Alan Crimmins: A Case Study
Cathy and Alan Crimmins thought they were going to spend a relaxing family vacation with their seven year old daughter (Kelly) and some close friends, on a lake in Canada. However, on the last day of their vacation Alan and Kelly are returning their friends to shore in a small boat, when the boat was struck by another boat. Kelly and the friends are shaken up but have little physical damage. Alan was not as lucky. He sustained substantial damage to the left side of his body, including his head.
Despite receiving immediate medical attention (there was a nurse on the other boat) Alan’s injuries almost take his life. He suffered a grand mal seizure in the helicopter on the way to the hospital and the crew had to revive him. When he entered the hospital he was given a 1 to 3 on the Glasgow Coma Scale test. A normal, conscious brain would receive a score of 15. In order to keep the swelling down on his brain, a normal reaction after a traumatic brain injury (TBI), he was placed in a drug induced coma where he remained for several days. Upon waking up Alan was officially diagnosed with diffused axonal injury, with subdural hematomas in the frontal lobe including damage to his right side motor strip. …show more content…
Though Alan’s wife Cathy knows very little about TBIs or the best treatment for Alan, she was forced to become his greatest advocate.
Over the next few months she must deal with an incompetent HMO system, and the frustration of little communication and continuity between professionals in the medical field and the health insurance company. Alan spent the next year moving from Canada to a hospital in the US then from an inpatient to an outpatient rehabilitation center. Though Alan was back at work within one year of the accident, the Crimmins lives were not back to normal. As Cathy puts it at the end of the book, “We have a reasonable facsimile of our
life.”
The book had several salient points. The first being how a brain injury affects not only the person who received the damage but also the lives of those around him. Alan’s wife was suddenly married to a completely different man. Alan experienced several side effects from the brain damage including memory loss, extreme disinhibition, and a lack of self-control that made him act more like a young child than a 44 year old man. He went from having an adventurous nature to be being terrified to swim in a pool and from a successful lawyer to someone who was not capable of being left alone. He also had a change in his personality. He went from being a wonderful father and husband to a man who was extremely verbally abusive to his 7 year old daughter and his wife.
Alan’s mother, father, and brother and as well as his friends were also affected by Alan’s brain injury. His father was so upset when he first saw Alan that he cannot even go into his room. Alan’s mother seemed to be in a constant state of shock and continually thought that Alan was going to miraculously get better. Alan’s brother left his wife and children in another state to spend several weeks helping Cathy. Many of Alan’s friends were so upset by his behavior they left the hospital in tears.
The second salient point was how fragile the US health insurance system was with Alan’s treatment. Cathy had to fight for Alan to receive adequate care. The insurance company fought them at almost every turn. They cut corners and sent them inadequate air transportation from the Canada to the U.S. which may have exacerbated Alan’s injuries. When he left Canada he was sitting up and talk but by the time he finally arrived in the U.S. Alan had become completely unresponsive. They also fought the amount of serves he could have at the rehabilitation center and the amount of serves he could receive as an outpatient.
The third salient point was that recovery for a person with a brain injury is like a “roller coaster ride.” Alan was responding to Cathy and the doctors in Canada only to become nonverbal after the transfer to the U.S. One day he would remember that he had a brain injury only to completely forget about it the next day. Cathy would see glimpse of Alan’s per-injury personality and believe that he was returning to “normal” only to be shocked by his behavior an hour later. Even his physical abilities would come and go depending on the amount of stress or fatigue Alan had.
Alan experienced may symptoms that are very typical of a person with a brain injury including both cognitive difficulties and decline in motor function. Cathy was told at HUP that it is very common for people with brain injuries to be inattentive. Alan could not concentrate on eating one day because Cathy’s shirt looked too beautiful. He went through several weeks of touching himself inappropriately in front of other people, which is a sign of disinhibition that many patients with frontal lobe damage exhibit. The same was true for Alan no longer knowing what was appropriate to say. He called his daughter awful names and remarked how stupid she was and he swore at the nurses and therapists.
