Traumatic Brain Injuries

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Traumatic Brain Injuries

Traumatic brain injury, otherwise known as TBI, is a brain injury that occurs due to some kind of impact to the head region – commonly through an accident or event sports. Traumatic brain injuries can range from mild to severe.

Types of Traumatic Brain Injuries

There are basically two kinds of traumatic brain injury, penetrating injuries and closed head injuries.

  • Penetrating injuries are the ones where something, like a bullet or debris has entered the head through a wound. The damage is generally confined to the area of the brain physically impacted by the external object.
  • Closed head injuries on the other hand, are the ones that are acquired through impact on the head, such a through helmet-to-helmet contact in football. This injury can lead to either primary brain damage, which is immediately visible in the form of aches, bruises and fractures or secondary brain injury, which manifests after some time. Secondary brain injury could include things like anemia, epilepsy, intracranial pressure, brain swelling etc.

Symptoms and Diagnosis of Traumatic Brain Injuries

Signs and symptoms of traumatic brain injuries include the following:

  • Headache and/or dizziness and loss of balance
  • Nausea or vomiting
  • Loss of vision or consciousness for a short period
  • Difficulty sleeping or sleeping too much
  • Memory issues that are short termed or long term depending on the severity of trauma
  • Mood swings or feelings of depression
  • Seizures or convulsions
  • Slurred speech, confusion or even coma

Traumatic brain injury is diagnosed by a speech-language pathologist. The pathologist may use the help of doctors, nurses or other therapists like physical therapists and even neuropsychologists. It needs to be understood that the more severe the head injury, like a car accident which involved collision, or violence such as home abuse, gunshot wound or combat injuries, the more severe would be the symptoms of the condition.

Complications Resulting from Traumatic Brain Injuries

Traumatic brain injuries can be mild, where the worse that happens are a few stitches to the head. But if the injury is severe, it could give way to the patient going into coma, get into a vegetative state or even be proclaimed brain dead. This is the reason why it is suggested that no matter how insignificant the injury may seem, it should be treated immediately.

A Mother’s Journey

A Mother’s Journey

On January 12, 2013, I received “that” phone call. You know the one I’m talking about. The one no parent wants to answer, much less hear. The man identified himself as Eric and informed me that my 19-year old son, Chase, had been in a tragic accident. A leisure hike with friends ended abruptly. Too abruptly. Following a split-second slip, into the stream of a 25 foot waterfall, landing on a rock, striking his head, breaking his arm and several bones in his face, lacerating his liver and kidney; the boy at the top of the cliff was gone. Just. Like. That.

He went from living life as a free-spirited, University of Tennessee, Chattanooga sophomore, YoungLife leader, to being fully dependent on a ventilator and Erlanger hospital staff.

Diagnosis…Traumatic Brain Injury.

Life as we knew it, ended that day.

Surgeries followed, a portion of his skull removed, broken arm set, vitals monitored, chest tubes placed, and then the unthinkable…less than a 2% chance to live unless he was placed on the ECMO machine. A machine that had only been used on one patient prior and the outcome had not been favorable. Heparin, a blood-thinner, would have to be administered. Chase had a brain bleed. Things weren’t looking good. Without it, he would die within the next 30 minutes. With it, he might die anyway.

He spent a month in Erlanger’s trauma unit, two months at Shepherd Center Atlanta (where he started walking with assistance), and three months at home…a total of six months…before he spoke his first word. Another month before he started eating again.

Someone once said this is not a sprint, it’s a marathon. I have to disagree…people plan for marathons and they have finish lines. This is a journey. A journey with a lot of uncertainties. No one can tell me if Chase will have a complete recovery and no one can tell me he won’t. There’s no date on the calendar with which I can write “end of the race”, “first day back at school”, “first day to drive again”…we pray those dates are in the future, but we don’t know for certain.

Six months from his injury, he and I started traveling, round trip, three hours a day, four to five days a week, for him to receive the therapy I believed would be his best chance at a full recovery.

It has been almost 28 months since that horrible day. Accepting the reality of the now has been a grieving process, to say the least, and I know it has just begun. I didn’t know I had also been injured because I was numbed by the trauma, living in the fast lane and hadn’t slowed down long enough to let myself feel the pain.

While it would be amazing if brain injuries were how movies play them out and the injured just “snapped out” of it and back to the person he was, that is not a reality. We were told multiple times, by Chase’s medical team, that all brain injuries are unique. He will not just “snap out” of it. Ever. Brain injuries are all different as different parts of the brain are affected. It’s a long recovery/healing process that takes many years, sometimes a lifetime. Every situation is isolated. No brain will “snap out” of anything.

