Neurology Now:
Special Report: Brain Injury

THE LONG ROAD HOME

CARROLL, LINDA

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For more information about traumatic brain injury, see Resource Central on page 46.

The last thing Kim Valentini remembers from the hot summer night that forever changed her life is a set of blindingly bright headlights swerving behind her as she switched lanes on a deserted stretch of Virginia highway.

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Everything that came afterward she learned from her fiancé who saw it unfold from the passenger seat: how the tailgating car had darted into the spot she was aiming for; how the Ford Bronco she was driving had flipped four times; how he had protected his head by putting his hands up against the roof of the rolling vehicle-and how she had not.

The next memory is of a hospital bed and a horrible headache. Her family is crowded around and someone is telling her that she's been in a coma for 17 days. She remembers begging for some Excedrin to ease the pain.

Valentini's cuts and broken bones have healed, but 11 years later, the injury to her brain still impacts her life. Her short-term memory is spotty and whole sections of her long-term memory seem to have been erased. Her thinking has slowed. She has trouble sometimes finding words for commonplace objects. And worst of all, she's lost touch with the person she once was.

“I had to redefine myself,” says Valentini, 36. “I couldn't remember the Kim I was before the accident. Although I could remember things from when I was really little, the Kim who graduated from college and worked and had gotten a couple of promotions at her job-I couldn't remember her. And it wasn't like I could just go open a book and see how I needed to be.”

When her vehicle rolled, Valentini became part of some sobering statistics: Each year, 1.5 million Americans suffer a traumatic brain injury (TBI). And 44 percent of those occur in traffic accidents. “It's a silent epidemic,” says Douglas I. Katz, M.D., medical director of the traumatic brain injury program at Braintree Rehabilitation Hospital near Boston. “The numbers are staggering. There are 5.3 million people living with disability because of TBI. So many of the diseases you hear about every day are dwarfed by TBI.”

And as people like Valentini quickly learn, the funds to treat and rehabilitate brain injuries are limited. “When you look at the resources applied for TBI versus other neurological disorders,” Dr. Katz says, “it's a tiny, tiny fraction of what might be expected, given its incidence and prevalence.”

Even though Valentini was wearing a seatbelt when her vehicle rolled, she still severely injured her brain. In the years since the accident, she's had 15 brain surgeries-and had last rites performed five times.

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When she finally was released from the hospital, Valentini had to move back in with her parents in Edison, N.J. She needed to learn to walk and to talk all over again.

The problems with speech were particularly troubling for a onetime A-student at Villanova University. Sentences took forever to piece together as she struggled to find common words. Often she'd come up with a word that was near to the one she needed-“bowl” instead of “pan,” for example. “Sometimes I still get that glitch and my mom and dad joke that I'm using ‘Kimmerbonics’ because I have my own language,” she says, smiling. “People understand what I mean. But I don't get the right word for something because it won't pop into my head quickly enough.”

Even after her speech improved, she had problems focusing on a single conversation if there was too much going on around her-a common problem for those living with a TBI. Dinnertime could be daunting. “If my mom was talking to my sister and my grandmother was talking to my dad all at the same time, I'd just get agitated and anxious,” she remembers. “It all sounded so loud in my head. I'd be like, ‘Please just stop!’”

Ultimately, her family figured out a fix. “They decided there could only be one conversation at a time,” she says. “They saw how much more at ease it made me. Then they slowly started to introduce one more person at a time. They were really giving me therapy at home, without realizing that was what they were doing.”

In the first two years, Valentini made a lot of progress; she was working hard to come back. But then her fiancé told her he couldn't wait any longer for the old Kim to reappear-the one who loved to go out dancing and go skiing, the one who was self-confident and bold. She suspects he was also frightened by the responsibility because, she says, “I was very fragile after the accident.”

That loss was almost too much to bear. “When my fiancé broke off the engagement, my whole bottom fell out,” she says. “I had been doing the rehabilitation the first two years because I wanted to be his wife. It took me a while to replace that goal.”

When the money from her insurance settlement ran out, Valentini got help from New Jersey's Division of Vocational Rehabilitation. But in time, even that agency lost interest in paying Valentini's bills, informing her that she wasn't improving fast enough.

For five years, there was no money for therapy. Valentini wanted to work. Going back to her old job as an operations manager was impossible. She couldn't even remember what the job entailed until she found her notes from a presentation in which she described the work.

She turned to temp jobs-but the brain injury got in the way there, too. “I'd get a temp job and I'd be so excited,” she recalls. “I'd work for two days and then I'd get a phone call. And they'd say, ‘We don't want you to come back.’ It was because I couldn't do the work.”

That was the low point, she says. “My self-esteem kept shrinking and shrinking and shrinking,” she remembers. “I thought, I can't do jobs people once did for me. I can't keep a job. I can't handle conversations at the dinner table-my family has to limit how they talk because of me.”

And then, something finally went right. Five years after the Division of Vocational Rehabilitation pulled the plug on her therapy, the agency offered Valentini a chance to enter a new intensive program at the Center for Head Injuries at the JFK-Johnson Rehabilitation Institute in Edison.

The doctors and therapists there showed her strategies to remember words. They taught her to use Post-It notes whenever she got up from her seat at work so that she'd remember where she left off. They taught her to write everything down in her date book.

Valentini knows her life isn't ever going to be the same as it was before. “It's taken a while for me to finally accept that my life is different, and that's OK,” she says. “Sometimes I don't even know if I want the old Kim back. I was working full-time 50 to 60 hours a week and trying to squeeze some fun activities in. And life was just a whirlwind. Now I have time to do other things, to stop and smell the roses. It's given me the opportunity to see a different side of living.”

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Treating Trauma

Level I Trauma Center

A hospital designated to care for the most critically injured patients. It provides teams of professionals specially trained to treat trauma and critical care injuries.

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Acute Rehabilitation

The first stop in rehab is at an inpatient setting. Treatment teams include physicians and nurses specializing in rehabilitation medicine, physical therapists, occupational therapists, speech therapists, and psychologists.

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Post-acute Rehabilitation

Comprehensive integrated programs provide outpatient or residential treatment. They help patients regain social skills, function in the community, and resume productive activities like school and work.

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Section Description

Eleven years after a horrific car wreck, one woman's ongoing recovery speaks for millions of brain-injured Americans

©2006 American Academy of Neurology

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