Rehabilitating Brain Injuries

By Dr. Brian Combs
Interviewed by Melissa Moniz
Wednesday - January 16, 2008
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Dr. Brian Combs


Interviewed by Melissa Moniz

As a clinical neuropsychologist and a rehabilitation psychologist, can you explain the similarities and differences of both professions?

In rehabilitation hospitals, there are usually both rehabilitation psychologists and neuropsychologists, and sometimes the same person is both. Neuropsychology focuses on brain-related problems and cognitive issues in patients who have had some kind of injury or illness affecting the brain. Rehabilitation psychology is involved with helping a person with a disability achieve their maximum potential. Both sets of skills are involved in working with brain-injured and stroke patients. All psychologists working with this population need to be rehabilitation psychologists. Some are also neuropsychologists.

How long have you been working at REHAB?

I have been here for about 10 years. And I am also at The Queen’s Medical Center, so my time is split between the two hospitals.

Can you describe what a typical work day is like for you?

Here at the REHAB Hospital I may see several patients in a day, attend team conferences and consult with staff. I will likely see patients who have had brain injuries, strokes or other injuries, and I’ll initially do some kind of evaluation. I usually look at their cognition - how well they’re oriented, how well they are able to focus, to reason, and to learn and remember things. I also look at how they are functioning emotionally, to see if there are any problems with adjustment such as depression or anxiety. I might do some counseling sessions with patients if there are any of these problems or if anything else is getting in the way of their rehabilitation. I also talk to the families of patients to see if they’re having any problems adjusting or understanding their family member, and provide counseling or education. I’ll attend team conferences, depending on which day of the week it is. There we discuss how patients are progressing and what their discharge issues are.

Dr. Brian Combs performs a neuropsychological test on a patient.
Dr. Brian Combs performs a neuropsychological test on a patient. The testing is done to determine the effects of a brain injury on the patient’s ability to think, remember, concentrate and solve problems

Can you explain the more common forms of evaluation in diagnosing a patient?

We’ll do anything ranging from a general mental status exam or observation of behavior, to a formal battery of neuropsychological tests, which are standardized tests that look at things like memory, attention and visual-spatial abilities. We can compare how the patient does on the tests to other people of the same age and look for any evidence of impairment. We try to cover all the different areas of brain function. Usually we do a short screening test here in the hospital that might take 30 to 60 minutes and cover all those areas briefly.

You mentioned comparing the tests by age. Does gender also factor in?

Mostly we see differences with respect to age and, in some cases, level of education. There are minor differences between males and females. Women tend to have a little better verbal memory on some tests and males tend to have slightly better visual/spatial skills.

Who makes up the brain injury team at REHAB?

The team consists of the attending physician, a physical therapist, an occupational therapist, a speech therapist, a nurse, a case manager and a psychologist.

What is your role in the team?

My contribution is to try to understand how the injury is affecting the person’s cognitive functioning, behavior and emotional functioning. I convey that to the team, the family and, of course, the patient himself. We see a lot of behavioral problems, especially things like agitation and impulsive behavior. It helps to have an understanding about the causes of those behaviors and what we can do to decrease them.

What are the more common cognitive effects of a brain injury or stroke?

Probably the most common cognitive effect, no matter where the injury is in the brain, is memory impairment, which can range from very mild forgetfulness to being virtually unable to remember anything that happened one hour ago or five minutes ago. So memory problems are the most common difficulties, but there are many others, and it just depends on how severe the brain injury is, and also the location of the injury in the brain. People with a right-sided injury to the brain will often have problems with spatial awareness, and people with an injury to the left side of the brain will have problems with language, either speaking or comprehending or both. Usually if the whole brain is affected there are a number of other problems, including attention, judgment, reasoning, planning, initiation and the inability to inhibit responses.

Do you see more long-term or short-term memory loss?

It’s almost always short-term memory loss. The person with a brain injury or stroke may be easily able to remember events that occurred before the stroke or injury, which is long-term memory, but has a lot of difficulty learning and retaining new information, which is what people usually refer to as short-term memory loss.

What are some of the more common forms of treatment for memory loss?

It’s difficult to train memory by just doing exercises. A lot of what we do is to try to improve other skills that contribute to the problem, like attention and organization. We also teach people to compensate by using various strategies. We’ll teach people to get in the habit of repeating what they hear, writing things down, keeping calendars, forming associations. Most of what we do for memory is to help the person learn techniques to compensate.

Are there any lasting problems from a brain injury or stroke?

It all depends on how severe the injury is. Some people have a full, or nearly full recovery, but most of the patients we see are left with some degree of disability. The most common complaints we will hear many years down the road are continued problems with memory and forgetfulness. Depression also occurs fairly commonly as time goes on. That can either be from the brain injury itself or the situation that the person finds himself in - perhaps not being able to work or losing contact with friends. So the secondary effects of the brain injury, like isolation and depression, can be particularly hard things for people to cope with. Psychological treatment and support groups can be helpful for those people. The Brain Injury Association of Hawaii has a support group that meets twice a month.

This information is provided as educational and is not intended as a substitute for consultation with a physician. For questions, consult your physician.


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