Stories about Maturity after Brain Injury
The following are stories of real life survivors of brain injury. Clicking on the titles will take you to their actual story.
As we learn to become adults there, we can also lose our capacity to fully function as an adult because of an injury to the frontal part of our brain. This proves to be the most illusive aspect of treating the brain injured survivor because there is no Ipad program called “Maturity.”
One of the hardest things for brain injured people is to regain the maturity to live independently. As Betty said earlier, she didn’t like being treated like an eight year old but recognizes that was the level she was on in some ways during her rehabilitation. I have seen many other examples of severely brain injured people relearning to become adults much more easily from parents. Being scolded, ordered around, having expectations placed upon you is much easier to take from mom than from a spouse, a friend or a co-worker. The firm hand of a parent is a familiar thing, even after a TBI.
Was it like having to go through adolescence again?: “Oh, without a doubt, yeah. A lot of my behavior was like when I was 10 or 12 years old for a while. I had to retrain the bad – I was basically doing behavior supports for myself again. Nobody ever said that this could happen. You might have some impulsive words coming out, I mean, which is pretty common. I mean, that would be the first thing I’d tell somebody, that’s kind of normal. Nobody ever told my wife this is going to happen. I mean, knowledge is really power. I mean, just knowing that this could happen, it don’t fix it but it helps.”
Many professionals believe that, such damage, even in a mild brain injury, can permanently rob the survivor of the capacity to behave like an adult. I am not convinced that is necessarily the case, but there is no question that such injuries do require a long tedious rehabilitation. While social behavior skills can be relearned, the process is much more work than it was the first time, with mixed results.
How do you think of in terms of eight visits versus the time it took you to learn to be an adult the first time?: “That’s crazy. You can’t relearn a lifetime of behavior in eight visits or six visits, whatever they’re giving you. If it wasn’t for her donating the majority of it, it would of never happened. I mean and of course she’s doing something else because she couldn’t afford to stay in business the way she’s doing but I got lucky. I ran into one person that for some reason said: “Hey, I see potential” because I was doing my first group at that time and she knew what needed to happen. So she wanted to make sure I got well, and she said “God touched her, that this is what she’s supposed to do.” And I have to tell you, I questioned God for a number of years after that accident.”
“So the Moving In is where you’re at, at a certain point, you’re going to get, you might cognitively get better, you might mature or whatever. But you have to accept who you are and make the best of what you have and that’s what that is. I mean, you may not be able to do what you did, but what do you want to do, what do you like now?”
Our philosophy is to ensure the best outcome after a TBI, the post morbid plan has to simulate the growth in behavior and maturity that we experience as children and young adults. The concept is easy to grasp in the context of speech pathology and physical therapy in the inpatient setting. Many severe TBI survivors have to relearn to both walk and talk, as if they were children again. When you apply that principle to long term improvement in the community, one must start from the realization that the frontal lobes are the slowest part of our brains to develop. Much of the neural networks that govern mood, executive functioning and maturity continue to develop well into our 20’s. If one is doubtful of that statement, think how you or your children behaved differently at 25 than at 18. One theory I have with respect to frontal lobe deficits is that there is nothing unique about the cerebral cortex about that part of the brain as it relates to neurobehavior. I believe that the reason most adul- like functions are handled by the frontal lobes is because that is the largest unused part of the brain’s hard drive in those critical adolescent and young adult years when most maturity occurs.
“We learn to become adults in our frontal lobes.â€ With that being true, if frontal lobes are damaged, much of adult maturity, adult behaviors may be lost or changed. Elizabeth sees this in herself, although in a context a little bit different than I have discussed it before in other stories. She begins by denying that she is generally disorganized, but then adds: “Most, most of the time I, I’m pretty good at it (organization). I can handle stuff and then the problem is if I don’t get it and I don’t understand something, I can, I can be talking great with you right now and if someone would come running through the door and ask a question about anything I can look at them and it, I cannot understand it. Those are the things that can kind of make me snap. I get crabby kind of real fast at them. I get scared. I don’t understand it. I get frustrated at myself for not understanding it and those, that’s the damage.” She describes herself as being â€œlike an eighth grader.â€ Why do you think an eighth grader? Elizabeth states; “Because with all the tests after my second injury, all the tests that I had done from the doctors writing tests, reading, taking all the tests, they pretty said I’ve gone downhill and
Fred’s Mom explains his immaturity; “I would worry about him because he, he was still childlike in a lot of ways. If I would go someplace and he wasn’t sure where I’d be, he would call on the phone all of time. He’d call his father, he would call me, where are you, when are you coming home. I think that he, he was fearful that – it was – he was like a child, like a little, a little child. I would have to – if I went away for the day I would make sure I had something cooked, something simple so that, if nothing else all he had to do was warm it up in the microwave or have sandwiches because he couldn’t cook anything for himself. Things like that, it was like, like leaving a, a child home.”
