A victim of a traumatic brain injury or closed head injury often has a team of medical specialists to assist  in the recovery and rehabilitation.  Each member of the team has a different background, specialty, and purpose and it is the teamwork between them all that works best for the patient.

A neuropsychologist is not a physician in the strictest sense, considering that he is essentially a psychologist specializing in treating functional disorders of the brain as well as behavioral malfunctioning.

You cannot expect a neuropsychologist to order for the routine tests often demanded by other physicians like EEGs, MRIs, or CT scans. On the contrary a neuropsychologist prefers to conduct a series of written examinations followed by personal interviews with the brain-injured victim. This series of tests is often referred to as a testing ‘battery’.

What is the purpose of such a testing battery?   The tests are done with the sole purpose of identifying some of the critical functional aspects of the brain. This includes memory capacity both short and long term, abstract reasoning skills, attention span, ability to focus, executive functioning capacity, motor skills and other emotional and cognitive traits. Based on the results of such tests along with other medical information, the neuropsychologist is then in a position to comment regarding the severity of the brain injury, its most viable treatment procedure and also predict what the future holds for the patient.

Opinions and viewpoints of the neuropsychologist are given serious cognizance by the jury in case there is a lawsuit filed by the victim of a traumatic brain injury or his family. He is treated as an authority when it is a matter of establishing the severity of the brain injury. The test results often go a long way to ratify the permanence of the injury and confirm the victim’s inability to work ever in his life.

A neuropsychologist often doubles up as a counselor and a therapist to bring back the brain-injured patient as close  to his pre-injury state.  They often also often provide group counseling sessions and recommend other forms of important rehabilitation.  They are an essential part of the brain injury treatment and recovery team.

Importance of the neurologist in the management of traumatic brain injuries

Doctors who treat a victim of closed brain injury usually comprise of several specialties, each one contributing his own perspectives and evaluations to the overall treatment regimen. Among others, the neurologist plays a key role in the treatment of traumatic brain injuries.

Who is a neurologist and what role does he play in the treating a brain-injured patient? A neurologist is a physician (MD or DO) specializing in treating ailments affecting the brain and the central nervous system. A neurological problem can have various physical manifestations including structural abnormalities or malfunctioning of specific zones within the entire nervous system of the body.

The neurologists’ job is to diagnose and treat such conditions, while physicians like psychiatrists and neuropsychologists concentrate on rectifying other injury-related problems like cognitive and mental disorders. However none of these specialties work in isolation. They work as a team.

After a traumatic brain injury, no treatment can start without the knowledge of the precise state of the victim’s nervous system. This is where a neurologist plays a critical role. He performs a comprehensive test to provide important information. The scope of his examination include the 12 important nerves of the head and neck, reflex action, sense of balance and muscle coordination, muscle strength and of course his mental and emotional state.

From his test results the treating doctors can access vital information about the victim’s state of consciousness, response to surroundings, general behavioral traits, orientation, attention span and memory.

There are a number of diagnostic tests which the neurologist performs including lumbar puncture, electroencephalography (EEG), electromyography/nerve conduction velocity (EMG/NCV) to identify the precise nature and severity of the brain injury.

A neurologist may at times refer  the victim of a traumatic brain injury to a neuropsychologist depending on the results of diagnostic tests like EEG, EMG, CT and MRI. He does this mainly to seek the opinion of the neuropsychologist as to which areas of the brain are damaged and which is still untouched by the trauma. This critical assessment of the situation would allow him to conclude how the trauma has impacted the victim’s thought procedure and outward behavior.

Diagnosis, treatment and recovery of victims of other types of problems related to brain injuries including seizures are also undertaken by a neurologist.

The Role Of The Psychiatrist In Treating Closed Head Injury

A victim of a traumatic brain injury or closed head injury often has a team of medical specialists to assist  in the recovery and rehabilitation.  Each member of the team has a different background, specialty, and purpose and it is the teamwork between them all that works best for the patient.

A psychiatrist is a physician (MD or DO) who is a specialist in treating mental illnesses, which could either be a result of genetic factors or an outcome of a trauma or accident. In the event of a closed head injury or a traumatic brain injury, the most inevitable outcome is impairment of the victim’s mental and cognitive faculties. The primary function of the psychiatrist is to diagnose and treat such impairments. The other specialty involved closely with the treatment of closed head injuries is the neurologist, who essentially handles the damages affecting physical abilities like seizures, etc. None of these physicians work independently. They work as a team.

