Gary Bedell (Boston)

... Unfortunately I am not a qualified Neuropsychiatrist/ Neurologist, but usually study brain function in normal volunteers. So, I wouldn't be the most appropriate person to talk to in this case - I wish you good luck though with the other experts you addressed.

Antonio Damasio (Iowa)

... there is little question about the effects of early prefrontal injury on Helene's behavioral/social difficulties. We have documented such relationships based on all published cases we could find for our 2004 Brain and Cognition paper and her scan looks similar, though her overall outcome would be considered good. This analysis followed children with focal prefrontal injuries into adolescence and adulthood and I continue to follow several of my own cases yet... NIH funded projects out of such cases... remain relatively few... published primarily as case reports. Recent work by Harvey Levin in Houston and Vicki Anderson in Australia is trying to expand the samples... such cases are very instructive and can be studied with functional as well as structural imaging in relationship to outcome... A small international meeting of current investigators would be quite an advance, and any private or foundation funding for studies would be most welcome. We are looking into that here. I'll be glad to help. Please let me know what else you find in your responses.

Paul Eslinger (PennState)

Jordan Grafman (NIH)

Wolfgang Grodd (Tübingen)

Thanks for passing that along. This patient does sound very interesting. I, unfortunately, have little in the way of clinical skills or advice (I am an experimental psychologist), but many of the people on your email list do.

Gerri Hanten (Houston)

Tessa Hart (Philadelphia)

Marco Jacoboni (LA)

The most important thing is to listen to her experiences of daily life with this injury. This is fundamental in order to, together with her, find ways to support her. Often the health care personnel and other authorities assume that they 'know' what the patients are experiencing and what their needs are, and of course the assuptions do not have to be wrong. But to really know it is important to hold off from taken for granted assumptions and instead think: 'I don't know your subjective world but I am intrested to know it'. Learning to live with a TBI means often 'a long way to go'. I assume that she has been in contact with other people with similar kind of injuries; they often can understand each other in the best way, they also can tip each other of ways to get various kind of help and support. Meeting others in the same situation can break off the loneliness the person maybe feels.

I am not a clinical psychologist or medic, so am not in a position to be able to offer specific advice. However, the Oliver Zangwill Centre has considerable expertise in working with survivors of head injury who have the cognitive and behavioural pattern you describe.

John Olver (Melbourne)

William Perlstein (Florida)

Lina Petrella (Kingston, Canada)

Marina Pavlova (Tübingen)

Anthony Stringer (Atlanta)

We do clinical studies on ToM/empathy .., At the moment we look at healthy controls but we have also done single case studies. The problem I would see with this lady is that she does not live near Manchester (or even in the same continent), so that would make it rather difficult to include her in any of our studies. I am not sure where she lives most of the time, she seems to be moving about. The best might be to contact any neurologists/imaging department where she lives, most will probably be interested to work with her as such cases are always fascinating. We would happily give our ongoing ToM/empathy tasks to someone who might do some brain scans on her closer to home.

... many cases similar to that... have aroused great interest in the paradox between normal neurological recovery after head trauma but abnormal neuropsychological recovery (in terms of psychosocial adjustment) even though patients may perform well on neuropsychological tests... there are a number of case studies that reflect similar problems.

Birgit Vollm (Manchester)

Chad Vickery (Mississippi)