The Case of Mary: A Tbi Case Study

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Pre-injury and post-injury

As mentioned above with the WAIS-III, there has been a newer version that has been used called the WAIS-IV (Fourth addition). This assessment is a general test for intelligence and was developed the cognitive abilities in adults. This test examines the relationship between the intellectual function of the individual and their memory (Benson & Kranzler, 2010). In Mary’s case, since there were no prior assessments conducted, it may be challenging to obtain a base line for her pre-injury assessment. Lichtenberger, Kaufman and Kaufman (2012) stated that patient’s with TBI consistently impacted the speed of processing. In Mary’s case, if she scored low on the subtests, it could be caused by the lack of appropriate processing speed.

Cognitive Speed

To test Mary’s cognitive speed, one assessment to administer is the PASAT (paced auditory serial addition test). The PASAT assesses the processing speed from auditory information (Mitrushina, Boone & Razani, 2014). During this assessment, Mary would listen to a recording with a stimulus of single digits every three seconds. She must add each new digit to the one presented prior. This assessment tests Mary’s cognitive function as it relates to processing speed. This will give detail as to why she cannot keep up in class when the teacher is presenting information and at what speed she is capable of processing.

Another assessment for cognitive speed would be the Trails A&B. This assessment requires patients to connect a series of 25 dots alternating between letters and numbers in ascending order as quickly as possible (Chan, MacPherson, Robinson and Lecce, 2015). The amount of time that the patient takes to complete the task, is generally the measurable outcome. However, the number of errors can be calculated in the score as well. For Mary, this will test her executive function as it relates to her short-term and long-term memory.

Recommendations for Accommodations

School

In Mary’s case, given that she has suffered a mild to severe traumatic brain injury, experiencing executive dysfunction as it relates to her short-term and long-term memory, behavioral changes, and emotional changes, she should be placed on an individualized education plan (IEP) at school while in recovery. The IEP can address short-term and long-term goals for Mary. The IEP can also address modified course work, longer testing time and note-taker services.

Home/Everyday

Due the traumatic event that happened to Mary, it is highly likely that Mary could develop Post Traumatic Stress Disorder (PTSD) as symptoms overlap one another (APA, 2013). It should be recommended that Mary attend talk therapy before administering psychological medication. This will allow Mary to process the traumatic event and reduce behaviors associated with PTSD. Mary should also be involved in cognitive rehabilitation therapy. This a goal-oriented therapy that can work in both aspects of life, school and home (PsychCentral, 2015). This allows and teaches patients to increase their processing ability and information interpretation.

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References:

American Psychiatric Association (2013). Major or mild neurocognitive disorder due to traumatic brain injury: Diagnostic and statistical manual of mental disorders, Fifth edition. Arlington, VA, American Psychiatric Association.

Benson, N., Hulac, D. M., & Kranzler, J. H. (2010). Independent examination of the Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV): What does the WAIS-IV measure? Psychological Assessment, 22(1), 121-130.

Chan, E., MacPherson, S. E., Robinson, G., Turner, M., Lecce, F., Shallice, T., & Cipolotti, L. (2015). Limitations of the trail making test part-B in assessing frontal executive dysfunction. Journal of the International Neuropsychological Society : JINS, 21(2), 169-174. doi:http://dx.doi.org/10.1017/S135561771500003X

Glasgowcomascale.org. (2017). What is GCS - glasgow coma scale. [online] Available at: http://www.glasgowcomascale.org/what-is-gcs/ [Accessed 2 Sep. 2017].

Green, R. A., Melo, B., Christensen, B., Ngo, L., Monette, G., & Bradbury, C. (2008). Measuring premorbid IQ in traumatic brain injury: an examination of the validity of the Wechsler Test of Adult Reading (WTAR). Journal of clinical and experimental neuropsychology, 30(2), 163-172. doi:10.1080/13803390701300524

Holdnack, H.A. (2001). Wechsler Test of Adult Reading: WTAR. San Antonio. The Psychological Corporation

Johnstone, B., Callahan, C. D., Kapila, C. J., & Bouman, D. E. (1996). The comparability of the WRAT-R reading test and NAART as estimates of premorbid intelligence in neurologically impaired patients. Archives of clinical neuropsychology: The official journal of the national academy of neuropsychologists, 11(6), 513-519.

Lekzak, M., Howieson, D., Bigler, E., & Tranel, D. (2012). Neuropsychological Assessment (5th ed.). New York, New York: Oxford University Press.

Lichtenberger, E. O., & Kaufman, A. S. (2012). Essentials of psychological assessment ser.: Essentials of WAIS-IV Assessment (2). New York, US: John Wiley & Sons, Incorporated. Retrieved from http://www.ebrary.com

PsychCentral. (2015, October 06). Cognitive rehabilitation therapy for traumatic brain injury (TBI): Does it work? Retrieved September 04, 2017, from https://psychcentral.com/news/2011/10/13/cognitive-rehabilitation-therapy-for-traumatic-brain-injury-tbi-does-it-work/30325.html