There can be several sub categories of specialization amongst psychiatrists; some specialize in child psychology while others focuses on treating adult mental disorders. Some may even focus their practice on various types of addictions. As far as the psychiatrist treating a patient of traumatic brain injury is concerned, he relies on the test results provided by the neuro-psychologist, before he can give his recommendations for treatment.  His treatment may include medication in conjunction with counseling and therapy which play adjunctive roles. All these combined, help in the diagnosis, treatment and speedy recovery of the patient.

In the event of a lawsuit filed by the victim or his family a psychiatrist plays an even more important role. He usually provides the jury a detailed analysis of the closedhead injury and how it has affected the various critical faculties of his patient. He also narrates his own perspective of the expected outcome of the trauma and how it is likely to affect the patient for life. Such analyses are critical with regard to the final figure of claim settlement of a brain-injured patient.

Closed head injury and SPECT scan testing

A victim of a closed head injury or a traumatic brain injury is not only treated by a host of physicians belonging to various specialties, but the victim also has to undergo a series of tests to help with the diagnosis and treatment. One such compulsory testing is the SPECT scan test (Single Photon Emission Computed Tomography, a kind of nuclear imaging test displaying the pattern of blood flow to the various tissues and organs of the brain).

Depending on the severity of the consequences, such accident compensations can run into thousands.

Essentially, the SPECT scan test involves the deployment of two technologies – the computed tomography (CT) and the use of a radioactive material called the tracer. It is the tracer which helps the physician to track the blood flow to tissues and organs.

How is this test done? It starts with an injection of a chemical to the victim of a closed brain injury. This special chemical disperses gamma rays which the scanner can easily detect. In a way this test is not the same as a PET scan where the chemical is absorbed by the blood and the tissues. In the SPECT scan, the chemical remains in the blood stream helping to track the blood flow within the body. This type of scan is also less expensive and more easily available than even the high resolution PET scan.

A computer interprets the information gathered from the gamma arrays into the 2-dimensional images, which subsequently takes the form of 3-D images of the brain.

Considered to be more appropriate and sensitive than MRI or CT scans, the SPECT scan enables in the detection of speed of blood flow through arteries and veins within the injured brain. This type of scan is also frequently done for any evaluation study of medically uncontrolled seizures that demand surgical intervention. In such situations the SPECT scan provides the flexibility of scanning the brain in between (interictal) as well as during a seizure (ictal). This helps to identify the blood flow to areas of the brain from where the seizures begin.

All of us are aware of the seriousness of a closed brain injury. While the main focus is on the treatment of the condition, the one question that keep bothering us is what could be the short and long term implications when an individual has suffered a traumatic brain injury or TBI?

There is no definitive answer to this question. The reason for this is that it is difficult to assess the condition as well as predict its development and final outcome soon after the injury has happened. Closed brain injuries can be varied in type and severity and since the injuries sustained in the brain are usually complicated by nature, it may take months or even years to predict what is going to happen to the future of the patient concerned.

Any traumatic brain injury, irrespective of its severity, entails significant outflow of money, both in terms of diagnosis as well as treatment and rehabilitation of the patient. To add to this, chances are that the victim may not ever be able to pursue his professional life, remaining unemployable for the rest of his life. The most important point to note in such a situation is that the trauma could have been the result of someone’s negligence or carelessness, where the sufferer is a mere victim of circumstances.

To arrive at a pragmatic prognosis in the case of a closed brain injury, doctors study some important indicators which help them to come to a realistic conclusion. These include the duration and severity of the coma as well as the precise location and the dimension of the trauma sustained.

The duration during which a victim of a closed injury lies in a state of coma is a definite indicator of an expected post-trauma amnesia as well as the time he would require to recover. The first few hours after the accident are critical for the doctors, as this is the time when they assess the severity of the impact to the brain.

If the closed brain injury is mild in nature, then the victim can suffer temporary coma and amnesia for a few seconds stretching to a few minutes at the most.  Recovery in such cases usually stabilizes within a few days or weeks. On the other hand if the victim goes into a comatose state that lasts some weeks,  it is expected that the amnesia resulting from the trauma can also last several months with recovery stabilizing after months or even years.

To arrive at any conclusion regarding the long term implications of a traumatic brain injury, doctors depend on the location and dimension of the trauma site. Since there are specific areas of the brain that are responsible for the various cognitive and behavioral faculties, injury to such areas can be a reliable indicator of the kind and degree of impairment that the patient is likely to suffer.

In conclusion, it can be said that the recovery time from a traumatic brain injury is often directly linked to the severity of the trauma. The first step in the treatment of a TBI, immediately after the accident, is to reduce swelling, since this can reactivate the brain cells to resume functioning to some extent. The portions of the brain which have suffered permanent damage are to an extent helped by areas of the brain which have been left untouched by the trauma.