Knowing traumatic brain injury's potential
Date: June 1, 2011
Most neurologists will see the devastation of traumatic brain injury (TBI) sometime over the course of their careers. But if they don’t follow these patients long-term, says Argye Hillis, they may not see the incredible progress that many patients make over time.
“Many neurologists stop following TBI patients after a short time,” she says, “so they give them a much dimmer prognosis than they should. They’ll think patients stop improving after six months or a year without a lot of data to support that idea. But I’ve followed patients for years and seen them continue improving if they receive appropriate rehab.”
Hillis works with colleagues from neurology and rehabilitation to assess TBI patients and make sure they receive the care that will put them on that road to recovery. If the injury is severe, the journey sometimes starts in neurosurgery, with surgeons including Jon Weingart. He and his colleagues deliver the acute care necessary to keep patients alive and minimize secondary injuries that lead to later problems after motor vehicle accidents, gunshot wounds, horseback riding injuries—a type of TBI unfortunately common to equestrian-friendly Maryland—and other types of severe TBI.
If scans show swelling, hemorrhaging or clots, among other problems, patients will likely receive surgery to resolve the acute problem, Weingart explains. When a patient is ready, Hillis and other neurologists will take over to determine the next steps.
“The advantage of coming here,” says Weingart, “is that you’ve got expertise in all different areas under one roof. That makes collaborations between neurosurgery and neurology especially smooth.”
Hillis gives TBI patients a complete neurological workup, delivering cognitive and neurological tests, as well as reviewing existing scans and ordering new ones if necessary. Based on a patient’s results, he or she might next be referred to psychiatry and rehabilitation, two departments that she and her colleagues work closely with. From there, a TBI patient might receive a variety of therapies: cognitive, speech/language, physical and occupational, among others.
Having worked for a decade as a speech pathologist before medical school, Hillis says her experience gives her a leg up with understanding the promise and limitations of rehabilitation. Following her patients over the years, she’s seen many of them progress from not being able to speak, walk or feed themselves to returning to work or school, getting married and leading productive lives.
“You might not know what’s possible,” she says, “unless you’ve followed patients through rehab and seen it for yourself. Knowing what potential exists helps us—and our patients—keep our eyes on the prize.”
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