2020

Extended Abstract
Vol.6 No.3

Case Study: Neuropsychological Rehabilitation of Adult Head Injured

Patient
Nabila Tarannum Khan
Global Mental Health Lab, Columbia University, USA

which can be categorized as :( Physical :Smell –no smell

Introduction
sensation, Vision-blurred vision, Lack of energy, Cognitive-
Barbara A. Wilson by using World Health Organizations (1980) Impairment: Memory problem, Behavioral: Sexual dysfunction-
conceptual frame work, classify the sequel of brain injury into Fear of sex. Emotional: Anger, Physiological changes/Somatic
impairment, disabilities and handicaps. Complain: Headache, Sleep disturbance.Due to head injury
Neuropsychological rehabilitation is a treatment modality that is Mr.A1’s Current Functional status: Unable to take responsibility,
offering hope to many with brain injury. It is employed by a Relationship problem with wife and Can’t go to office.
neuropsychologist to assist patients who have sustained cognitive,
emotional and behavior impairments as the result of brain injury.
Neuropsychological rehabilitation (NR) is concerned with the Neuropsychological Rehabilitation plan for Mr.A1:
amelioration of cognitive, emotional, psychosocial, and behavioral
deficits caused by an insult to the brain. (Barbara W.2007).
TBI can result in physical, cognitive, social, emotional and
behavioral symptoms, and outcomes can range from complete
recovery to permanent disability or death,(wikepedia)
TBI is a major cause of death and disability worldwide, especially
in children and young adults. (Alves and Bullock, 2001). A head
injury is any injury that results in trauma to the skull or brain. The
terms traumatic brain injury and head injury are often used
interchangeably in the medical literature. ( Snelson,et al.,2019)
In the case of brain injury, parts of the brain are no longer able to
function normally. This can result in cognitive, emotional,
behavioral or physical impairments. So this head injured patient
need neuropsychological rehabilitation to get rid of these problems
to maintain better quality of life. For this purpose Case study has
done of Mr.A1, 32 years old, married male Head Injury (HI)
patient, referred to the researcher after completing medical
treatment for Neuropsychological rehabilitation for better
management. He was selected as a participant of the present
study.(Diagnosis: Haemorrahagic Contusion, Site of the injury:
Left Front-Temporal region. Date of the accident: 26.03.08,
Duration of injury:5 to 6 hours, Causes of injury: Fall from height,
History of seizures-Nil, History of retrograde amnesia-present,
Post traumatic amnesia-present, Nature of lesion: Multiple
Hemorrhagic Contusion. The comprehensive assessment is vital to
development of sensible and coherent intervention
programmes.Within Case management
systems(Intagliata,1982;Beardshaw and Towell,1990) or the care
programme approach(Department of Health,1990).Hence for the
assessment purpose researcher used Semi-Structured
questionnaire, in -depth interview, Mini Mental State Examination
(MMSE) in Bangla, Neurobehavioral Functioning Inventory
(NFI), Self- Rating Scale 0-100 point and observation in the case
of Mr.A1.Through in-depth interview, information was gathered Fig.1.1: Neuropsychological Rehabilitation plan for Mr.A1
from Mr.A1 and his caregiver (wife). The problems were found
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Extended Abstract
Vol.6 No.3

Fig.6: illustrates, according to NFI,in the pre assessment session ,

Fig.1.1.shows that after the accident Mr.A1 followed the three the respondent’s(A1) greatest problems fall within the realm of
levels of treatment procedure .From the three at the last phase of the Somatic, Aggression, Motor and Depression scale.
the treatment procedure he referred for Neuropsychological Difficulties’ relating to Memory/Attention and Communication
rehabilitation where he assessed and received neuropsychological was less significance from the patient’s point of view. In the pre-
treatment (therapeutic techniques) for Rehabilitation purpose. assessment session the highest percentile (%) score was in
Some techniques were applied to achieve successful rehabilitation Somatic area and the lowest percentile (%) score was in
plan. communication area, it were 86 and 21 accordingly. And in the
post assessment session these score were 42 and 14 respectively.
Such as,Psycho education, Relaxation, Thought Challenge and So it indicated that the problem severity was significantly reduced
Socratic questioning, Personal construct Therapy, Pros and cons, after intervention.
Anger management techniques and Memory Intervention (
external memory aids to keep a daily for daily activities), so that
he can improve his memory. Comparison of NFI Scores over time

