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APP3037 Case Study 2 – Traumatic Brain Injury Assessment

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Miriam is a 35 year old woman living in the suburbs of Melbourne who suffered a traumatic brain injury in a head on motor vehicle accident (MVA) 12 months ago. At the time of her injury she was working as a senior manager in for a large bank. She is married to Jake (38 years) who works as a logistics manager for a large transport company. Together they have two children, Josh, aged 6, who is currently in grade 1 at the local primary school, and Kayla, aged 2.

Miriam was alone in her car travelling at 100kms per hour on a freeway when a drunk driver crossed to the opposite side of the road, causing the head on collision. Her head contacted with the windscreen and she suffered facial contusions and severe trauma to her right leg. She sustained a closed head injury causing damage to her frontal lobes, specifically to the premotor and supplementary motor areas of the left hemisphere, and the prefrontal cortex, dorsolateral prefrontal cortex and the orbitofrontal cortex bilaterally. She also suffered a series of small bleeds and white matter damage to her temporal lobes bilaterally.

Following the accident Miriam spent 6 weeks in an acute care hospital. She was unconscious for three days, and suffered a period of 1 month post-traumatic amnesia. She displays a retrograde amnesia for the period of 6 months prior to the accident that persists to the current time (1 year later). From the acute care setting she was transferred as an inpatient to a rehabilitation facility for a period of a further 3 months where she underwent intensive therapy to learn to walk and talk again. Since discharge she has continued her rehabilitation program as an outpatient, and persistent weakness remains in her right limbs. Her speech production also remains effortful and telegraphic, and a dysarthria remains evident.

As a consequence of the MVA Miriam has been unable to return to her demanding work role. Although her post-traumatic amnesia is resolved, she continues to have problems with memory, concentration and reasoning. Although she does not suffer anterograde amnesia, she does suffer impairments in her short term memory. Her husband reports that she constantly repeats the same anecdotes and has trouble remembering to take her medication and to assist her children beyond their basic care.

Jake also reports a personality change in Miriam. He says that she is becoming increasingly frustrated and has started to have anger outbursts, and it is not unusual for her to move from laughter to anger very quickly. Despite being described as a bubbly and fun person before the MVA, she now presents as flat and detached from her emotions most of the time. Since she has a six month retrograde amnesia for the time prior to the MVA she has no recollection of Kayla learning to walk and talk, and her physical impairments make it difficult for her to pick or hold her young daughter.

After reading the case study, respond to the following, using references to support your conclusions:

  1. Using information from the case study regarding Miriam’s injuries, describe the relationship between the location of the damage in her brain to her symptoms. (approx. 400 words).
  2. Considering the information from the case study and using Erikson’s theory of psychosocial development as a framework, describe the implications for the lived experience of Miriam (e.g. in relation to family, work/school, friends ; approx. 400 words).
  3. Considering the information from the case study and using Erikson’s theory of psychosocial development as a framework, describe the implications for the lived experience of Miriam's family (e.g. in relation to family, work/school, friends etc.; approx. 400 words).
  • Uploaded By : Katthy Wills
  • Posted on : October 15th, 2022
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