Case 1 Comments

The child of a lower-middle-class, mid-west family, the patient was entering his third year in the US Army at the time of his accident. By all accounts, the patient would have served the minimum amount of time in the military then used the GI Bill to finance a college degree. Those plans were; unfortunately, forever put on hold. Although still possessing superior verbal intelligence, he has difficulty using these intellectual reserves in novel situations. Unpredictable, unusual, and changing patterns in the flow of life are very upsetting to this individual--he is now a creature of habit. He is able to cope with one-on-one interactions with a fair degree of tolerance; but when his environment becomes too complex, or emotionally provocative, deterioration in function and behavior are quickly observed.

Skills learned prior to his accident, such as playing chess, are relatively retained; although deficits in manual dexterity and complex coordinated movement make these activities effortful. Complex sequences, such as making a pot of coffee, are not linked seamlessly and automatically, but represent a series of distinct sub-activities that must be consciously considered, then reconsidered, before they are arranged in their proper sequence. Distracters, such as a telephone call or knock on the door, can be catastrophic, ruining this painfully constructed sequence of activities--a house of cards that will fall at the slightest provocation. After months of once-a-week sessions I have gained the patient's trust and now feel comfortable 'lending a hand' without offending the patient. Pride is relatively retained, and easily offended.

His difficulties in movement (he is a high risk for falling), poor social etiquette, and poor judgment isolate him from society at large. Attempts to provide him with an external connection to the world (i.e., Internet service) resulted in other, nefarious, individuals preying on his naivety.

Although at times crass, rude, and self-centered; I find him thoughtful and honest, although overly so, at times.

Research has shown that normal rats will not associate with brain-injured rats. The experimentally produced brain-injured rats are shunned by the 'normal' rats. Humans have not evolved from rodents, at least with regards to our compassion for brain-injured brothers and sisters.