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Posted: October 15th, 2020

Case Study: Traumatic Brain Injury

APP3037 Case Study 2 – Traumatic Brain Injury
Miriam is a 35 year old woman living in the suburbs of Melbourne who suffered a traumatic brain
injury in a head on motor vehicle accident (MVA) 12 months ago. At the time of her injury she was
working as a senior manager in for a large bank. She is married to Jake who works as a logistics
manager for a large transport company. Together they have two children, Josh, aged 6, who is
currently in grade 1 at the local primary school, and Kayla, aged 2.
Miriam was alone in her car travelling at 100kms per hour on a freeway when a drunk driver crossed
to the opposite side of the road, causing the head on collision. Her head contacted with the
windscreen and she suffered facial contusions and severe trauma to her right leg. She sustained a
closed head injury causing damage to her frontal lobes, specifically to the premotor and
supplementary motor areas of the left hemisphere, and the prefrontal cortex, dorsolateral
prefrontal cortex and the orbitofrontal cortex bilaterally. She also suffered a series of small bleeds
and white matter damage to her temporal lobes bilaterally.
Following the accident Miriam spent 6 weeks in an acute care hospital. She was unconscious for
three days, and suffered a period of 1 month post-traumatic amnesia. She displays a retrograde
amnesia for the period of 6 months prior to the accident that persists to the current time (1 year
later). From the acute care setting she was transferred as an inpatient to a rehabilitation facility for
a period of a further 3 months where she underwent intensive therapy to learn to walk and talk
again. Since discharge she has continued her rehabilitation program as an outpatient, and persistent
weakness remains in her right limbs. Her speech production also remains effortful and telegraphic,
and a dysarthria remains evident.
As a consequence of the MVA Miriam has been unable to return to her demanding work role.
Although her post-traumatic amnesia is resolved, she continues to have problems with memory,
concentration and reasoning. Although she does not suffer anterograde amnesia, she does suffer
impairments in her short term memory. Her husband reports that she constantly repeats the same
anecdotes and has trouble remembering to take her medication and to assist her children beyond
their basic care.
Jake also reports a personality change in Miriam. He says that she is becoming increasingly
frustrated and has started to have anger outbursts, and it is not unusual for her to move from
laughter to anger very quickly. Despite being described as a bubbly and fun person before the MVA,
she now presents as flat and detached from her emotions most of the time. Since she has a six
month retrograde amnesia for the time prior to the MVA she has no recollection of Kayla learning to
walk and talk, and her physical impairments make it difficult for her to pick or hold her young
daughter.
After reading the case study, respond to the following, using references to support your
conclusions:
1. Using information from the case study regarding Miriam’s injuries, describe the relationship
between the location of the damage in her brain to her symptoms. (approx. 400 words).
2. Considering the information from the case study and using Erikson’s theory of psychosocial
development as a framework, describe the implications for the lived experience of Miriam
(e.g. in relation to family, work/school, friends etc.; approx. 600 words).
3. Considering the information from the case study and using Erikson’s theory of psychosocial
development as a framework, describe the implications for the lived experience of Miriam’s
family (e.g. in relation to family, work/school, friends etc.; approx. 400 words).

Case Study: Traumatic Brain Injury
Student Name
Institution
Course

Case Study: Traumatic Brain Injury
Using information from the case study regarding Miriam’s injuries, describe the relationship between the location of the damage in her brain to her symptoms. (approx. 500 words).
Question One
Premotor and Supplementary Motor Cortex
The premotor and supplementary motor regions of the brain are responsible for the planning and preparation of movement, respectively. Research shows that damaged sustained to these sub-regions of the motor cortex impaires ……….
In Miriams case, she has muscle weakness in her right region …. Which is the result of injuries sustained too xxx sub-region ….
Prefrontal Cortex (Broca’s) Dorsolateral Cortex – Orbital frontal Cortex
The prefrontal cortex (PFC) and its sub regions; dorsolateral (DLPFC) orbitofrontal (OFC), ventrolateral (VLPFC) are responsible for “executive functioning” and acts as a receiver of information from other regions of the brain.
Damaged sustained to the PFC
In Miriam’s case
Temporal lobe (Wernicke’s) White Matter (Arcuate Fasciculus) – Maybe incorporate the implication of the bi-lateral damage sustained in the temporal lobe into the above two sub headings please. The white matter damage causes impaired message delivery to the frontal lobe region so it can be linked in.

Question Two – Lived experience of Miriam in three context and the implications
Considering the information from the case study and using Erikson’s theory of psychosocial
development as a framework, describe the implications for the lived experience of Miriam
(e.g. in relation to family, work/school, friends etc.; approx. 600 words).

Family
Work/School
Friends

Question Three – Lived experience of those around Miriam and the implications
Considering the information from the case study and using Erikson’s theory of psychosocial
development as a framework, describe the implications for the lived experience of Miriam’s family (e.g. in relation to family, work/school, friends etc.; approx. 400 words).

Family
(Husband Jake 35 years old / Son Josh 6 years old / Daughter Kayla 2 years old)
Work
Friends

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