New hope for brain-injured patients

“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 they’re going to function moving forward. It’s an important and empowering step in the recovery process.”