Posted on April 24, 2012 · Posted in TBI Voices
This entry is part 24 of 32 in the series Quinn

Tangible TBI Deficits: Quinn Part Twenty-Four

Quinn Part Twenty Four  –  Further Recovery Leaves Tangible TBI Deficits


In our previous part, Quinn’s wife describes how time and the ability to return to his normal depression meds had helped him return to a more normal function. Yet tangible TBI deficits remain:

Has he been neuropsychologically tested for tangible TBI deficits?


What are the tangible TBI deficits did that identify?

There are many.  There’s judgment issues; there’s some disinhibition; there’s short-term memory; overall concentration; overall multitasking; pretty much anything related to executive functioning, had some deficits on this test.

Executive functioning is the most difficult tangible TBI deficit thing to test, in neuropsychological testing.  Did they rely significantly on clinical interview with you, in reaching those conclusions?

I don’t believe so.  There was just a very small portion of the interview with me.  The rest of it was with him, and then he had two days of testing after that.


Among the problems in relying on neuropsych testing to identify executive functioning problems and tangible TBI deficits  is that the testing is done in a laboratory, where distractions and stress are controlled.  Further, the tests requires choices to be made.  Yet, it is the ability to function as an adult in face of the real world challenges that defines whether the brains  “ chief executive” is working. Thus, almost all neuropsychological testing is said to lack “ecological validity.”

It is for this reason that the best neuropsychologists use the test results as only the framework for an assessment, which should be based upon the changes the brain injured survivor is having in the real world.  The best way to assess those changes is through clinical interviews, of the injured person, but most importantly his or her spouse, parents, co-workers.

This need for a fuller understanding of the clinical change in a person and tangible TBI deficits, is the primary motivation for this TBI Voices initiative.

How would you describe the change in his behavior, now versus what it was two years ago?

He’s much more emotional about things.  It’s, it’s significantly improved, when he’s on the right mixes of medications, which have been changing all the time.  But, he definitely, he’s more emotional, as far as general moods go.

What about the temper?

Temper is usually under control, but there are plenty of times that the very smallest thing will set him off.

What are the small things that set him off?

I, unfortunately, haven’t figured out what are those things that set him off.  I will say something to him, ask him has he done X, Y and Z today, and he’ll say he did X.  He didn’t do Y and Z.  And I’ll say, why not?  I had asked you to do X, Y and Z yesterday, and reminded you this morning?  Why haven’t you done it?  And sometimes he’ll answer, because of this or that; and other times he’ll yell at me, why am I nagging him?  Why am I giving him a hard time, just because he didn’t do it, even though all I was trying to find out was why it hadn’t been done.

There’s a, there’s a change in the relationship that comes between a spouse and a, between two spouses that doesn’t happen when the primary caregivers is a mom.  Because you’ve always been told what to do by your parents, and it’s, more of a partnership in married people.  Is there an element in that that is that suddenly you were treating him like you were his mom and not his spouse?

I’m sure there was.  And not necessarily his mom or a parent, but why am I trying to boss him around?  Why am I trying to be in charge?

In our experience, which began with our charter experience of this particular problem is worse for men than it is for women, likely because of the hit to machismo that comes from losing so much face to with a woman you took pride in protecting.  While it didn’t reach crisis proportions with Quinn, we are aware of too many cases when too early of discharge has resulted in violence, centered around this dynamic.  See our story of Kevin,  Few marriages survive that violence.

Next in Part Twenty Five – Fatigue Brings Out Mood Issues 

By Attorney Gordon Johnson


About the Author

Attorney Gordon S. Johnson, Jr.
Past Chair Traumatic Brain Injury Litigation Group, American Association of Justice :: 800-992-9447