A person who suffers a blow or jolt to the head (a closed head injury) or a penetrating head injury may frequently develop a condition that disrupts the function of the brain, known as a traumatic brain injury (“TBI”). TBI is a leading cause of death and disability in the United States. Each year, 1.4 million people sustain a traumatic brain injury. 50,000 of those die from the TBI, 235,000 people are hospitalized, and 1.1 million people are treated and released from an emergency room. The injury may be relatively minor, such as a mild concussion or a brief period of unconsciousness, or it may be severe, such as a lengthy period of unconsciousness (i.e., a coma) or amnesia after the injury.
Each year, 80,000 to 90,000 people will sustain a long-term disability as the result of a TBI. The Centers for Disease Control and Prevention estimate that at least 5.3 million Americans currently have a long-term or lifelong need for help to perform activities of daily living as a result of TBI.
The leading causes of traumatic brain injury are falls, motor vehicle accidents, being struck by or against an object, and assaults by another person. TBI need not be caused by a blow to the head; a violent jolt of the head such as one might experience in a rear-end automobile collision (“whiplash”) may result in serious brain injury. In a violent collision, the head snaps forward and the brain hits the front of the skull; then the head snaps backward and the brain hits the back of the skull. These impacts can cause serious brain injury. Shaken-baby syndrome is an example of a serious brain injury being inflicted without a direct blow to the head. Even in this age of advanced medicine, there is no cure for a TBI. Recovery from a brain injury depends on the brain’s “plasticity,” that is, the brain’s ability for other areas of the brain to take over the functions of the damaged areas, to “rewire” itself.
If you have suffered a blow or jolt to the head, it is important that you get medical evaluation and treatment as soon as possible. There are some new drugs and procedures available today that can help to limit the “secondary” damage caused by swelling of the brain. However, these procedures are effective only when administered soon after the injury is sustained.
Traumatic brain injuries are classified into three categories: mild, moderate, and severe:
Mild Traumatic Brain Injury – A person with a mild TBI is one who has had a traumatically induced physiological disruption of brain function as manifested by any period of loss of consciousness and/or confusion and disorientation less than 30 minutes and/or posttraumatic amnesia (loss of memory for events immediately before or after the accident) or confusion of not more than 30 minutes. Mild traumatic brain injury is the most common TBI and is often missed at the time of the initial injury. 15% of people with mild TBI have symptoms that last one year or more.
Symptoms common to mild TBI include fatigue, headaches, visual disturbances, memory loss, poor attention and/or concentration, sleep disturbances, dizziness and/or loss of balance, irritability, feelings of depression, and, rarely, seizures. Other symptoms associated with mild TBI include nausea, loss of smell, sensitivity to sound and lights, getting lost or confused, and slowness in thinking. Sometimes the cognitive symptoms are not readily identified at the time of the injury, but instead may show up as the person returns to work, school, or housekeeping. Friends and colleagues may notice changes in the person’s behavior before the injured person realizes anything is wrong.
Moderate Brain Injury – Brain injuries are classified as moderate when the Glasgow Coma scale (a measure of various functions, altertness, responsiveness, and such) is between 9 and 12, and with a loss of consciousness at least 20 minutes to six hours and/or posttraumatic amnesia of greater than 30 minutes but less than 24 hours and/or a skull fracture.
There may be long-term physical or cognitive deficits as a result of a moderate TBI. Much will depend on the type and location of the specific injuries to the brain. Rehabilitation will help to overcome some deficits and help to provide skills to cope with any remaining deficits.
Severe Brain Injury – A severe brain injury is one with a Glascow Coma Scale score lower than 9 and accompanied by a loss of consciousness of more than 6 hours or posttraumatic amnesia lasting more than 24 hours. Severe brain injuries are life-threatening. If the person lives, he or she will typically be faced with long-term physical and cognitive impairments. The range of the deficits can vary widely from a vegetative state to more minor impairments that may allow the person to still function independently. The person will require extensive rehabilitation to try to overcome some of the deficits and earn strategies to cope with others.
