Information From Katy

Hi Everyone,

I thought this information might be helpful - and allow everyone to better understand what is going on with Courtney on a day-to-day basis. I'll post it on the blog too.

Courtney's Brain Injury:
Courtney has suffered a Traumatic Brain Injury. This kind of injury results from an outside force hitting the head. There are two categories of TBI that cause trauma to the brain - Courtney has Diffuse Injury. Also referred to as Difuse Anoxal Injury, this results from the shearing and tensile forces associated with significant acceleration/deceleration trauma (like a car accident). The connecting elements of neurons (called axons) are torn and interrupted, causing widespread loss of connectivity. Immediate unconsciousness is a hallmark clinical feature of Diffuse Axonal Injury. Courtney injured the temporal and parietal lobes of her brain. The temporal lobe is located just above the ears, under the frontal lobe. It is responsible for memory, perception, and ability to understand language. The parietal lobe is located just behind the frontal lobe which is at the front of the head. Its responsibilities include the ability to feel (touch sensation), and the ability to integrate sensation for pain, temperature, and movement.

Courtney's Stages of Recovery:
Recovery from a brain injury is a complex process that depends on numerous variables including site, type, severity of injury, and age, among others. The recovery process can plateau at any stage of the recovery process. if the recovery process is prolonged at one stage, each stage after that will also be prolonged. Courtney is in Braintree Rehab Hospital, which uses its own scale to measure the recovery process. I've marked Courtney's current state with "***"
Unconsciousness
Coma
Wakeful Consciousness (Vegetative State)
Confusional
Minimally Conscious State
Confusional State
Post-Confusional
Evolving Independence
Social Competence / Community Re-entry

Coma: When a person is in a coma, it resembles a deep sleep. Their eyes are closed and they have no recognition of or response to internal or external stimuli. They have no apparent sleep/wake cycles.

Wakeful Unconsciousness: This stage is also called a vegetative state. A patient has emerged into this stage when sleep/wake cycles resume and they begin to show reflexive behaviors such as limb posturing, non-purposeful restless movements, startle to loud sounds, or blinking to visual threat. Patients at this stage are still persistently unresponsive and all movements are reflexive.

***Minimally Conscious State***: When patients begin to show higher brain function they have emerged into MCS. This stage is marked by inconsistency. A person may begin to fixate and track people across the room, or turn their head if they name is called. They may begin to follow simple commands or start using objects in a functional way (like combing their hair). These activities are inconsistent - for example, a person may give a high-five if asked one time, but then be unable to replicate this command.

Confusional State: When patients are able to consistently follow commands and use objects consistently and functionally, they have emerged into a confusional state. The hallmark on the confusional state is memory dysfunction, or post traumatic amnesia. Patients are unable to form new memories and are significantly confused as to month, date, year, where they are, and what happened to them. They will be unable to recall recent events and will be unable to recall information from hour to hour or even minute to minute. These patients also demonstrate very poor attention and concentration, varying to very sedate top highly agitated. In this stage, frustration is common and patients will react accordingly. This is common when patients are confused and unable to make sense of their world. Given these behaviors, it is important to maintain a quiet environment, frequent rest breaks, and develop consistent routines.

Evolving Independence: Patients emerge from the confusional state when PTA resolves and new memories can be formed. Patients in this stage are no longer confused and are able to recall elements of their day. Despite this improvement, patients continue to demonstrate significant memory impairment. Deficits in higher level cognitive function become apparent at this stage with continued difficulties in reasoning, abstract thinking, problem solving, and attention. Patients are often discharged at this stage, but continue to need intensive outpatient therapy.

Social Competence / Community Re-entry: Once patients are able to resume community activities such as returning to work or school, they have entered this stage. Even though patients have returned to their normal lives substantial modifications in their homes, work, and school environment are necessary to help compensate for lingering deficits.


Types of Therapy Courtney Receives:

Physical Therapy: Focuses on strengthening, coordination, balance increasing leg flexibility, transferring in and our of bed/chair, and walking.

Occupational Therapy: Focuses on improving strength, coordination, and function of the hands and arms. They also help patients re-learn daily activities, such as bathing, dressing, self-feeding, meal preparation, household tasks, and community activities. They work on the cognitive and perceptual components needed to perform functional activities, including attention, memory, problem solving, insight into impairments, safety awareness, and compensatory strategies.

Speech-Language Pathologist: Focuses on problems with speaking, listening, comprehending, reading, and writing. They also work on improving cognitive skills.




I hope this helps!

Love,
Katy

PS - for everyone with Facebook, I'm updating the group "Get Well Soon Courtney" regularly again :)