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Healing the Forgotten: New Hope for TBI Patients

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March is traumatic brain injury awareness month.

After finishing a double shift, nurse Sarah C. was on her way home. "I remember standing on the sidewalk waiting for the green 'WALK' sign. I looked both ways," she says. "The next thing I remember is waking up in an ambulance."

On that afternoon, Aug. 19, 2005, Sarah C.'s life changed forever. One of the EMTs in the ambulance told her that a delivery truck had run up onto the sidewalk, throwing her to the opposite side of Victory Boulevard, a major six-lane road on Staten Island. "I told the EMT that I felt fine and wanted to go home," she says. But the EMT told her it would put her in danger. Looking up, she saw her grandmother's spirit standing in the ambulance doorway. Her grandfather's spirit was next to the EMT, which made her feel safe.

Although she felt fine in the ambulance, Sarah C.'s skull had endured a hairline fracture and the ligaments in her right hip had ripped. By the time they reached the emergency room, Sarah C. had slipped into a coma, where she remained unconscious for three weeks. When she regained consciousness, she could not move her eyes. "I saw people's faces in pieces which made me nauseous. My body felt like a sack of potatoes," she recalls. "Then I started projectile vomiting."

Because her head had fallen forward when she was thrown across the road, the nerves around Sarah C.'s eyes were shattered. She stuttered so badly that no one could understand what she was saying. She suffered from short-term memory loss and headaches. "All I could think of was how lucky I was to have survived," she says. After three weeks, she was out of her wheelchair and walking with a cane. "I never stopped to think that I wasn't really functioning."

Nine years later, Sarah C. considers herself "the luckiest woman in the world" and says that the accident "was the most positive thing that ever happened to me." For the last four years, she has been participating in a full-service day program for patients with traumatic brain injury where patients receive individual cognitive and speech therapy as well as participating in groups that strengthen reading, writing, art and music appreciation skills.

Dr. Mona Greenfield, founder of Metropolitan Communication Associates in Greenwich Village, has been working with TBI patients for more than 15 years. Most of the people who come to her program are living on restricted incomes or Social Security disability. They have Medicaid or Medicare as their insurance carriers. Many were high-functioning professionals before the car accident, physical violence, or fall resulted in their developing permanent brain damage. Most of the patients have mobility issues and speech impairments that create difficulty for them in getting around and expressing their needs to healthcare providers. The prevailing medical opinion is that their conditions are incurable. Many patients report that they receive minimal treatment from doctors who seem in a hurry to get them to leave. Is it any wonder that TBI patients report feeling discouraged, depressed, hopeless, and anxious?

Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. In 2010, 2.5 million TBIs occurred either as an isolated injury or along with other injuries.

A bump, a fall, or a head injury can cause the brain to be damaged to a certain degree. TBI can lead to impairment in communication skills, reasoning, memory, and emotional well-being. The CDC website states that:

TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer's disease, Parkinson's disease, and other brain disorders that become more prevalent with age.

Dr. Greenfield believes that, "TBI is not a 'death sentence.' With support and strategies that can be implemented over time, skills can be regained because of the brain's neuroplasticity." Each patient at Metropolitan Communication Associates is treated with respect. The program, which is offered three afternoons a week, combines group work with individual sessions that include cognitive drill work, desensitization, relaxation techniques, meditation, and creative visualization. The support groups and auxiliary activities provide opportunities for social interaction in a safe, supportive environment. This helps individuals to develop social skills and confidence to deal with the community at large. Because traumatic brain injury patients struggle with flashbacks, severe anxiety, and hyper vigilance that are part of post-traumatic stress disorder, the opportunity to meet regularly with other people offers an antidote to the isolation which frequently becomes a default behavior for people suffering from PTSD.

TBI patients are entitled to have hope. "Over time, skills will get relearned. Stimulating neural pathways will provide for what has been damaged," says Dr. Greenfield. "Our patients have shown us that if you work on the skills and strategies while offering support, they will get better. They may not be exactly how they were before, but their skills and feelings about themselves will improve."

Sarah C. will be the first acknowledge that the work is not easy. "You cannot avoid pain in the beginning. You have to learn not to share the loss with everyone but it can make a world of difference to have people who get what you are going through," she says. In her case, it meant searching her soul to find strength so that she can now be there for others like herself. She adds, "With the right emotional and mental support, and the right guidance, you cannot be who you were, but you can be the maximum of who you are."