We hear more about brain injuries than ever before. After his tour bus was struck by a Walmart tractor-trailer in 2014, actor and comedian Tracy Morgan underwent daily speech, cognitive, occupational and physical therapy for his traumatic brain injury. In an interview a year later, Morgan said, “I have my good days and my bad days, or I forget things,” as he also described recurring headaches. And in sports, with the beginning of the 2013-14 NFL season, an independent neurological consultant stays on the sideline of each team for every game as part of the NFL’s concussion protocol.
About 85% of the time, symptoms from a concussion or minor head trauma (other names for mild TBI) resolve within a short time. More than 50% of these cases result from falls or motor vehicle crashes. Unfortunately, about 15% of those injured have more persistent effects, some permanent.
More Common Effects of Mild Traumatic Brain Injury
Mild TBI has been referred to as a “silent epidemic” because the signs and symptoms are often subtle. Someone feels fine a few weeks after an accident, only to find out from a loved one, co-worker or friend that all is not the same. Many people experience the most common signs of mild TBI, including nausea, persistent headaches, double vision, or dizziness. Problems with concentration and recurrent headaches are common and are viewed by some as the brain “working overtime” to heal completely.
Within months, many generally feel better, but upon returning to the workplace or to school, some are overwhelmed. Unable to remember the name of a co-worker or a simple chemical formula, they have problems with basic cognitive skills. It becomes challenging to learn new material, to concentrate or to pay attention. The injured person has a low threshold for confusion and thinks more slowly. When using a computer screen, headaches return, often accompanied by problems with double vision or blurriness. Complaints of disbelief range from, “I’ve forgotten my bank account PIN number,” to “I can no longer parallel park.”
Psychological Disruption
Not expecting what may have been a relatively mild car crash to cause long-term issues, the mild TBI patient often minimizes the deficits or tries to compensate. In leaving notes all over the house or carrying an index card with the names of co-workers, there is an effort to both dismiss and to compensate. If recall and concentration abilities continue to fail, then frustration and depression can set in. The TBI patient feels socially isolated, not wanting the “secret” to be disclosed. However, the deficits are often apparent to others, and they may encourage the injured to seek further medical evaluation and care.
The Clinical Setting
Because mild TBI can be difficult to identify objectively, medical providers look at the entire clinical picture, including the severity of the original blow to the head, whether there was a loss of consciousness, how the patient scores on basic tests of recalling numbers and words, and, upon reviewing test results, whether more subtle neuro-psychological symptoms emerge. Vision disturbances, including subtle but rapid movement of the eyeball, may provide clues. Even more recent developments in MRI imaging of the white matter of the brain can help the radiologist determine whether the axons (the connectors between the brain cells) have been torn.
Treatment and Support
When all of these tests, evaluations, and scans are considered together by a treatment team, then truly effective treatment can begin. Eyeglasses with subtle prisms can help restore peripheral vision and re-train the brain to see. Social workers, psychologists and concussion specialists are more in tune with the cognitive and emotional effects. A mild TBI patient’s sense of mental wellness can be improved with acceptance and rehabilitation of the brain through mental and visual exercises. Targeted medication can alleviate mood impairment. Family, co-workers and friends can be educated to understand that a person with TBI may be irritable, experience mood swings or may simply zone out, but these are not intentional, and over time they can be better controlled.
Summary
The impact of a traumatic brain injury may not become apparent until long after the cuts and bruises have healed following an accident and blow to the head. The feelings of isolation, depression, and frustration can only be lessened through an inter-disciplinary approach with the patient, the family, and health care professionals.
While this collective effort can never lessen the blow to the head, it can make the
“new normal” easier to bear for the patient, as well as the injured’s friends, co-workers, and family.