Cognitive deficits associated with moderate and severe TBI include difficulties with attention, concentration, distractibility, memory, speed of processing information, confusion, impulsiveness, language processing and “executive functions.” Executive functions refers to the complex processing of large amounts of intricate information that we need to function creatively, competently and independently as beings in a complex world. Thus, after injury, individuals with TBI may be unable to function well in their social roles because of difficulty in planning ahead, in keeping track of time, in coordinating complex events, in making decisions based on broad input, in adapting to changes in life, and in otherwise “being the executive” in one’s own life.
Speech and language difficulties due to a moderate to severe TBI include not understanding the spoken word, difficulty speaking and being understood, slurred speech, speaking very fast or very slow, and problems with reading and writing. Sensory problems include difficulties with the interpretation of touch, temperature movement, limb position, and fine discrimination. The person with moderate to severe TBI may have partial or total loss of vision, weakness of eye muscles and double vision, blurred vision, problems judging distance, involuntary eye movements, and intolerance of light. Physical changes include paralysis, chronic pain, loss of control of bowel and bladder, sleep disorders, loss of stamina, changes in appetite, regulation of temperature, and menstrual difficulties in women. Moderate to severe TBI can cause a wide range of functional changes affecting thinking, language, learning, emotions, behavior, and sensation. TBI can also cause seizures and increase the risk for such conditions as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more likely as the person grows older.
One of the most common problems among people who sustain a TBI is fatigue. Studies of people with TBI found that between 37% and 98% of them said they had some type of fatigue. There are three types of fatigue: (1) Physical fatigue, feeling tired and the need to rest; (2) Psychological fatigue, in which the person can’t get motivated to do anything; and (3) Mental fatigue, in which you can’t concentrate after a while and find it hard to stay focused.
Physical Fatigue – this is due to muscle weakness and can come from having to work harder to do things that were easy before the TBI. This include things like dressing, working around the house, even walking. Physical fatigue tends to get worse in the evening, after a busy day, but tends to get better after a good night’s sleep. Often, physical fatigue will get better as you become stronger, more active and get back to your old life.
Psychological Fatigue – psychological fatigue comes with depression, anxiety, and other psychological conditions. This type of fatigue gets worse with stress and usually is not helped by sleep. Psychological fatigue is often at its worse in the morning. To treat psychological fatigue, it is necessary to find its cause. For instance, if the psychological fatigue is due to depression, medication and therapy may be necessary to help treat the condition. Major depression in the general population runs at about 5 or 6%; of persons that have suffered a TBI, that number increases ten-fold, so that 50 to 60% of persons who suffer a TBI also experience a depressive episode. Anxiety seems to occur in twice as many people who suffer a TBI than in the general population. The anxiety may take to form of posttraumatic stress disorder, in which the person has “flashbacks” in which they relive the event, to the development of phobias, in which the person experiences dread centered on a specific situation, such as being in a car or elevator, or flying. Persons who experience a mood disorder such as depression or an anxiety disorder, such as PTSD, a specific phobia, or generalized anxiety, may need to be given appropriate psychiatric medication and undergo months, even years, of psychotherapy.
Mental Fatigue – mental or “cognitive” fatigue after a TBI makes it hard for the person to think or concentrate. The more the person has to concentrate, the more mentally fatigued he or she may become. This happens because the TBI forces the person to concentrate harder to do tasks that used to be easier. Working harder to get dressed or walk can make the person physically tired, and working harder to stay focused can make the person mentally tired In some people, mental fatigue causes them to be irritable; others have headaches. Mental or cognitive fatigue is the type of fatigue that the least is known about of the three types of fatigue associated with TBI.
A TBI may cause the person to have a seizure, a change in behavioral state that results from abnormal activity in the brain. The occurrence of a seizure due to some acute precipitating physiological disturbance does not mean that the seizure will ever happen after the precipitating cause has resolved. When seizures occur without any obvious cause, then the person may be considered to have epilepsy. In a personal injury accident, a seizure is more likely to occur due to brain trauma, especially “open” or penetrating wounds to the brain.
