Therapy For Brain Injuries

By Dr. Kent Yamamoto
Interviewed by Rasa Fournier
Wednesday - April 27, 2011
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Dr. Kent Yamamoto
Physiatrist at rehabilitation Hospital of the Pacific

Where did you receive your schooling and training?

I graduated from Lutheran High School here in 1993 and then went to Creighton in Omaha, Neb., for under-grad and medical school. I then went to San Antonio for residency at the University of Texas Health Science Center at San Antonio. I’ve been back here since 2006 and I started working at REHAB in 2007.

What do you do as medical director for traumatic brain injury (TBI)?

Program development and making sure patients are getting adequate specialized and specific care for their brain injury.

What treatment is there for people who have suffered TBI?

There is no cure for TBI. The best treatment is preventing it from occurring in the first place. This can be done by removing trip hazards from Grandma’s and Grandpa’s house, by not drinking and driving, and by always wearing a helmet when riding a bike or motorcycle. For those who have sustained an injury, however, there are things we can do to help the healing process and to improve function. A lot of what we do in therapy is getting patients to form new neuronal connections. We do this through repetition and by constantly challenging the brain. But there’s a point where your body won’t heal anymore, and that’s where you look at adaptive techniques, medications and equipment such as prostheses or splints to help people regain independence.

Most recovery occurs whether or not you are involved in a structured therapy program. What therapy does is get you that extra 20 percent or more than if you weren’t to do therapy. You also learn how to do things the right way. It is very difficult to correct something that you’ve learned incorrectly.

How important is having a support system?

Having a support system is vital to good outcomes. There’s a lot of literature on the difference between brain injury patients with a good support system - spouse or family support - versus those without family support, and there’s a huge difference in outcomes. This is why we focus on support system education in our TBI program.

Dr. Kent yamamoto does a vision test on a patient who suffered a traumatic brain accident. Nathalie Walker photo .(JavaScript must be enabled to view this email address)

Is each injury and recovery rate different?

Patients surprise me all the time. In regard to prognosis, I have learned to never talk in absolutes. It’s amazing how resilient people’s bodies are. Conversely, I’ve also had patients whose outcomes never reach my expectations. Generally, the highest rate of recovery occurs within the first three months after an injury. After this, the recovery rate is not as brisk; however, it usually continues for a year or so.

Can you talk about the range of brain trauma?

Brain injury is categorized into mild, moderate and severe. Most brain injuries, 75 percent, are considered mild, and most of the mild brain injuries don’t result in any sequelae or residual problems.

A concussion is basically a brain injury. The more severe the brain injury, the more at risk you are to experiencing post-concussive symptoms.

Most of the mild injuries go home with outpatient therapy.

The moderate and severe injuries typically come to REHAB, unless the injury is so severe that they cannot cooperate with therapy.

Can you talk more about the residual problems?

In post-concussive syndrome, there are three categories of deficits: physical, cognitive and emotional. Physical complaints commonly are headaches, dizziness and sensitivity to light or noise. Cognitive deficits include impaired memory, difficulty concentrating and difficulty with multitasking. Then there are emotional issues, such as irritability, aggression and depression. These three areas also can interact with each other. For example, if they are sensitive to light, when they go outside on a sunny day, this can bring on their headaches and it can also affect their mood.

There may be personality changes as well. One’s personality trait may be amplified after a brain injury, or conversely, may make a 180-degree turn. This is why the divorce rate following a traumatic brain injury is high.

Are they depressed because they’re upset to be suffering an injury, or does the injury actually change their mood and personality?

Unfortunately there’s not really that much literature on brain injury, so we’re not too sure what exactly is going on. This is why it’s so difficult to treat.

One positive about the recent war in the Middle East is that there’s been a lot of exposure and awareness of brain injuries. This has resulted in increased funding for TBI research. As far as medications go, there are no federally approved medications for TBI, so hopefully, with the increase in research and awareness this will change. But for now, we need to borrow medications from other disciplines and diagnoses, such as Ritalin, typically for ADHD, to improve concentration; Aricept, typically for Alzheimer’s, to improve memory; and Seroquel, which is an antipsychotic, for agitation.

How do most brain injuries that you see occur?

Most of them are due to falls. Most falls are in the very young and in the very old. Specific to Hawaii is elderly men who fall from a ladder while picking mangos or papaya. The second most common cause are motor vehicle collisions, which are more common in the teenage years when people are learning to drive. The third most common cause is sports-related. Sports-related injuries make up about 20 to 25 percent of all traumatic brain injuries - getting struck by a baseball or baseball bat, head-on collisions, head-butting with soccer or helmet-to-helmet contact in football.

After someone is injured, what happens next?

When a patient is severely injured, they go to the closest trauma hospital.

If you are medically stable and unable to return home, that’s when you would be transferred to a transition facility such as REHAB hospital. They are placed in an individualized therapy program of physical, occupational and speech therapy.

How long is the typical length of stay?

We base the duration of stay on the patient’s improvement, potential and goals. When patients show continued functional improvement, we know they’re benefitting from the therapy. They are discharged once we’re not seeing functional gains, or if they meet their goals of going home. The typical length of stay is two weeks.

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