Progress Eleven Years Post Injury

Does recovery from a brain injury ever end? This is a question that survivors of brain injury and their families often wonder. The case of F.K. illustrates that recovery is a continuous process and that progress from a brain injury can still occur even 11 years post-injury.

F.K. was a carpet layer who enjoyed car racing and country music prior to his brain injury. He was separated from his common-law wife and three children. On November 10, 1998, F.K's life was forever changed. He was riding in the back of a moving truck that had rolls of carpet in it. The driver of the truck hit a speed bump and F.K. flew out of the back of the truck and struck his head on the pavement. F.K. was unconscious and bleeding from his mouth and the back of his head at the scene of the accident.

A diagnosis of closed head injury with a cerebellar bleed was given after F.K. was transported to the hospital and CT scans were read. His initial CT scans revealed an occipital skull fracture on the right side of F.K's head, a cerebellar hematoma and diffuse cerebral edema (swelling). Due to the severity of F.K's injury, neurosurgical intervention was required. He had a partial frontal lobectomy (removal of brain tissue), an anterior temporal lobectomy and a subtemporal decompression, all on the left side of his brain. Four days after F.K's brain injury, he required a right frontal ventriculostomy (a tube placed in the brain that drains excess fluid) due to increased intracranial pressure (ICP).

Once F.K. was medically stable, he transitioned to acute rehabilitation within the hospital. He had multiple physical impairments including decreased strength and balance, decreased visual processing, and impaired balance and gait, which required him to use a wheelchair for ambulation. Cognitively, F.K. had impaired short term memory, was easily distracted, was impulsive with no awareness of his surroundings, and he performed well below his age and educational norms on all standardized testing. Since F.K. could not remember, he would confabulate (make things up) to fill in the holes in his memory. Although, F.K.'s physical and cognitive deficits were serious, the most difficult aspect to manage was F.K.'s behavior.

F.K. was obsessive over food. He wanted to eat massive quantities of food and non-edible items (toothpaste, soap, etc) and would not remember having eaten a meal. This caused F.K. to become angry and frustrated to the point of being physically aggressive when not given food. F.K. would manipulate hospital staff to try to get them to give him more food. Exiting the therapy areas, refusing to engage in therapy tasks and general non-compliance were also behaviors that F.K. exhibited.

On March 11, 1999, F.K. was admitted to the inpatient program at Centre for Neuro Skills® (CNS). He required constant supervision due to his behavior and decreased safety awareness. F.K. constantly asked for food and many of the same behaviors that he exhibited in the hospital were still present. Outbursts over food were directed at both staff and other patients. F.K. would steal staff lunches and other patients' food.

Improvements were being made despite F.K.'s behavior. Within four weeks of arriving at Centre for Neuro Skills, F.K. was able to walk without the aid of an assistive device. He eventually admitted that he had sustained a brain injury and was not able to drive or return to work at this time. Several programs were initiated to curb F.K.'s behavior regarding food. One program involved F.K. having to "pay back" any food that he stole from staff or other patients. Another program involved satiation to food. F.K. was given as many carrots as he wanted. He ate one pound, 4 ounces and 2 cups of carrots before reporting being full (he also turned orange from eating too many carrots).

Due to F.K.'s severe food obsession, he was gaining weight at a rapid pace. When he was admitted into the program at Centre for Neuro Skills, he weighed 190 pounds. At one point, he reached 220 pounds. F.K. reported, "Food is the most important thing in my life."

Approximately, one year after being admitted to the inpatient program at CNS, F.K. transitioned to the Assisted Living program. There was a slight decrease in F.K's behavior with this transition in programs. He enjoyed playing cards ad bingo with other patients, as well as fishing and other community outings. However, the refrigerator and cupboards still had to be padlocked to prevent F.K. from eating all of the food. In March of 2001, F.K. was diagnosed with Type II diabetes (diabetes mellitus). He was at 155% of his ideal body weight. He required Actos to control his blood glucose levels and Xenical for weight loss.

In September of 2008, F.K. was tested for neuroendocrine dysfunction due to his traumatic brain injury. His testosterone level was below normal and his insulin-like growth factor was severely deficient. These levels seemed to explain F.K.'s extreme fatigue, inability to tolerate exercise, decreased cognitive functioning and some of his issues with food. F.K. was prescribed Androgel (testosterone replacement) and Tev Tropin (growth hormone replacement) by an endocrinologist. By May of 2009, many improvements in F.K's health were noted. Actos (for blood glucose control) was discontinued, he lost 15 pounds, and was more alert and less fatigued. In fact, F.K. began to regularly participate in "Fitness Boot Camp" in the community. He reported that he enjoyed this activity immensely. While F.K. was still obsessed with food, he was easily redirected and he could enjoy eating in a restaurant with his family with few problems.

Although F.K. still resides at CNS, he has continued to make gains in his recovery, even 11 years after his brain injury. He is able to travel out of state to visit his family, participates regularly in community activities, and enjoys dancing and karaoke. Most importantly, F.K. reports being happy and feeling great!