Head Injury Patients

On placement earlier this semester I was treating an 11 year old who had sustained a severe head injury. This patient had DAI to parietal, temporal and frontal lobes, with the frontal lobes being the worst affected. From my previous knowledge I knew that patients with frontal lobe damage usually presented with those typical ‘frontal lobe behaviors’ of aggression, lack of insight ect. As this patient began to regain consciousness the ‘frontal lobe behaviors’ became very clear. When encouraged to do something that he didn’t want to do he would swear at me (with words that 11 year olds should not know), become aggressive and sometimes violent. He would also become clearly frustrated, would perseverate and demonstrate a lack of insight (i.e. telling me that he could walk to the bathroom when he was unable to stand independently).

Initially I found these situations difficult but as I treated this patient more I worked out strategies and ways to handle this patient. If the patient tried to hit me I would stop and say in my clearest voice “do not do that” or if they swore at me I would stop and say “no that is a bad word”. This may sound silly on paper but with this particular patient this worked really well. Anyway my point is that even though we are taught about these types of patients, it is so different when you actually see a patient with these types of behaviors.