Mild Traumatic Brain Injury, Not so Mild After All
Although Traumatic Brain Injury affects over 1 million people each year in the United States, it is generally ignored as a major health issue. The term “mild brain injury” can be misleading. The term “mild” is used in reference to the severity of the initial physical trauma that causes the injury.
Intro to Brain InjuriesA case of mild traumatic brain injury is an occurrence of injury to the head resulting from blunt trauma or acceleration or deceleration force. But what causes this to happen? The brain is not a hard, fixed substance. It is soft and jello-like in consistency, composed of millions of fine nerve fibers, and "floats" in cerebral-spinal fluid within the hard, bony skull. When the head is struck suddenly, strikes a stationary object, or is shaken violently, the mechanical force of this motion is transmitted to the brain. When the head has a rotational movement during trauma, the brain moves, twists, and experiences forces that cause differential movement of brain matter. The sudden movement or direct force applied to the head can set the brain tissue in motion even though the brain is well protected in the skull and very resilient. This motion squeezes, stretches and sometimes tears the neural cells. Neural cells require a precise balance and distance between cells to efficiently process and transmit messages. The stretching and squeezing of brain cells from these forces can change the precise balance, which can result in problems in how the brain processes information. Any time the brain suffers a violent force or movement, the soft, floating brain is slammed against the skull's uneven and rough interior. The internal lower surface of the skull is a rough, bony structure that often damages the fragile tissues within the brain as it moves across the bone surface. The brain may even rotate during this process. This friction can also stretch and strain the brain's threadlike nerve cells called axons. Although the stretching and swelling of the axons may be microscopic, the impact on the brain's neurological circuits can be significant. Even a "mild" injury can result in significant physiological damage and cognitive deficits.
Intro to Brain Injuries ContinuedAnother mechanism of injury involves changes that occur in the neuron's ability to produce energy for the cell's vital function in structures called mitochondria. An initial increase in energy production occurs followed by a dramatic decrease that affects the ability of the cell to produce structural proteins to preserve the diameter of the axon. This change occurs gradually over time and may be responsible for the delay in symptoms sometimes observed. As a person recovers, the cells re-establish the precise balance needed to ensure effective information processing, but this may mean some compensation or adjustments to the neural cell's original alignments. The more neural cells must compensate or adjust to an injury, the more likely the task takes longer and may not be as complete. For example, when a person sprains or fractures an ankle, professionals recommend cold/heat treatments, rest and supports and specific exercises to help the ankle adjust to the injury and recover maximal function. Depending on the severity of the ankle injury and what is required after recovery the injury can disrupt a person's life. Obviously, a human brain is much more complicated than an ankle. Yet, similarly rest, supports and "exercises" for the brain may be recommended to rehabilitate and restore useful function. Depending on the severity of the injury and what the person needs to do, a mild brain injury can disrupt a person's life for a short period of time or even longer.
Diagnosing a Brain InjuryDue to the diffuse and subtle nature of mild brain injury, it is common for typical neuroimaging such as CT scan or MRI's to show no evidence of injury. The limitation of these brain imaging technologies is they often cannot detect mild brain injury. Mild brain injury can often damage the "white matter" of the brain. "White matter" consists of the axons of neurons or connections in the brain. This is much harder to capture or visualize using common types of brain imaging. There are newer, more sophisticated imaging technologies that show promise in more effectively capturing the damage that occurs in a mild brain injury. However these imaging technologies are currently more expensive, and are not as readily available. Some of the newer imaging techniques include, Positron Emission Tomography (PET), Single Photon Emission Computerized Tomography (SPECT), Functional Magnetic Resonance Imaging (fMRI) and Diffuse Tensor Imaging (DTI). Neuropsychological assessment is typically used to assess the functional impact of a mild brain injury. This assessment is normally done when some type of brain dysfunction is suspected.
A mild brain injury is often initially diagnosed by evaluation of the symptoms a person reports after sustaining the injury. The assessment is comprised of a wide range of tests that objectively measure specific brain functions. Testing includes a variety of different methods for evaluating areas like attention span, orientation, memory, concentration, language, mathematical reasoning, spatial perception, abstract and organizational thinking, problem solving, social judgment, motor abilities, sensory awareness and emotion characteristics and general psychological adjustment. The neuropsychological evaluation can be used as a starting point. It can assist brain injury professionals in identifying specific cognitive areas that have been damaged, as well as those areas still intact. A Mild Traumatic Brain injury or the "invisible injury" is difficult to detect in certain instances.