As I have often said on these pages, injury to the brain, involves a significant shift in the maturity level of the individual, and this is especially true at one to three months after emergence from coma. As we would protect our children to live independently or make important decision with respect to their well being, we must also constrain the desires of a brain injured person until recovery has reached a point where reasonably adult decision making can occur. That didn’t happen with Gina.
Do you see a change in your maturity levels between 20 and 24, during that period you, you met your now husband, you started in data processing, became an executive secretary, as you look back do you see a change in your maturity over that period?: “Huge, yes.” Tell me about that.: “When I started data processing with the MLS I was still kind of a happy go lucky, like I was in high school. And as I was working in data processing, and as I was going to college at night, I guess I started to see where I wanted to be as a adult, where I really didn’t look at that so much prior to that. That’s probably the best way to say it.” Did you see that in the interactions with your husband?: “Yeah. Because when we first started dating I was just dating everyone. But I was a good girl. And we just developed our relationship and became really good friends, and then we became seclusive (exclusive), is that the proper word? Which is just he and I. And at that time, about that time when he and I saw each other, only each other, then I started looking at him as my future life partner.”
Brain injury hits each child differently, not just because the pathology is unique, but because it will sidetrack maturity differentially depending on the age of the survivor at injury. A 16 year old who has learned some life lessons will have different set of challenges than a 9 year old. Further complicating the assessment challenges is the different family dynamics from case to case. With a strong family structure, with continuing parental authority, many of the challenges of growing up will be overcome, albeit at a different rate as might otherwise be expected. Remove that structure and development might be entirely haphazard and dangerous.
Do you feel like she’s stuck or is she maturing just at a slower rate?: “I think she’s maturing at a slower rate because she has been exposed to different school to work programs where it’s all different jobs whether it’s with the public or not. I think she gets along well with the new people that she meets, the employers and the jobs that she has to adjust to.” In many ways a grown up girl. What was it like for her to become a teenager and go through adolescence with this injury and these problems?: “Ah, she’s very behind schedule I think socially and not so much mentally.”
At an age that most parents are struggling with the sexuality and drive for independence of their children, Nancy is hanging out at curbside with 10-12 year old girls awaiting a blown kiss from a boy band. No word describes this in the context of a pediatric severe brain injury like my coined term, dyscocious, the mirror image of the precocious. I define the term dyscocious to mean a pathological frontal lobe immaturity where a young adult survivor who has a childlike grasp of mature subject matter.
What is so significant about Nancy’s story, is the stark contrast between her relatively normal cognitive function and her childlike personality. Her Mom explains:She came out of the injury angelic because that’s the way she went in. We noticed the girls who were teenagers that were in at the same time she was for other brain injuries or injuries were very emotional – would cry in the middle of the night. It was very difficult for me to listen to that – thinking is that what she’s going to do three years from now or four years. Is she going to turn into that age level and is she going to be that emotional? That never occurred thank goodness.
What recognition does Nancy have that she’s different than her friends or different than kids her age?: “She knows that they have boyfriends. She knows that they all drive a car. She knows that all have jobs and they’re making money and they have progressed with their life. That they have ideals to go to college. That they aspire to be something. Whereas it seemed like it was about four months ago before we actually pinned her down to what do you want to be when you grow up? It could have been a dolphin trainer one day. It could have been a veterinarian the next or it could have been, a secretary. It was all over the place. So IEPs were really difficult to pin down.”
There’s a period of time when you’d come home from the hospital, where there’s a clear shift in the nature of the relationship between you and Laurie.: “Mm hmm.” Instead of being an equal partner now you’re more like a child. : “Mm hmm.” Did you ever have to go through that sense of stop I’m a grownup and not, as Lethan says “I’m not 4?” (http://whoamiagain.com ): ” I still have issues that I have, I sometimes have problems that yes, I am like a child. And I understand that, and, you know. In the support group setting a couple of months ago, I met a new brain-injured patient who is a teenager, who had that same, has that issue, and I explained to him look, you know, your parents are just trying to help, and I understand my wife is just trying to help.