Eight months out — the calendar he keeps missing
| Patient | 34M, chronic phase |
|---|---|
| Injurybifrontal and anterior temporal injury | |
| Severity | Worst GCS 13 |
| Days since injury | 240 |
| Before the injuryIndependent. Warehouse shift lead, lived alone, managed his own money. | |
| PrecautionsImpulsivity with money — sister holds the account; written budgets only; Appointment adherence depends on phone prompts — confirm every booking by text | |
Test yourself
What is the priority intervention for the memory failure?
The teaching
The chronic bifrontal patient presents as a memory problem that is really a self-management problem. The evidence-backed tools are unglamorous: external aids trained as skills, metacognitive strategy practice, a functional demonstration of executive failure for the people who need to see it, and a vocational return engineered around the demands analysis. What you do with it: build the aid into his actual day, measure the executive failure under realistic load, and write the return-to-work plan with the employer inside it.
- Financial exploitation risk — formalize money management before the next instalment
- Low mood with hopelessness about work — screen for depression; suicide risk after TBI is real
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Velikonja D et al. INCOG recommendations for management of cognition following traumatic brain injury, part V: memory. J Head Trauma Rehabil. 2014. Cicerone KD et al. Evidence-based cognitive rehabilitation: updated systematic review. Arch Phys Med Rehabil. 2019 · Turner-Stokes L et al. Multidisciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev. 2015. Bayley MT et al. INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury. J Head Trauma Rehabil. 2023 · Kennedy MRT et al. Intervention for executive functions after traumatic brain injury: a systematic review, meta-analysis and clinical recommendations. Neuropsychol Rehabil. 2008. Cicerone KD et al. Evidence-based cognitive rehabilitation: updated systematic review. Arch Phys Med Rehabil. 2019