Alan also lost control over the right side of his arm and leg. This is typical of someone who had sustained damage to their motor cortex. Alan denied his disabilities which are typical of a person post brain injury. Alan did exhibit some things that were rare for a person with a TBI. Alan thought that his wife was two different people, a term called reduplication paramnesia. Though the doctors say that they had read about it, it is not something that was typically seen after a brain injury.
Another atypical thing about Alan’s brain injury was the progress he made within the first year. Lisa Gordon, who was the case manager overseeing Alan’s rehabilitation, made several comments about how Alan’s progress was not typical. She said that Alan had “cleared quickly” meaning he had better orientation compared to most people with his extent of brain damage. She also remarked that he was a lot less self-centered than other TBI patients. She attributed this to the high amount of education Alan had.
Alan returned to his previous activities much quicker than most people with his extent of brain damage. He was back to driving within 5 months of the accident and he returned to work part-time only 6 months after the accident. The Human Resource director at Alan’s work said that they only had one other person return to work after a brain injury and he was a janitor. Within only a few months of working Alan was back to having 220 accounts (a full case load is 170), though he was mentally and physically exhausted by the end of the day.
An SLP can be a positive contributor to a person with a TBI by providing immediate and intensive therapy that is individualized. Alan had intensive physical, occupation, and speech therapy which contributed to his progress. However, when the treatment was not individualized he made little progress. At HUP Alan received physical therapy in a busy room, and make little progress. On the brain injury ward at the rehab hospital he was sequestered in a small, sheltered gym and he made substantial progress. During a clinical evaluation an SLP can look for strengths and weaknesses that they can pass on to other people on the client’s rehabilitation team in order to have the maximum benefits from therapy.
An SLP can also assess the communication needs of the patient and connect it to speech tasks that will have the greatest benefit for the client. Alan made the most progress when he could relate what he was doing in therapy to benefits in the outside world. When he could see the connection between what he was working on in therapy and real life, he was motivated to continue to work on the task. An SLP can tap into this intrinsic motivation by evaluating the personal and professional communicative needs of the client, and increasing the likelihood that the client will work hard to make progress.
Despite receiving immediate medical attention (there was a nurse on the other boat) Alan’s injuries almost take his life. He suffered a grand mal seizure in the helicopter on the way to the hospital and the crew had to revive him. When he entered the hospital he was given a 1 to 3 on the Glasgow Coma Scale test. A normal, conscious brain would receive a score of 15. In order to keep the swelling down on his brain, a normal reaction after a traumatic brain injury (TBI), he was placed in a drug induced coma where he remained for several days. Upon waking up Alan was officially diagnosed with diffused axonal injury, with subdural hematomas in the frontal lobe including damage to his right side motor strip. …show more content…
Though Alan’s wife Cathy knows very little about TBIs or the best treatment for Alan, she was forced to become his greatest advocate.
Over the next few months she must deal with an incompetent HMO system, and the frustration of little communication and continuity between professionals in the medical field and the health insurance company. Alan spent the next year moving from Canada to a hospital in the US then from an inpatient to an outpatient rehabilitation center. Though Alan was back at work within one year of the accident, the Crimmins lives were not back to normal. As Cathy puts it at the end of the book, “We have a reasonable facsimile of our
life.”
The book had several salient points. The first being how a brain injury affects not only the person who received the damage but also the lives of those around him. Alan’s wife was suddenly married to a completely different man. Alan experienced several side effects from the brain damage including memory loss, extreme disinhibition, and a lack of self-control that made him act more like a young child than a 44 year old man. He went from having an adventurous nature to be being terrified to swim in a pool and from a successful lawyer to someone who was not capable of being left alone. He also had a change in his personality. He went from being a wonderful father and husband to a man who was extremely verbally abusive to his 7 year old daughter and his wife.
