New hope for brain-injured patients

Posted on 14 February 2023

Neuropsychologist Dr Katie Hamilton recently joined Mediclinic Morningside, providing specialised psychological intervention for patients with brain trauma.

Neuropsychology is the study of the relationships between the brain and behaviour, cognition, mood, and personality. Although its an established field internationally, it is a new speciality in South Africa – and was officially recognised only in 2020, when the Health Professions Council of South Africa (HPCSA) opened the register for psychologists in this category.


“As a neuropsychologist, I study how disease and trauma affect the brain, and the relationships between the brain and cognition, behaviour, personality, and mood,” says Dr Katie Hamilton, who recently opened her practice at Mediclinic Morningside. “My goal is to help patients – and their support networks – understand how brain trauma has affected them, and assist them in reclaiming their lives.”


Neuropsychologists typically see people who have experienced a stroke (cerebrovascular accident), head injury (e.g., assault, accident, concussion), brain tumour or brain bleed, epilepsy, dementia, and neuromuscular or movement disorders. “The brain is responsible for everything – from breathing to speech to thought to movement to emotions and more,” says Dr Hamilton. “The types of changes that can occur after injury are vast – from losing the ability to differentiate between dream and reality, to depression, lack of insight, thought disorders, delusional thinking and developing paranoia, and changes in your memory and other cognitive areas.”


How a neuropsychologist can help

Most clients seek help understanding any changes to cognition, emotion, and/or personality following an illness or injury that affects the brain. Alternately, even if a patient does not have a diagnosis or history of any of the above, a neuropsychologist can assist if they are experiencing:

memory difficulties
concentration difficulties
changes in the ability to problem solve or deal with information
changes in the ability to speak, read, write, or understand what others are saying
mental fog.

“I explore whether changes in behaviour, cognition, mood and personality are a result of an organic cause (injury or disease) or a functional cause (psychological or psychiatric),” Dr Hamilton explains. “Often, a person experiences a combination of organic and functional influences and I can help differentiate the root causes of the various changes.”


Differentiating these root causes is much like solving a complex puzzle. “We look at three aspects – how the patient’s life was before the brain trauma, how it has changed subsequently, and what would explain the changes,” Dr Hamilton says. “The most important aspect is identifying the mechanism to explain the neurological or psychiatric changes. This entails asking why it happened. Was it caused by stroke damage to that area? Was it as a result of a concussion? If it all fits nice and neatly with changes in one organic area or neurochemical system, it’s neurological. If there’s no mechanism that explains it, it’s probably psychiatric. And often it is a combination, with an intertwined relationship between the organic and function.  Once we understand the mechanisms, we can treat appropriately.”

Multidisciplinary approach

Rehabilitation entails a holistic and multidisciplinary approach. “In an ideal situation, we will include physiotherapy to assist with balance, walking and movement; speech therapy; occupational therapy for extra cognitive support; and a counsellor for family support,” says Dr Hamilton. “Where necessary, we can also call on social workers for extra assistance. Research shows that the best long-term outcome involves therapy, but medication is prescribed as an adjunct when required. We also discuss the role of neuropsychology in providing the support patients need throughout their rehabilitation.”


Neuropsychology helps ensure patients fully understand the implications of their brain injury and how to overcome or manage any changes in cognition, mood and/or personality.  “Your brain is what allows you to engage and experience life,” says Dr Hamilton. “A neuropsychologist can help someone understand how they’ve been affected by a particular injury.  Often patients don’t know what has happened, so we’re able to explain how and why they are possibly thinking differently.”


She adds that two years after the brain injury, the focus switches from neurological rehabilitation (trying to get the brain to improve), to adaptation, which entails compensation techniques. “There is never a point where we lose hope. We focus on giving our patients purpose and agency. We assist them in accepting the permanent changes to their behaviour, cognition, mood and personality. Understanding how brain function has changed after an injury or illness is essential for a patient to work out how theyre going to function moving forward. Its an important and empowering step in the recovery process.”  

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