CASE 1. Female 21 years old DOL: November 28, 2016

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1 CASE 1 Female 21 years old DOL: November 28, 2016 Injuries and Sequelae: GCS: 4 / 15 and coma for 3 weeks Multifocal intracranial hemorrhage at right thalamus and left frontal and temporal lobe Diffuse axonal injury Right hemiparesis

2 Ongoing Symptoms: Pain Dizziness Headaches She sleeps three to four times per day for one to two hours and hours per night Intermittent blurred vision Reduced sensation on the right side of her face Poor concentration, memory, initiation Inappropriate affect, at times, e.g. laughing inappropriately in any scenario, childish behaviors

3 Pre-Accident Function Prior to the accident, the client lived independently in a basement apartment (location unknown), and would visit her family approximately three times per week Client used public transportation for community access Completed high school Enrolled in a full time two-year Medical Administration program at Seneca College

4 GOS-E Assessment What information would you gather? What tools would you use? How would you score?

5 CASE 1 Male 28 year old DOL: December 15, 2016

6 Pre-existing History Concussion as a child between age of 8 and 12 years old while snowboarding. Work related injury to his left index finger Substance-induced psychosis requiring two hospitalizations Query alcohol overuse with approximately units per week Daily marijuana use One pack per day cigarette smoker

7 Injuries Moderate left parietal scalp hematoma Subtle underlying fracture of the left parietal bone subjacent to the hematoma near the vertex Small scalp hematoma in the right temporal occipital region laterally Air in the soft tissues of the scalp Query fracture of the posterior right petrous temporal bone Query diastases of the lambdoid suture Small amount of pnemoncranium Opacification in the right mastoid air cells Thin crescentic right temporal subdural hematoma Petechial intra-axial hemorrhage within the right temporal lobe Small amount of subarachnoid blood Subdural hematoma 7mm hemorrhagic contusion right temporal lobe Progression of hemorrhagic cortical contusions more anteriorly in the right temporal lobe at the tip with surrounding vasogenic edema Suspect evolving tiny hemorrhagic contusions in the inferior right frontal lobe Minimal increase in size of cortical hemorrhagic contusion postero-inferior right temporal lobe Progress of effacement of the lateral and 3 rd ventricles indicative of cerebral edema Opacification of the right maxillary sinus Stable opacification of the right maxillary sinus.

8 Ongoing Symptoms: Headaches Dizziness Pain

9 Pre-Accident Functioning Independent with ADLs. Living with parents at the time of accident. He was previously living independently with roommates but moved out due to conflict. Driving license was suspended pre-accident for driving under the influence of alcohol. Client obtained his high school diploma and completed a two-year Arborist Program. Client worked at an arborist company for two seasons He opened and ran his own tree removal company. Client shut down the company after 5-6 years, stating the company was folding. He then returned to the original arborist company working full time for 8 months before the accident.

10 Post-Accident Functioning Paranoid beliefs about the events surrounding the accident. Living at home with parents Independent with ADLs Independent with transportation (biking and public transit) Strained relationships due to behaviors Multiple failed return to work attempts (returned to previous job for 5 days before quitting, quit multiple jobs after 3 to 5 days due to perceived conflicts with employers and colleagues, returned to work the next day after quitting

11 GOS-E Assessment What information would you gather? What tools would you use? How would you score?