Alan’s mother, father, and brother and as well as his friends were also affected by Alan’s brain injury. His father was so upset when he first saw Alan that he cannot even go into his room. Alan’s mother seemed to be in a constant state of shock and continually thought that Alan was going to miraculously get better. Alan’s brother left his wife and children in another state to spend several weeks helping Cathy. Many of Alan’s friends were so upset by his behavior they left the hospital in tears.
The second salient point was how fragile the US health insurance system was with Alan’s treatment. Cathy had to fight for Alan to receive adequate care. The insurance company fought them at almost every turn. They cut corners and sent them inadequate air transportation from the Canada to the U.S. which may have exacerbated Alan’s injuries. When he left Canada he was sitting up and talk but by the time he finally arrived in the U.S. Alan had become completely unresponsive. They also fought the amount of serves he could have at the rehabilitation center and the amount of serves he could receive as an outpatient.
The third salient point was that recovery for a person with a brain injury is like a “roller coaster ride.” Alan was responding to Cathy and the doctors in Canada only to become nonverbal after the transfer to the U.S. One day he would remember that he had a brain injury only to completely forget about it the next day. Cathy would see glimpse of Alan’s per-injury personality and believe that he was returning to “normal” only to be shocked by his behavior an hour later. Even his physical abilities would come and go depending on the amount of stress or fatigue Alan had.
Alan experienced may symptoms that are very typical of a person with a brain injury including both cognitive difficulties and decline in motor function. Cathy was told at HUP that it is very common for people with brain injuries to be inattentive. Alan could not concentrate on eating one day because Cathy’s shirt looked too beautiful. He went through several weeks of touching himself inappropriately in front of other people, which is a sign of disinhibition that many patients with frontal lobe damage exhibit. The same was true for Alan no longer knowing what was appropriate to say. He called his daughter awful names and remarked how stupid she was and he swore at the nurses and therapists.
Alan also lost control over the right side of his arm and leg. This is typical of someone who had sustained damage to their motor cortex. Alan denied his disabilities which are typical of a person post brain injury. Alan did exhibit some things that were rare for a person with a TBI. Alan thought that his wife was two different people, a term called reduplication paramnesia. Though the doctors say that they had read about it, it is not something that was typically seen after a brain injury.
Another atypical thing about Alan’s brain injury was the progress he made within the first year. Lisa Gordon, who was the case manager overseeing Alan’s rehabilitation, made several comments about how Alan’s progress was not typical. She said that Alan had “cleared quickly” meaning he had better orientation compared to most people with his extent of brain damage. She also remarked that he was a lot less self-centered than other TBI patients. She attributed this to the high amount of education Alan had.
Alan returned to his previous activities much quicker than most people with his extent of brain damage. He was back to driving within 5 months of the accident and he returned to work part-time only 6 months after the accident. The Human Resource director at Alan’s work said that they only had one other person return to work after a brain injury and he was a janitor. Within only a few months of working Alan was back to having 220 accounts (a full case load is 170), though he was mentally and physically exhausted by the end of the day.
An SLP can be a positive contributor to a person with a TBI by providing immediate and intensive therapy that is individualized. Alan had intensive physical, occupation, and speech therapy which contributed to his progress. However, when the treatment was not individualized he made little progress. At HUP Alan received physical therapy in a busy room, and make little progress. On the brain injury ward at the rehab hospital he was sequestered in a small, sheltered gym and he made substantial progress. During a clinical evaluation an SLP can look for strengths and weaknesses that they can pass on to other people on the client’s rehabilitation team in order to have the maximum benefits from therapy.
An SLP can also assess the communication needs of the patient and connect it to speech tasks that will have the greatest benefit for the client. Alan made the most progress when he could relate what he was doing in therapy to benefits in the outside world. When he could see the connection between what he was working on in therapy and real life, he was motivated to continue to work on the task. An SLP can tap into this intrinsic motivation by evaluating the personal and professional communicative needs of the client, and increasing the likelihood that the client will work hard to make progress.