Neuropsychologist’s Role in Treatment of Traumatic Brain Injury – The 4 Cs-Caring, Compassion, and Continuity of Care

Abstract
Neuropsychologist typically evaluate and treat people with traumatic brain injury (TBI), often as a first point of contact with a person outside the hospital, their primary care provider, and/or neurologist, who is a specialist in the brain and behavior, and will spend considerable time evaluating them (typically 8-12 hrs) and if warranted and appropriate, treating them. In this role, we need to be mindful that TBI can have lifelong consequences. As such, our diagnoses, findings and recommendations, serve to set the path of the individual on their course and trajectory. Traumatic brain injury is a significant global health issue with long-term consequences, including increased risk of neurodegenerative diseases.TBI affects nearly 70 million people annually worldwide and has a substantial impact on public health, with 22% of people in the United States experiencing at least one TBI with loss of consciousness in their lifetime. Traumatic brain injury involves primary injury from mechanical tissue deformation and secondary injury from chronic pathologic processes, such as ischemia, metabolic dysfunction, and neuroinflammation. Individuals with a history of TBI have an increased risk of developing dementia and other neurodegenerative diseases, such as Parkinson’s and Alzheimer’s disease.TBI leads to increased oxidative stress, protein aggregation, and chronic inflammation, contributing to the progression of neurodegenerative diseases. Some of the progression of these diseases can be forestalled by interventions by the neuropsychologist or their recommendations. We also have the capacity to serve as a partial gatekeeper, or buffer of who our patients get referred to, and what they get out of it. It is well known that people with TBI have experience reduced cognitive functioning that ranges in duration and severity. Cognitive rehabilitation interventions target problems in attention, memory, and executive function, which when not addressed, can interfere with the effectiveness of mental health services. Further, people with TBI have deficits in insight regarding evaluation of self and others, which can lead to disruption in daily functioning, poor ability to anticipate consequences, and other difficulties in daily functioning, such as pain management. As insight is gained into these deficits, reversals in behaviors can occur, as individuals with TBI begin to see the true challenges and consequences of the TBI now and into the future. Their neuropsychologist should be prepared and ready to deal with the non-linear process of recovery in TBI. Several evidence-based treatments have proven effective for individuals with TBI. These include cognitive-behavioral therapy for depression and hopelessness, mindfulness-based cognitive therapy, acceptance and commitment therapy, and emotion-regulation interventions. Providers must consider the unique interplay between neurological and psychological factors in TBI to optimize care and improve outcomes.