The journey back: tracking progress of people with brain injuries

Brain injuries can have devastating consequences: speech, balance and mood disorders, inability to remember familiar faces, and loss of skills as basic as reading or even tying shoelaces. Dr. Nora Cullen is seeking to improve the quality of life for these patients by studying the way they recover their abilities and the impact of rehabilitation on their ultimate outcome.

Dr. Cullen is a physiatrist (a specialist in physical medicine and rehabilitation) and a researcher at Toronto Rehab, where she treats people with acquired brain injuries caused by trauma and illness such as motor vehicle crashes, falls and tumours.

"We see people at a very difficult time in their lives," says Dr. Cullen. "They've just had something catastrophic happen to them. We start to work with them just as they're stabilizing. They are ready to start learning and doing again. It's an incredibly important and interesting time to be involved with them."

As these people go through the rehabilitation process, their level of functionality - both physical and cognitive - at each stage is recorded in the brain injury database, the largest of its kind in Canada and an extension of a much larger database in the United States.

Toronto Rehab is the first Canadian health care centre to use such a database to evaluate its programs for these patients. "We have hard numbers that describe what patients can do in their daily lives when they are admitted, and again when they leave, reflecting the positive changes that they have made during their inpatient rehabilitation," says Dr. Cullen. Patients return yearly for follow up assessments to track their progress over time.

The sophisticated database is now so extensive that it can also be used to predict outcomes for individuals with specific types of injury. "Using our database, we can give people with brain injuries a much better idea of what their level of function will be in a year because we have access to detailed observations of more than 300 people," says Dr. Cullen. "We can say it with a reasonable degree of certainty."

Dr. Cullen is drawn to the "practicality" of her specialty, a field known as physiatry. "When I was in medical school I considered going into neurology. But physiatry is more practical in terms of helping people to maximize their function, helping patients to be as good as they can possibly be.

"It is a great area because most patients improve a great deal under our care. We give people the assistance they need to get back to life as they once knew it, as much as they are able. It's very gratifying."

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