At the 2015 Paradigm Innovation Symposium, Teresa Ashman, PhD, ABPP-Rp, FACRM, Director of Neurorehabilitation Psychology, Shepherd Center, presented a session discussing the importance of addressing psychological issues in the treatment of catastrophic injury claims. The best chance for a successful recovery following a catastrophic injury, such as a spinal cord injury (SCI) or traumatic brain injury (TBI), comes from a holistic team approach. Only then can you facilitate reintegration back into the community and back to work for these injured people. Included in any successful, comprehensive rehabilitation program are psychological and neuropsychological services that utilize best practices to address the emotional impact of the experience, along with treatment for any cognitive impairment sustained during the injury.
Psychological issues with SCI and TBI claims:
- There is high prevalence of post-injury depression in SCI and TBI claims (25-60%)
- These issues can arise any time post-injury.
- Exacerbates existing injury related psychosocial challenges.
- Limited mobility leads to more isolation.
- Suicidal intention and severe depression are common.
Identifying depression after the injury:
- Comprehensive assessment by a mental health professional is important.
- It is important to distinguish between the grief process of loss of identity and depression.
- There are challenges in separating the symptoms of a TBI with depression, which can lead to misdiagnosis and unnecessary medications.
Treatment of post-injury TBI depression:
- The evidence is lacking and is often anecdotal or based on case studies.
- Pharmacological treatments – The studies done in this area have been inconclusive as to their effectiveness. Shepherd did a clinical trial comparing the efectivenes of Zoloft to Placebo on TBI patients. This showed both groups improved in depression, anxiety and quality of life during the 10-week trial. Their conclusion was that Zoloft was slightly more effective than placebo. However one of the big issues impacting their recovery appeared to be access to care and medical attention. Just having someone to talk to and pay attention to them improved their condition.
- Non-pharmacological treatments – Physical exercise, cognitive rehabilitation, relaxation treatment and cognitive behavioral therapy have all been shown to be effective, but again, the evidence is lacking and there has not been sufficient study in this area.
Role of Neuropsychologist and Rehabilitation Psychologists in TBI claims:
- Goal is to restore patient to maximum pre-morbid functioning.
- Help patient regain functional independence and confidence.
- Provide concrete methods to ensure patient safety.
- Educate patients and family about secondary prevention.
- Facilitate patient’s psychological adjustment
In conclusion, the power of the mind and the strength of the human spirit is an incredibly powerful healing tool for recovery from any injury. Targeted cognitive behavioral therapy and a holistic approach to treatment seem to have the greatest impact on assisting patients from recovering from these traumatic, life-changing injuries.