A common misbelief is that Traumatic Brain Injuries (TBIs), even mild TBIs (mTBIs) are easily recognizable, and that the individual knows that they have one. There is also misconception that concussions, and other mTBIs involve loss of consciousness, severe headaches, and memory loss. Though those are three symptoms, they are not the only ones, and not everyone that has a concussion or mTBI has all or sometimes any of those symptoms. Another false belief is that symptoms occur immediately after head trauma, though some do, but it can sometimes take hours, days, or even weeks for symptoms to show. There can be a long enough period of time between head trauma and onset of symptoms that the individual, and even doctors, sometimes don’t link the two together. One other mistake that is made is thinking just because the individual didn’t get hit in the head, therefore no TBI/mTBI occurred. This is also wrong. Just like in shaken baby syndrome, the head can be violently shaken, or a sudden deceleration, can cause the brain to sort of slosh in the skull and impact against the inside of the skull causing injury. This is common with automobile injuries and whiplash.
Just like with most injuries, brain injuries can range from mild to severe. TBIs result in permanent neurobiological damage which may produce lifelong problems or changes for the individual.
Moderate to severe TBIs usually refer to injuries that are defined as:
- Moderate TBI is a brain injury that results in a loss of consciousness from 20 minutes to 6 hours and a Glasgow Coma Scale of 9 to 12
- Severe TBI is a brain injury resulting in a loss of consciousness of greater than 6 hours and a Glasgow Coma Scale of 3 to 8
How much impact a moderate to severe TBI has depends on a number of things: Severity of initial injury, speed and degree of physiological recovery, functions affected, meaning of dysfunction to the individual, help and resources available to aid recovery, areas of function not affected by the TBI.
Moderate to severe TBI affects and symptoms can include: cognitive, language and speech, sensory, perception, vision, hearing, smell, taste, physical changes, social/emotional changes, and seizures.
Cognitive deficits can include difficulties with: attention, concentration, distractibility, memory, speed of processing, confusion, perseveration, impulsiveness, language processing, and executive functions.
Language and speech symptoms include: receptive aphasia (not understanding the spoken word), expressive aphasia (difficulty speaking and being understood), slurred speech, speaking very fast or very slow, problems reading, and problems writing.
Sensory symptoms include: difficulties with interpretation of touch, temperature, movement, limb position and fine discrimination.
Perception symptoms include: the integration or patterning of sensory impressions into psychologically meaningful data.
Vision symptoms include: partial or total loss of vision, diplopia (weakness of eye muscles and double vision), blurred vision, depth perception problems, judging distance, nystagmus (involuntary eye movements), and photophobia (intolerance of light).
Hearing symptoms include: decrease or loss of hearing, tinnitus, (ringing in the ears), and increased sensitivity to sounds.
Smell symptoms include: anosmia (loss or diminished sense of smell).
Taste symptoms include: a loss or diminished sense of taste.
Physical Changes may include: physical paralysis/spasticity, chronic pain, control of bowel and bladder issues, sleep disorders, loss of stamina, appetite changes, difficulties with regulation of body temperature, and menstrual difficulties.
Social-Emotional may include: dependent behaviors, changes in emotional ability, lack of motivation, irritability, aggression, depression, disinhibition, denial or lack of awareness of problem(s).
Seizures: convulsions associated with epilepsy may be of several types and can involve disruption in consciousness, sensory perception, or motor movements.
TBIs can be classified as mild if loss of consciousness and/or confusion and disorientation is less than 30 minutes. While MRI and CAT scans are often normal, the individual has cognitive problems such as headache, difficulty thinking, memory problems, attention deficits, mood swings and frustration. These injuries are commonly overlooked. Even though this type of TBI is called mild, the effect on the family and the injured person can be devastating and long lasting. (Other names for mTBI: concussion, minor head trauma, minor TBI, minor brain injury, and minor head injury)
mTBIs are the most prevalent TBIs and are often missed at time of initial injury. Approximately 15% of people with mild TBI have symptoms that last one year or more. They are defined as the result of the forceful motion of the head or impact causing a brief change in mental status (confusion, disorientation or loss of memory) or loss of consciousness for less than 30 minutes. Post injury symptoms are often referred to as post concussive syndrome, and symptoms can show up 7-10 days after the injury and last weeks, months, or even years.
Common symptoms of mTBI can include: fatigue, headaches, visual disturbances, memory loss, poor attention/concentration, sleep disturbances, dizziness/loss of balance, irritability-emotional disturbances, feelings of depression, and seizures. Additional symptoms can include: nausea, loss of smell, sensitivity to light and sounds, mood changes, getting lost or confused, and slowness in thinking
With all TBIs, including mTBIs, symptoms may not be present or noticed at the time of injury. It may be hours, days, or weeks before they appear and by the time they do, sometimes the head trauma is forgotten about and the cause of the symptoms is difficult to determine. Symptoms are often subtle and are often missed by the injured person, family and doctors. The person looks and often moves normal in spite of not feeling or thinking normal. This makes the diagnosis easy to miss, and family and friends often notice changes in behavior before the injured person realizes they have a problem. Frustration at work or when performing daily tasks may finally bring the person to seek medical care.
***This summer, beginning July 9, 2017, I will be riding my bike (with a friend), unsupported, and self funded from the west to the east coast to raise awareness and money for #TBI. Please follow along as I train and prepare for the ride, and as we make our way steadily eastward during the ride. We will be pulling trailers behind or bikes with camping gear, food, water, clothes, etc. I will post regular updates on this blog, as well as on social media, in addition to more info on TBIs. All donations (donation website is active) greatly appreciated and go to charity (Brain Injury Association).
My training (and daily ride) can also be found on the following: