Mr. P., 20 years old at the time of his admission to CORE, had sustained a severe traumatic brain injury in a head-on collision at age 14. From a physical and psychometric standpoint, Mr. P. had made a good recovery. However, he demonstrated significant frontal systems dysfunction, as evidenced by increased irritability, impulsivity, and oppositional behavior toward his family. He also became physically aggressive with his parents. Although very high-functioning from an intellectual standpoint and a very talented musician and computer enthusiast, Mr. P. demonstrated great difficulty adhering to a treatment schedule and making progress toward academic and vocational goals (time management and prioritization of activities were particular weaknesses).
Over the course of his six-month stay at CORE, he participated in intense therapy with strict contingencies for correct performance and application of other rehabilitation principles (e.g., error-free learning). One year following his discharge, Mr. P. was living independently, earned his G.E.D., and successfully maintained employment in a challenging setting for over six months. His long-term plans were to attend college, but his current focus was on maintaining stability in his personal and vocational pursuits, as recommended by his treatment team.
Executive dysfunction, including impulsivity, poor decision-making, and setting priorities are some of the most elusive symptoms to treat in individuals with traumatic brain injury and other neurological illness. It is assumed that physical neurological changes occur prior to positive behavioral changes. However, currently there is no way to measure these physical changes to the brain, and by extension to know when treatments are on the right path. Future developments in neuroimaging will allow us to see these changes before they behaviorally manifest, and thus direct treatment to maximal effectiveness.