Connor was 25 when he had a severe brain injury in a motor vehicle accident which occurred at work. The truck he was driveway for a highway paving company which was owned by his family was hit by a tractor trailer which had lost control. Connor was med-evacuated to a nearby hospital where he was stabilized and then transported to a Level 1 Trauma Center where he underwent neurosurgery for a subdural hematoma and repair to facial, jaw and arm injuries. He remained in a medically induced coma for 10 days and as he improved entered into medical rehabilitation. In the medical rehabilitation program, Connor was highly agitated and confused. He was physically aggressive towards staff and was non-complaint with most of the rehabilitation therapists who attempted to work with him. Connor was discharged after 45 days in the rehabilitation program and returned to his parent’s home where his physical aggression continued. He was seen in outpatient programs in the community where he would work on physical therapy and strengthening skills, but refused to participate in cognitive, behavioral or psychological services.
Connor’s behavior remained aggressive in the home and he began to use alcohol and abuse his prescribed pain medications. Additionally, he started a body building regime and began using anabolic steroids to increase his muscle mass and strength. He left the home to live with his friends but soon was having difficulty sustaining friendships and got into legal trouble in the community due to his aggressive behavior. His family and Worker’s Compensation Case Manager convinced Connor to enter into a residential treatment program which offered treatment for individuals with a brain injury and alcohol and substance abuse problems. Initially he did well in that program, but as he progressed towards independence he found access to alcohol and “street drugs” and became more physically aggressive towards program staff and in the community. After several incidents he left that program to return to his parent’s home where his aggressive behaviors as well as substance use escalated to the point where he was at risk.
Through an intervention initiated by Connor’s Worker’s Compensation Case Manager he was referred to the Neurologic Rehabilitation Institute at Brookhaven Hospital (NRI) where he entered into the Inpatient Neurobehavioral Rehabilitation program. There Connor participated in rehabilitation therapies designed to address his brain injury and substance abuse problems. Physicians managed his substance withdrawal and his behavior was stabilized. As Connor’s ability to participate in treatment improved he made rapid gains in all areas and within 70-days had entered into the Transitional Living Program (TLC) where he resided with five other individuals and returned to the hospital daily for his continuing rehabilitation program. With his psychologist, Connor began weekly therapy sessions with his parents. The family problems had been hidden in the years prior to Connor’s brain injury and following his injury became the focus of Connor’s anger. With support Connor was able to address these issues and understand that although his brain injury had affected many aspects of his life he could identify goals and return to independence.
Connor’s goal of returning to employment was assisted by the NRI Job Coach. Connor began to work with members of the hospital’s maintenance staff who with the Job Coach conducted a Work Skills Assessment. That enabled the Rehabilitation staff, Job Coach and Maintenance Team members to create a work re-entry program for Connor which provided on-the-job skills training in a real work environment. Connor enjoyed the work experience and soon found himself a member of Maintenance Team. As he adjusted to the work re-entry program Connor’s anger outbursts became self-regulated and his focus shifted to returning home to his own apartment and getting a job. His goals were realized after 62-days of work re-entry and Connor discharged to his home community.
In our follow-up with Connor at the six and twelve month points post-discharge he was living independent and working in construction. He had remained drug and alcohol free and at the twelve month follow-up we learned that he had married a woman from his hometown and was expecting to become a father.
Presenting problems: Severe TBI with left and right frontal and temporal lobe injuries, depressed skull fracture, facial fractures, left humerus fracture; right hand and wrist fractures; medically induced coma of 10 days duration. Agitated, confused and aggressive behaviors accompanied by short and long term memory problems, information processing deficits and Executive Dysfunction. Alcohol and substance abuse began after discharge from medical treatment which exacerbated aggression.
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