After some neurological catastrophes, patients can have focal, specific deficits. Stroke patients, for example, may not be able to move an arm or leg. Patients who suffered TBI have more diffuse and less specific impairments. Most have had some degree of diffuse axonal injury, so that the whole brain is involved.

Many of the problems for TBI patients occur in the cognitive and emotional areas. To begin with, they have trouble with memory. Besides the amnesia surrounding the injury, they also have trouble making new memories. That is a common pattern with memory loss. Oldest memories are usually retained, whereas new ones are hard to hold onto. This is frustrating for both the patient, and his family and friends. A person with trouble remembering new information has trouble with many of the tasks of daily living, to say nothing of driving a car or going to work.

Patients after a TBI are usually emotionally labile. They often suffer from headaches, and with the memory loss they can be easily frustrated. But the emotional instability is also part of the injury. The frontal lobes which are commonly injured areas, house parts of the brain responsible for impulse control and judgment. Loss of impulse control makes many things difficult for these patients.

Just reviewing the Rancho Los Amigos Scale can give an idea of what a patient might be like as he recovers from his TBI, a process that can be very slow. For example, a patient at Cognitive Level VII, Automatic-Appropriate, may very well be at home, especially if he had no other serious injuries. As noted previously, he may, “have problems in new situations and may become frustrated or act without thinking first, have problems planning, starting, and following through with activities, have trouble paying attention in distracting or stressful situations.” Obviously this is difficult for everyone. Complicating the impairment is the fact that the person may not realize the extent of his injuries or deficits. He may think he can do things he did before when he cannot yet. He may be inflexible and stubborn because he is having trouble solving problems and understanding situations. He still needs to be supervised.

However, a patient who has progressed to Cognitive Level VIII, Purposeful-Appropriate will be able to do more. He will realize he has a problem and begin to compensate for it. His thinking may be more flexible, and he may be able to come up with solutions to problems. He may be learning at a slower rate, but he will be learning. He might be ready to drive or be evaluated for job training. But he will still need assistance as things come more slowly to him, and he may show poor judgment when overloaded and overly stressed.

Part of the process is helping to move a person who has suffered a TBI further along the recovery continuum.

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