The long-term effects of TBI depend on a number of factors, including the severity of the initial injury, the rate and completeness of physiological healing, the types of functions affected, the meaning of dysfunction in the person’s life in the context of his or her roles, values, and goals, the resources available to aid in the recovery of function, and other factors. Most spontaneous improvement from a TBI occurs within the first month after a brain injury. Some additional gains may occur over the next three to six months. The long-term effects of a TBI are different for every person. Some may experience only subtle difficulties, while others will have moderate dysfunction, while to still others the TBI may be life-threatening.
Persons who sustain a moderate-to-severe brain injury usually experience problems in basic cognitive skills: holding their attention, concentrating on the tasks at hand, and remembering newly learned material. They may think, speak, and solve problems solving. They may be confused easily when normal routines are changed, they may persevere at tasks too long, being unable to switch to a different tactic or a new task when encountering difficulties. On the other hand, some victims of a TBI may jump at the first solution they see, substituting impulsive responses for considered actions. They may be unable to go beyond a concrete appreciation of situations, to find abstract principles that are necessary to carry learning into new situations. Their speech and language may be impaired: word-finding problems, understanding the language of others, and the like.
With TBI, the systems in the brain that control our social-emotional lives often are damaged. The consequences for the individual and his or her significant others may be very difficult, as these changes may imply to them that “the person who once was” is no longer there. Thus, personality can be substantially or subtly modified following injury. The person who was once an optimist may now be depressed. The previously tactful and socially skilled negotiator may now be blurting comments that embarrass those around them. The person may also be characterized by a variety of other behaviors: dependent behaviors, emotional swings, lack of motivation, irritability, aggression, lethargy, being very uninhibited, and being unable to modify behavior to fit varying situations.
Any of the ways we have of sensing/perceiving may be affected by TBI. Vision may be affected in many ways: loss of vision, blurred visual images, inability to track visual material, loss of parts of the field of vision, reduced depth perception, and sometimes disconnection between visual perceptions and visual comprehension, so that the person does not now what he or she is seeing. Changes also may occur in the sense of hearing, smell, taste, and touch; the individual may become overly sensitive or insensitive. Further, the person my have difficulty sensing the location of his or her own body in space. Other individuals with TBI may have recurring problems with balance, vertigo, and ringing in the ears.
The severity of the injury and the resulting direct effects on the individual’s body systems may not predict the amount of impact in a person’s life. This follows because each of us draws in different ways on differing parts of our brains For example, a severe injury to the frontal brain area may have less impact on an agricultural worker’s job performance than a relatively mild frontal injury would have on a physicist’s work. In sum the meaning of the various patterns of injury and the associated damages in any person’s life will depend on pre-injury lifestyle, personality, goals, values, resources, as well as the individual’s ability to adapt to changes and to learn techniques for minimizing the effects of brain injury.
It has been suggested that “recovery” is a misnomer and that “improvement” better describes what happens in the long run after TBI. The word recovery suggests that that the effects of TBI will disappear, while the reality of the situation is that improvement is all that can be expected in most, if not all, cases. With TBI, some of the effects may truly disappear after a couple of years or more, but more frequently these long-term changes linger on—subtly or not so subtly—changing only slowly, if at all, over the course of the person’s life. Brains do not heal like broken limbs, and everybody’s brain is different. Although they may superficially appear alike, no two brain injuries are the same and the consequence of two similar traumatic brain injuries may be vastly different.
If you or a loved one has suffered a traumatic brain injury due to another person’s carelessness – such as an automobile accident caused by another person’s inattentiveness or a slip and fall on a store’s slippery floor – it is important that you promptly seek representation by a personal injury law firm experienced in this type of injury. Monetary damages you are entitled to receive when you have sustained a traumatic brain injury include all of your medical and rehabilitation costs, lost wages because you were unable to return to work, and loss of enjoyment of life due to your impaired condition.