100
Family therapy: Emotion focused techniques were used to 90
80
disclose wife’s suppressed emotions, where empathetic listening Pre-assessment score

Percentile
70
60 In Percentile(%)
and reflection was provided, and tried to normalize these feelings. 50
40 Post-assessment score
Psycho education was given to wife, where wife were informed 30 In Percentile (%)
20
about the head injury and effects of different types of physical 10
0
and mental problems that might be happened from the injury.
So n

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Sometimes wife played the role of co-therapist for behavioral and

o
at

ot
si
em
m

ica

M
es

es
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cognitive problems.A1 was given sessions for three months. Total
De

m
m
Co
session was 13.From these last 2 sessions was follow-up.
Problems

Changes of the problems based on the Pre and Post

Assessment: Fig: 7: NFI scores of A1, According to Caregiver (wife):
In subjective rating,A1 has rated his problem severity in “0” to
Fig.7: illustrates , according to the caregiver, greatest problems
“100” point rating scale. First three sessions were baseline session.
fall within the realm of the Somatic, Motor, Aggression,
Twelve and thirteen number session was follow-up session. Depression and Memory/Attention scale and Communication
Significant changed has been found in Pre and post assessment was less significance from the caregiver’s point of view . In the
phase. pre-assessment session the highest percentile (%) score was in
Somatic and motor area, it was 95 and the lowest percentile
Objective rating: (%)score was in communication area, it was 42. And in the post
assessment session Somatic and motor score were 50 and
Mini Mental State Examination (MMSE): 42respectively. And the communication score was 18. So it
According to MMSE his score was 29 that indicated there was no indicated that the problem severity was significantly reduced after
cognitive dysfunction. intervention.
After treatment again MMSE was applied and his score was
30.That indicated A1’s problem was slightly improved. Tab1.12: Observation Report:
Neuro-behavioral Functioning Inventory (NFI): Type of Pre -assessment Post- assessment
According to NFI, observation period period
Weakness in the There was no
Comparison of NFI Scores over time Motor behavior legs. There was weakness in his
problem with legs.
100
90
80
balance and clumsy
Pre-assessment score
Percentile

70
60 In Percentile(%) feeling while
50
40
30
Post-assessment score walking.
In Percentile(%)
20
10 Language Language was ok. Language was ok.
0
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u n or

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Recent memory Memory was intact.

gg io

Memory
ot
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A cat
om

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ep

problem.
D

Problems
Style of Style of Overall
performance performance was performance was
ok, patient was ok.
Fig 6: NFI scores of A1, According to patient (A1): focused and co-
operative.
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Extended Abstract
Vol.6 No.3

Spatial and Visual Blurred vision Vision was ok. Discussion:

awareness-
Personality Patient showed Patient was well The psychologists can deal with these types of problems like the
socially appropriate manner and looked neurologists.
and acceptable confident.
behavior. Moreover, Head Injury falls A1 into trouble. For example, A1 is
helped to decide of adopting a baby. The members of his family
were co-operative. They were suggested how to behave and deal
Through Tab.1.12.In the pre assessment session Mr.A1 came in with the patient. But if we could do it earlier, it would be better.
well dressed. A1 seemed gloomy and helpless. His facial The researchers plan was to visit the home environment and to
expression was depressed, but in the follow-up session Mr.A1 visit office environment to see actual nature of behavior but it was
looked confident and his face was always smiley. not possible.

Prognosis Criteria:

The patient was very much motivated and devoted to the treatment
process. He practiced all the techniques, whatever he learnt from
the psychotherapy session. It made him skilled to manage himself.
So the short term prognosis is good, but a better prognosis can be
made after long term follow-up which was not done.