It is not uncommon for someone who sustains a mild brain injury to receive a clean CT scan. You were smart to consult a neuropsychologist for more diagnostic information. And, the neuropsychologist's conclusion that your problems were present before your injury makes sense. If you stunk in math before your injury, you'll still be counting on your fingers after the accident. A person with depression prior to the accident probably will emerge from the injury with depression. In fact, the depression may be worse because you are reacting to the fact that you experienced a traumatic event. There may be no physical/organic cause for your depression that did not exist prior to the accident. You simply would be reacting normally to a traumatic event. What you need to do is find out why you take longer to get things done, to clean house, etc. if these problems did not exist before the accident. Feeling slowed down is very common after a brain injury, by the way. You may benefit by getting a second opinion from another neuropsychologist or a neuropsychiatrist if you feel that you need medication. This does not diminish the opinion of the first neuropsychologist; a second opinion simply gives you more information.

Even though your son was injured over one year ago, he still can continue to make progress. It is worth the effort to assess his current problems and pursue treatments that may help. You can take the first step in this assessment and then consult the appropriate professional(s).

First step: Make a written record of the communication problems. Try to answer the following questions.

What words are problematic? Your current observations are very helpful -- he has trouble with words not used pre-injury. Your son is having difficulty partly because information learned prior to an injury may be easier to recall than information attempted post-injury.

Are there any clues to why he cannot say certain words? Is he receiving your message? That is, can he hear and understand what you are saying to him? If so, does he have the ability to express himself? For example, can he mentally retrieve words? physically speak the words? put them in a meaningful sentence?

Note the environments in which problems occur. Are there distractions in the environment? Is it too noisy? I someone making him nervous?

As you can see, communication involves complex cognitive and physical functions. Once you have gathered detailed information about your son's difficulties, you may wish to consult a speech language pathologist for an evaluation of your son and therapy recommendations. The speech language pathologist can advise your family with suggestions such as speaking only when facing your son, slowing down your rate of speech, simplifying your vocabulary, etc. If a hearing problem is suspected, an audiologist may be consulted.

(Reference: Blosser, J., DePompei, R. (1996). Crossing the Communication Bridge: Speech, Language and Brain Injury. Brain Injury Association, Inc.: Alexandria, Virginia.)

Actually, personality and behavior changes are quite common after a brain injury. Many people experience a decrease in inhibition – making them less anxious about things. On the other hand, it can also make them more impulsive, aggressive or irritable. Some people even describe the person as being calmer and quieter after an injury. It’s hard to predict and sometimes the changes are temporary. Also, sometimes people who experience a traumatic event that brings them close to death make changes in their lives that have nothing to do with a brain injury.

Maybe you can clean Pat’s office? On the other hand, even you might not be able to handle that!

You may be experiencing symptoms of obsessive-compulsive disorder. It depends on how often you obsess and how much it disrupts your life. Obsessive-compulsive disorder has been linked to several areas of the brain including the frontal lobe and the neurotransmitter called serotonin. It is possible that damage to certain parts of your brain such as the frontal lobe may have contributed to your symptoms. Medications affecting serotonin such as Prozac and Luvox have been used with some success in treating OCD. In addition, cognitive-behavior therapy can be very effective, particularly for milder cases. Don’t be afraid to seek help. Talk to your physician or make an appointment with a psychiatrist or psychologist who can help you evaluate your symptoms and discuss options.

It sounds like your dad is a pretty interesting guy who can still do a lot of things and has some big dreams. Usually what I recommend is for the family and the patient to visit several facilities to see which one is the best match for the patient. You and your father will better be able to judge if a facility is a good match for him than any "expert." If your dad does need 24-hour supervision or cannot be left alone, it may be necessary for you to use an adult care facility even if it’s not the "best" possible option. A less restrictive option may be to locate mentors or other people that can work with brain injury survivors one-to-one. Find out if there are local brain injury support groups. Often these are the best sources for ideas and information since they consist of survivors and family members who have gone through similar situations.

On the other hand, if your father only needs minimal supervision your family may be able to help out a lot. Most people very much prefer the company of their family to the company of strangers. If you, your sister, and your aunt all work during the day, perhaps you could hire someone to provide in-home or part-time supervision. Maybe as your dad recovers, he will require less supervision during the day and can live with a family member without the need for daytime supervision.

Consider consultation with a physiatrist or neuropsychologist who may be able to assess your father’s strengths and weaknesses, suggest an appropriate level of care, and refer you to the necessary resources.

I don’t think I’ve met a person with brain injury who didn’t feel this way to some extent. Figuring out what to tell people about an injury or even whether to tell people anything at all can be difficult. Loss of confidence and worrying about making a mistake are also common experiences of people after a brain injury. Many people who were previously comfortable around people become "shy" after the injury. They’re worried about what others think and about making a mistake that will let others know they are "weird."

Pat is glad to hear you already know that explanations aren’t necessary! Your injury is YOUR business. You do get to decide who to tell and who not to tell. Besides, a lot of the time the person who is most likely to notice "deficits" is the person with the brain injury! After all, everyone sometimes forgets things, seems distracted, is emotional, or can’t think of the right word. Obviously if your injury is more noticeable from your appearance, speech, or behavior, this can be more difficult to handle since people will wonder and many will ask. But one of the things about TBI is that the person often looks "healthy." (Although this can have drawbacks too since others may not be as sympathetic or understanding).

