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Traumatic Brain Injury and Head Concussion
You don't have to be knocked out in order to sustain a brain injury. Mild traumatic brain injury (MTBI), also known as concussion, is becoming a serious public health problem. Most brain injuries are considered mild and appear to be trivial blows to the head, but it turns out that the consequences are not so mild and often lead to deep and prolonged impairments of the brain.
Of the many thousands of questions we have heard in our years of brain injury advocacy, three themes keep repeating themselves:
- With coma cases, the doctors are saying only "we will just have to wait and see."
- In concussion cases, the doctors are saying there was no brain injury; and
- Regardless of the severity of the injury, there is a significant ignorance about the long term behavioral problems and symtoms of brain injury.
Severe Brain Injury A brain injury, also called head injury or traumatic brain injury, refers to an injury where there is damage to the brain because of an external blow to the head. A "brain injury" or "closed head injury" occurs when there is a blow to the head as in a motor vehicle accident or a fall. In this case, the skull hits a stationary object and the brain, which is inside the skull, turns and twists on its axis (the brain stem), causing localized or widespread damage. Also, the brain, a soft masss surrounded by fluid that allows it to "float," may rebound against the skull resulting in further damage.
There may be a period of unconsciousness immediately following the trauma, which may last minutes, weeks or months. Due to the twisting and rebounding, the traumatically brain injured patient usually receives damage or bruising to many parts of the brain. This is called diffuse damage. An "open head injury" is a visible assault to the head and may result from a gunshot wound, an accident or an object going through the skull into the brain. This type of head injury is more likely to damage a specific area of the brain.
Some traumatic brain injuries require bone and tissue grafts for the patient. This opens up another possibility of problems as the trade of cadavers is not regulated by any federal or private agency. Body parts brokers make hundreds of millions of dollars selling products crafted from donated human bodies, even though it is illegal to profit from cadaver parts.
Subtle Brain Injury The absence of a significant or identifiable period of loss consciousness does not mean that an injured person has not suffered a permanent brain injury. Likewise, permanent brain injury can occur without a person having hit his or her head. While seemingly not as dangerous as injuries involving coma, hematoma, and surgery, these injuries can be life altering, and in some cases as disabling as many coma injuries.
Far too much of the focus in the study of what the researchers always call "mild" brain injury, is trying to predict how serious a brain injury will become, based upon the way in which the patient interacts with medical professionals in the acute stage. This misses the point. Certainly, if there was no concussion, there isn't likely to be a brain injury. But once there has been a concussion, the focus should not be on categorizing how serious the concussion was, but on what deficits the person is left with, after a healing period, and what we can do to minimize the disruption of those deficits upon this persons life.
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Symptomatology The third major area of focus is a much more detailed treatment of the symptomatology of brain injury. The classic approach is that those with coma injuries have very specific focal deficits, and the "a" and "dys" words of the brain injury glossary are often used to describe these deficits. And most of what is being done in brain injury rehabilitation relates to treatment for the "a" and "dys" conditions. Yet, from the beginning of our brain injury advocacy, we have been struck by the paradox of the numerous miracles in coma cases, and the countless tragedies in the non-coma cases. As time passes, what start as drastically different medical emergencies, pose remarkably similar challenges to the survivor and the survivor's family and friends. After the "a" and "dys" conditions have been identified and treated, the diffuse and subtle problems relating to fatigue, memory, multi-attending and depression remain. So while we have expanded our treatment of the focal deficits, our most important challenge is to broaden understanding of the subtle effects of brain injury |
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