What to Do If You or Someone Else Has a Mild Traumatic Brain InjuryThe changes that have occurred from a brain injury are an important part of the recovery process. This makes education and awareness crucial for both the person with a brain injury as well as family and friends. The person with an injury and others need to understand that a "mild" brain injury can result in changes in thinking and memory that can affect a person's ability to return to their life. While a person can "look fine," a brain injury is an invisible injury.
Research has shown that education and information about the possible consequences can be helpful to the person with an injury and family members. Some basic symptoms for family and friends to be aware of include, early symptoms such as headache, dizziness or vertigo, lack of awareness of surroundings, and nausea with or without memory dysfunction and vomiting. Later symptoms may include persistent low grade headache, lightheadedness, poor attention and concentration, excessiveness or easy fatigue, intolerance of bright light or difficulty focusing vision, intolerance of loud noises, ringing in the ears, anxiety and depressed mood, irritability and low frustration tolerance. The recovery from a mild TBI injury is not always quick. For a mild traumatic brain injury, the issues are the same as moderate to severe brain injury. While there are general guidelines for recovery, there can be wide individual variation in the timeframe for recovery. It can take several weeks, or several month for symptoms to fully resolve. Recovery is often uneven, there will be "good days" and "bad days." This is normal in recovering from a brain injury. An important thing to keep in mind, on the "good days," people want to get as much done as they can. Often, this can lead to overdoing it, which can bring back symptoms that were previously gone. Even on the good days, it is important to give yourself more time to complete tasks, and to listen to your body. You cannot "tough out" a brain injury. Create the best possible environment for recovery, substance like caffeine, alcohol and nicotine can affect a person with a brain injury much more than it did before the injury. Be aware of the possible consequences of alcohol on recovery post injury. It is recommended to abstain from alcohol consumption during the recovery period post injury. Give yourself more time to complete things, issues like fatigue, attention and memory issues can cause delays in completing tasks that were easily done before the injury. Allowing additional time to do things like laundry, menu planning, shopping, bill paying can help. Thinking out the steps needed to complete tasks and writing them down can be helpful too. Better planning can decrease stress and anxiety. Professional help is important, it is important to understand the effects of a brain injury. The injury itself can impair the ability of a person to accurately assess their abilities. And once problems are identified, often a person with a mild brain injury struggles with figuring out effective strategies to compensate for problem areas, and can help implement effective strategies. You do not need to figure out brain injury all on your own.
Mild Traumatic Brain Injury Vs. ConcussionIt is important to understand that a concussion is a physical injury to the brain that causes a disruption of normal functioning just like any other physical injury disrupts your normal functioning. For example, some ankle injuries are more disruptive than others, just as some brain injuries are more disruptive than others. The better we understand any injury, the better our chances are for a speedier and healthier recovery.
There is some confusion as to the definition of a concussion and the definition of a mild traumatic brain injury. A brain injury can be viewed along a continuum that incorporates concussion, mild traumatic brain injury, moderate traumatic brain injury and severe traumatic brain injury. Each type of brain injury varies depending upon, one, whether the person was unconscious, two, how long you were unconscious, three, the length of you amnesia, four, the resulting cognitive behavioral and physical problems and five, the recovery.
To further clarify, a concussion is defined as a trauma that induces an alteration in mental status that may or may not involve loss of consciousness. Concussion as detailed by guidelines developed by the American Academy of Neurology and the Brain Injury Association, commonly is divided into three different types. A grade one concussion is when a person is confused but remains conscious. A grade two concussion, a person remains conscious, but develops amnesia. A grade three concussion, a person loses consciousness.
If concussion and mild traumatic brain injury are seen as part of the brain injury continuum, with grade three concussion and mild traumatic brain injury overlapping, one can get a better understanding of how these definitions complement each other and enhance our understanding. The Brain Injury Association estimates that approximately 75% of all brain injuries fall in the "concussion-mild traumatic brain injury continuum." For the majority of people who sustain a concussion, a full recovery is possible with appropriate diagnosis and management.
Remember: You Are Not AlonePeople may say things like "you look fine," with the implication that you should be fine or that you look healthy. It is an invisible injury. Sometimes talking with others who have experience similar experiences can help a person with a brain injury understand they are not the only one dealing with these issues.