As for how to get over the anxiety, there are a few things to try. One is to practice these situations with a friend, family member or therapist. Are there particular types of situations that make you nervous? Are there questions you’re not sure how to answer? Is the flow of the conversation disrupted because of confusion or a memory problem? If you can rehearse these situations, you can build up confidence for life in the real situation. A therapist may be able to help you analyze what aspects of social situations make you uncomfortable and provide relaxation techniques to deal with anxiety. Finally, participation in a support group for brain injury may be helpful. I can guarantee if you go to a group, you will find others dealing with similar issues. Advice and feedback from someone who has been there is often the best thing.

Are there programs in your area that might evaluate your "damage" or take you on as a patient? In terms of an evaluation, you could certainly arrange to have neuro-imaging done to look for any structural anomalies in the brain. You could also have a neuropsychological evaluation to look at your cognitive strengths and weaknesses. Any rehabilitation program working with people with brain injury should be able to perform these services or refer you to someone who does. Ask your primary care physician for help in finding the resources in your area. As for taking you on as a patient – that would depend entirely on what you might need help with.

I’m afraid I can’t give you much guidance as far as participating in research. That would depend on what kinds of research projects might be run at hospitals or universities near you. The fact that your injury occurred so long ago and occurred while you were a child may also limit how many research studies you could be included in.

First, I should tell you that what you are experiencing is very common. Short-term memory problems, irritability, and a lower tolerance for stress are among the most frequent symptoms among survivors of brain injury. In addition, people often feel misunderstood by family members – especially if they look healthy on the outside. It is important that you talk to your family. For example, when you say, "I feel like my wife has to put up with another child." – is this how she feels, or is it how you think she feels? Have the two of you discussed the injury’s impact on your relationship?

A therapist with experience working with persons with brain injury can help you to develop ways to manage your anger and frustration. Consider involving your wife in therapy so you can address these problems together. In some cases, there may be medications that can help you better control emotions. You might want to start by keeping what behavior therapists call an ABC diary of the times you get angry. At the end of each day, write down all the things that made you angry using this system:

Antecedent – this is what was happening before you got angry. For example, if you were angry with the kids, what were you doing before you were angry? What led up to the anger? What were you thinking? What were you feeling? (For example, were you thinking about a problem? Were you already upset about something?).

Behavior – this is what you actually did when you were angry. For example, if you were angry because your child misbehaved, what did you do? Did you yell? Curse? Throw things? Hit a wall? What were you thinking about when you were angry?

Consequence – how did things end? How did you calm down again? How long did it take to calm down? Did you accomplish what you wanted to accomplish? (For example, did your children learn what they did wrong and receive appropriate discipline? Did you solve a problem with your wife?) Did you feel better? What was the effect on the people around you? Were they upset? Crying? Avoiding you? It is important to look at the consequences of your anger in order to identify ways to more effectively achieve a desirable outcome.

By keeping a diary like this, you can identify situations that tend to create anger and frustration in your life. There may be ways to avoid some situations that lead to anger and frustration. Are there situations that made you angry that shouldn’t have? Are there situations where your anger is appropriate? You may also identify times of the day, things you’re thinking about, your mood, or something else that contributes to your anger. You might be surprised about what you learn.

You also should keep in mind that everyone gets angry – and sometimes for good reason! How you deal with your anger is very important. Feeling angry is one thing. How you behave is another. It is the behavior that is most important to control. This is especially true with your children. All parents get angry, but good parents maintain enough self control that they don’t curse at, belittle, scream at, or hit their children. Instead they express their anger in a way that both lets the child know what the parent is angry about, teaches a lesson, and reminds the child they are loved even when they do something wrong.

Consider what type of outcome you want when something makes you angry. How can you best accomplish that outcome? Try to figure out ways to express your anger in a way that gets your point across without hurting others. If your anger is especially hard to control, talk to your family about how you would like them to respond when you are angry. For example, should they leave you alone or give you reassurance? What works best for you and your family? Most of the time, when people look at the "C" part of their diary, they find their anger isn’t making things better and they need to find ways to change. Talking with your wife and a therapist about ways to cope will help immensely.

Hematomas are blood clotting in tissue. I’m sure your father’s physicians will monitor these closely. As you noted, surgery is sometimes required to remove the clots. As for "typical behavior," it is very difficulty to predict brain injury outcome from skull fractures, or points of impact. The reason is that in high-speed traumas such as motor vehicle accidents, the brain can sustain multiple impacts as the person (and the brain) bounces around during accident. The brain often rebounds inside the skull creating injuries opposite the point of impact. In addition, diffuse injuries can occur because of rotational forces. Alcohol use at the time of injury further complicates the picture. Research has shown the persons who are intoxicated at the time of a brain injury are likely to have more problematic post-injury symptoms. Hopefully your father will beat the odds in this regard. To sum up, behavior is just very difficult to predict based on a CT or a MRI. As frustrating as it may be, there usually isn’t much to do, but "wait and see."

Probably the best advice is to be patient and remember that recovery from brain injury is a long-term process. You will have a better sense for how your father’s recovery is going after about six to twelve months. It is important that he follow all his doctors' treatment recommendations and that he refrain from alcohol use (which limits recovery). You may also want to consider having a neuropsychological examination done to establish a baseline against which you can measure future recovery.