Brain injury program meets needs of teens

Focus is on academic re-entry, social issues

A new program that focuses on the special academic and social needs of adolescent brain injury patients has opened at Kessler Institute for Rehabilitation in East and West Orange, NJ. It's one of the few formalized programs nationally for adolescent brain injury patients and the only one in New Jersey.

Kessler has always treated some adolescents in its outpatient traumatic brain injury program. "In New Jersey, there are only adult special services or children's special services. There didn't seem to be anything to address the needs of adolescents," says George J. Carnevale, PhD, assistant director of psychology and neuropsychology at Kessler Institute for Rehabilitation's East Orange facility.

In the past, Kessler had no services for younger adolescents. Children 16 and older simply were admitted to the adult brain injury program. The adolescent program takes patients as young as 12 and as old as 19.

Adolescents don't relate well to programs for adults that concentrate on getting patients back to work, and they feel like they're too old for pediatric programs, Carnevale points out. "That's why we developed a program with a strong professional staff with expertise in academic re-entry and the psychosocial and development issues specific to adolescents. We want to maximize our ability to work effectively with that population." (For more on how adolescents differ from adults, see story, p. 100.)

Kessler's brain injury program is an outpatient day program run by an interdisciplinary team. Patients attend as many as five days a week, depending on individual needs.

The length of stay is expected to be two to three months for patients who are admitted after their acute rehab stay, and less for patients who have been released to the community and are experiencing problems.

Many times, for patients who are victims of multiple trauma, the cognitive impairments are not diagnosed until the patients are discharged to the community. Those patients may be admitted to the Kessler program for additional services.

Cognitive and other types of disabilities caused by brain injury may be invisible to many people because the patients look good, Carnevale says. That's particularly true with adolescents, who place a big priority on appearance.

"Adolescents have a real desire to be back with their friends, to get back into the swing of things and not lose pace with their peer group. This can be a real problem if they aren't able to compete when they go back," he explains.

For example, if patients are unable to compete in school when they return after an injury, they may be in for failures that could cause anxiety disorders in addition to their head injuries.

Kessler's program aims to provide early intervention to lessen secondary complications of brain injury. The program includes the following:

o Simulated classroom activities.

In the hospital setting, brain injury patients tend to deny the long-term effects of their injury. In the case of adolescents returning to school, they haven't been studying in the acute care hospital and don't know if they can remember what they read, if their ability to pay attention has been impaired, or if they are still able to organize and write a term paper.

At Kessler's day treatment program, patients participate in simulated classroom activities during which they may write a term paper, learn a language, practice geometry, or try out other skills.

"They can evaluate themselves and test their skills in a safe environment before they go back to a real-world setting. They develop an awareness of what they have to cope with," Carnevale says.

o A return-to-school program.

Therapists with backgrounds in special education work with the school systems and the adolescents' teachers to develop an individual educational program that can overlap into the regular school program when the student returns.

o An extensive psychological component.

The psychological component was added to decrease the secondary complications that occur when patients put themselves in situations that don't match their current cognitive capabilities. Most of the brain injury patients will return to school, but they will have to learn different study methods to cope with their cognitive deficits.

Brain injury also can cause personality changes. An adolescent who was self-conscious before the injury, for instance, can become anxious to the point of disability.

"A head injury may not produce severe cognitive deficits, but it can release a psychological condition that becomes a major focus for the patient," Carnevale adds.

Brain injury patients often don't have a full awareness of their deficits because their injury impaired the ability to judge their own performance. They may have severe memory problems that are apparent to others but not to themselves.

"This particularly a problem with adolescents who are going through a difficult time in terms of self image anyway. The idea of brain damage is extremely difficult for them to accept, and they need a great deal of support and education," Carnevale says.

o Group therapy.

Many therapy groups revolve around cognitive issues. For instance, there is a problem- solving group, a memory group, and a new learning group. Some groups address behavioral and psychosocial problems such as self-esteem, stress management, changes in social functioning, and sexuality.

As needed, patients may be assigned to groups that deal with specific issues such as visual perceptual problems.

o Substance abuse education.

Up to 60% of emergency department admissions for head injury involve alcohol use, Carnevale says. In addition, many brain injury victims later turn to alcohol or drugs to boost self-esteem or cope with depression. The Kessler program includes drug and alcohol counseling and may refer patients to outpatient resources for specialized detoxification or substance abuse treatment.

Patients also are encouraged to attend Alcoholics Anonymous or Narcotics Anonymous meetings that take place on the hospital campus.

[For more information on Kessler's adolescent day treatment program, call (973) 414-4711.]