Ask the Doctor

Dr. Rolf Gainer, PhD, Diplomate, ABDADr. Rolf Gainer, PhD, Diplomate, ABDA, is the chief executive officer of the Neurologic Rehabilitation Institute at Brookhaven Hospital and the vice president of Rehabilitation Institutes of America. He is also the founder of the Neurologic Rehabilitation Institute of Ontario, Canada. Dr. Gainer is a psychologist who has been involved in the creation and operation of brain injury treatment programs since 1977. He has published numerous articles on mental health and rehabilitation topics and has given lectures at many international conferences over the years. Dr. Gainer remains active in outcome research.

My son has become increasingly self-destructive since his brain injury over 10 years ago. Where can I find an appropriate program to keep him safe?
Few programs in the United States offer the kind of secure, safe environment that people like your son need. Our intensive neurorehabilitation program addresses the specific needs of individuals with behavioral problems and helps keep them out of harm’s way while they are relearning skills to cope with their disability following a brain injury.

My 32 year-old daughter has become addicted to drugs and alcohol. She was in a work-related accident six years ago and was diagnosed with a frontal lobe brain injury. She has not been successful in several rehabilitation programs. Can her addiction and brain injury problems be treated?
Because NRI is an accredited hospital, we’re able to offer treatment for people dealing with substance abuse and a brain injury. In fact, we’re one of the few facilities in the country to specialize in addiction problems resulting from a brain injury.

What type of program can serve my 50 year-old brother who has become extremely violent since his brain injury?
NRI offers an intensive neurobehavioral program in a locked, secure environment that offers safety and medical oversight. Through our program, we are able to help individuals make gains in controlling and reducing their behavioral issues.

My father has been in over six brain injury rehabilitation programs since his brain injury at age 40. He constantly tries to run away and is violent. Where can we turn for help?
For some patients, a locked environment is the safest environment available. In NRI’s intensive neurorehabilitation program, we’re able to offer a secure environment for your loved one.

My husband is severely depressed and suicidal since his brain injury four years ago. He has had many psychiatric hospital admissions and no brain injury rehabilitation program will accept him. Can your program help?
At NRI, we often treat individuals who have not been successful in other placements. Our intensive neurobehavioral program offers a safe, supportive environment that can offer hope and help.

I am a nurse case manager seeking referral information for a 43-year-old male with a brain injury and extreme behavior disinhibition and cognitive problems. He needs long-term treatment in a program that offers a secure, locked and controlled environment. Can he be served in the NRI program at Brookhaven hospital?
Yes. NRI offers a safe, locked, and controlled environment, and we’re able to address the issues specific to those dealing with problems like disinhibition and cognitive impairments.

I am a life care planner working with an individual with a severe brain injury and his family. We are looking for a program that can provide long-term care for a person with behavioral problems and physical assistance needs. The family is concerned with the future, as they are getting older. Can NRI design a program that can offer this person and his family an alternative?
Every patient admitted to NRI receives a customized program. Through our specialized brain injury care, we are able to offer treatment in a secure environment that ensures safety throughout the person’s lifespan. Additionally, we have specific services available through our new program THE LIFESPAN ALTERNATIVE. As a patient gets older, we’re able to work within the available resources to customize a course of care that takes their age and any health changes into consideration.

My brother has been in and out of psychiatric hospitals since his severe brain injury seven years ago. He hasn’t been able to receive the rehabilitation he needs due to his psychiatric problems that have developed since his brain injury. What can NRI do to help him?
The NRI Intensive Neurobehavioral Rehabilitation program can help to stop the cycle of repeat emergency psychiatric hospitalizations and short term stabilizations. The NRI program can manage severely disruptive behaviors through our medical, rehabilitation and behavioral expertise. We can help your brother by providing treatment and rehabilitation to address his psychiatric problems and self-damaging behaviors and to address his neurological rehabilitation needs.

