple ones, is an insurmountable task. He can’t explain why these things appear so difficult for him, but people do not understand because he looks so normal.

To the member of the nursing staff who gets cross with a head- injured patient when he does something he has been told not to do, or forgets to do something he was told to do, we say, ‘Please don’t get cross, the patient really can’t help it and he needs your understanding.’

To the doctors who say he will be back to normal in a few weeks and should be able to return to work then, we say, ‘Please find out more about how head injuries affect patients, and the time it can take to recover, even partially, from those injuries.’ Families of the injured hang on to every word spoken by a doctor - after all he or she is expected to have some knowledge of how the injuries might affect the patient, so it is very important that doctors choose their words carefully, do not build up false hopes for the family, and do not make statements that with hindsight even the layman can see are very misleading.

We would also ask the medical world, ‘Where is the posthospitalisation care?’ as, in our experience, the patient is sent out from hospital and expected to cope on his own. His only link with anyone ‘medical’ is his GP who, with the best will in the world, is unable to offer any help other than to see the patient and ask rudimentary questions without providing any answers or details of where assistance might be sought. Bearing in mind the number of head injuries which occur annually, we were surprised that there appeared to be no one to turn to for help; at least, if there was, then neither the hospital nor the GP was aware of such a person or organization.

Our son returned to work, but even now only part-time, and when his job was changed he felt he could not cope. That situation has still not been resolved yet.

It has been two years now and our son is still not one hundred per cent well; the last two years have been a nightmare for the whole family and we are not through it yet. If only we had known more about what to expect and how to cope when our son was discharged from hospital. It has been a shock and a frightening experience for us all. Our daughter was diagnosed as suffering from post-traumatic stress and was put in touch with a social worker who involved the whole family and, through his sympathetic attitude, was able to help us all.

Six months ago we at last found a professional interested in head injury, although he worked in the neighbouring health district. It was a relief and a tremendous help to find someone who knew how we all felt. The Headway publications he offered us were also greatly reassuring. Our sincere thanks go out to all those who have listened, tried to understand, and did not tell us we were the lucky ones. Time does heal.

A Silent Epidemic

Over the last two decades the number of people suffering from head injuries has increased so dramatically that it has been described as a ‘silent epidemic’. The first reason for this is the enormous medical advances, high-quality technology and improved emergency services, which mean that more people are surviving. It is estimated that, as late as the 1970s, 90 per cent of all severe head-injured patients died; now the majority survive. The single most important factor in reducing deaths after head injury is the newly acquired technical ability of doctors to recognize and treat blood clots in the brain. The second reason would seem to be that we live in an age of speed and risk. Think of how many more motorways exist and the increased number of cars there are on the roads. It could be said that the speed of life has increased, people travel more, and as quickly as possible. The result of these two factors is that more people are having head injuries, more people are being kept alive and more people are walking around with the residual after-effects of head injury. The magnitude of the problem is seen to be even greater when we realize that a large percentage of survivors are adolescents and young adults with relatively normal life expectancies. It is also undoubtedly true that, although there has been a dramatic increase in head injuries, there has not been the corresponding increase in posthospital health care. Therefore this means that the majority of people with head injury do not receive the care they need after the acute medical emergency is over.

Facts about Head Injury

1. It is estimated that one million people in Britain attend ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• About the Author
• Contents
• Figures
• Foreword to the first edition by HRH The Princess of Wales
• Headway
• Preface to first edition
• Preface to the second edition
• Acknowledgements
• 1 Information about Head Injury: Setting the Scene
• 2 What Happens in a Head Injury
• 3 The Road Towards Recovery
• 4 Understanding & Coping with the Physical Effects of Head Injury
• 5 Understanding & Coping with Cognitive Symptoms after Head Injury
• 6 Understanding & Coping with Emotional & Behavioural Problems
• 7 Head Injury: A Family Affair
• 8 Special Issues
• 9 Long-Term Emotional Adjustment: Letting Go
• Prevention of Head Injury
• Glossary
• Useful addresses
• Suggestions for Further Reading
• Index