My stepbrother has become addicted to drugs and alcohol since his brain injury three years ago. He has been discharged from neurological rehabilitation programs due to his addiction and drug-seeking behaviors. Can he be treated in the NRI Intensive Neurobehavioral Rehabilitation program?
Individuals with a brain injury and an addiction are difficult to serve in traditional rehabilitation programs. The NRI Intensive Neurobehavioral Rehabilitation program has the capacity to provide for detox in a secure and safe setting as well as to begin the process of behavioral, cognitive and psychological rehabilitation that will enable your step-brother to address his brain injury and substance abuse treatment needs. Many of our patients come to NRI with a brain injury and substance abuse problems that have prevented their participation in rehabilitation.

I am a Trust Officer involved in the administration of a family trust for the benefit of a 55-year-old woman with a severe brain injury. Her aging parents are also disabled and are concerned about their daughter’s future. They know that she has severe disabilities, including problems controlling her temper. They do not want her to be placed in a nursing home. Can NRI help?
The NRI programs offer a continuum of care for the person with a severe brain injury. Our hospital-based inpatient programs include secure treatment options and comprehensive rehabilitation services. NRI’s community-based programs include transitional living, community living and our LIFESPAN PROGRAM that’s designed to accommodate the needs of a person with severe disabilities in a progressive, community-oriented setting. The LIFESPAN PROGRAM is an alternative to nursing home placement and provides the full spectrum of long- term supports for independent living.

I am female who was diagnosed with brain cancer (Glioblastoma Multiforme right temporal lobe) in 1995. I underwent a craniotomy, chemotherapy, and experienced ‘more than usual’ radiation to the area of my temporal lobe. How can I improve memory, concentration, logic, reading and cognitive skills?
It appears that you have done well in your recovery and would benefit from some specific cognitive rehabilitation to focus on the issues that confront you. Have you had a neuropsychological evaluation to identify the specific problem areas as well as the areas of strength? This type of evaluation would be helpful in determining the type of cognitive rehabilitation that will help you remediate the problem areas. Usually, cognitive rehabilitation occurs through occupational or speech therapy or with specially trained educators. For some people, computer- based cognitive retraining is very helpful. Are you currently involved with your local Brain Injury Association in British Columbia? The association usually can help you find a neuropsychologist who specializes in brain injury as well as identify programs and specialists in your community. The British Columbia Brain Injury Association maintains an excellent web site with resources. The internet has many other brain injury resources which may be of assistance to you. You might also try biausa.org, the U.S. brain injury association, and look at the resource materials they offer. I encourage you to continue your efforts to find help to address your cognitive problems. It sounds like you are motivated to achieve success, which is critical. Please let me know if we can be of further help.

My 26-year-old daughter was in a car accident two years ago and was in a coma for three weeks. She has never received substantial treatment for her brain injury since then. I’ve heard that after two years, people with head injuries don’t get better, and I am worried that time is running out for my daughter. What can I do to help her?
I have good news for you. While many family members and brain injury survivors are told that the recovery “plateaus” after two years, it simply isn’t true. It’s a myth that has been debunked by scientific studies. The latest research and data from sources like the National Institutes of Health Consensus Report on Rehabilitation of Traumatic Brain Injury indicate that recovery and progress continues throughout an individual’s lifetime.

Today, more and more medical professionals are developing life-long recovery plans for their TBI patients. Fortunately, the legal system is also using the evidence to champion for longer treatment options for TBI survivors. Since good information drives policy, it is imperative that we all continue to support good research and that we act as aggressive advocates for our family members, friends and patients with TBI. We must continue to educate physicians and health providers, who will in turn inform insurance companies and advise state-funded programs.

Many of our own patients at NRI come to us several years post-injury. While such a delay in treatment can create some obstacles, they still have a significant clinical response to treatment. The road to recovery isn’t always easy, but once TBI survivors get into the right program, they experience a dramatic change across many areas of life.

You may be interested in our current findings that reflect increased independence, improved social role function, and other gains that occur in the years post-injury. Please refer to the following presentations to learn more about post-injury concerns:

I encourage you to continue seeking treatment for your daughter. It isn’t too late, but time is still an important factor. The sooner your daughter gets into a specialized treatment program, the sooner you’ll begin to see results, and that’s going to make a big difference for everyone involved in her care.

If you have any personal questions for Dr. Gainer, please contact him by calling Brookhaven Hospital at OR 918-438-4257.