As I type this, tears are running down my face. Private meltdowns have become a part of my day as I search for daily glimpses and yearn for my firstborn son to return. He’s still the same adventurous, God-fearing, coffee-loving, car enthusiast, light up a room Chase, but he’s different in many ways too.

Please allow me to quote my younger son, “the reality is this Chase was born two years ago, while the old one died. It’s not only terrible but also beautiful that a new form of life could come out of such tragedy, which is only the work of God.”

On a positive note, Chase is doing well. As well as could be expected given his injury. Stay tuned, I will share more on the next blog…

Concussion Alert – For Youth Sports

Concussion Alert – For Youth Sports

During play and otherwise, there are a series of different injuries one is susceptible to sustain. While some of them may manifest quickly in the form of bleeding, bruising, and pain, others take time to surface. These “hidden” injuries pose significant threat to your health and well-being, and may even lead to death if not addressed in a timely fashion. The concussion in one of them!

What is Concussion?

It is a kind of severe brain injury usually resulting from acute blow to the head. It occurs as a result of physical impact – either when something hits the head or the victim accidentally walks headlong into a barrier. Concussion typically does not manifest its signs immediately. It may take days or weeks for the symptoms to mature fully. Timely medical assistance is crucial to keep brain damage at bay.

Common Symptoms Associated with Concussion

Although concussions do not materialize physically, there are a few symptoms you can use to identify the problem in a timely manner. If you find anyone depicting any of these symptoms, rush for medical help immediately. The sooner you are able to get help for the victim (be it you or anyone else), the lesser the damage will be.

  • Confusion: The victim will depict confusion about his/her whereabouts and the incident. The person may look dazed, stunned, incomprehensible or unresponsive after impact.
  • Forgetfulness: The person forgets basic details like names, numbers and other personal information. S/he is most likely to forget instructions given to him/her.
  • Coordination Difficulties: The person walks clumsily, in a disoriented fashion and seems to have lost control over his/her body.
  • Slowed Reflexes: The victim has unconventionally slowed reflexes, taking a long time to think before reacting.
  • Unconsciousness: The injured party falls unconscious after impact, even if for a short duration.
  • Mood, Behavior and/or Personality Changes: Popular changes in mood include high irritability, unwillingness to converse, and sudden wish for seclusion.
  • Headache and/or Nausea: There may be a continuous throbbing pain at the affected area, often followed by nausea and/or vomiting.
  • Visual Impairment: The person is unable to see clearly, has double vision, and cannot make sense of his/her views.
  • Unexplained Sensitivities: Sudden development of sensitivity towards light or sound reflects unprecedented brain injury.

It is always a better idea to seek medical help immediately after any accident, especially if the impact occurs on the head. Timely discovery of the problem is key to rapid recovery.

Back-To-School after Concussion – A Parents’ Guide

Back-To-School after Concussion – A Parents’ Guide

Children and teens are prone to injuries, especially during play. They may sustain a concussion following severe physical impact to the head. It is advised to get them immediate medical help after an accident to diagnose a concussion in a timely manner.

Common Symptoms Associated with Concussions

The concussion does not manifest physically. Here are some of the symptoms you can use to identify a concussion. If any or all of these symptoms prevail, seek immediate medical attention for the child in order to limit damage.

  • Appears confused, dazed, unintelligible, or incapable of recalling past events.
  • Loses consciousness, memory, cognition, and/or the ability to coordinate.
  • Exhibits sudden changes in mood, behavior and preferences, usually pointing towards an underlying problem.
  • Reflexes are unusually slowed or elaborate.
  • Vomits or complains about severe headache and nausea.
  • Sleeps involuntarily and unusually.
  • Faces problems balancing, seeing clearly or following instructions.

Post-Concussion Care Guidelines

  • If you child or teen has sustained a concussion, it is imperative for you not to push him/her for personal or academic goals. Complete rest is the key to recovery. If the affected child is forced to return to the game before the medical practitioner declares him/her okay, s/he is at a risk of augmenting the damage to the brain, which may result in severe consequences.
  • Besides this, you should facilitate the child to relax, giving him/her time to heal. Keep them engaged in low-intensity activities. If they complain about recurring symptoms, consult the medical practitioner for advice. The road to recovery is gradual and long; don’t rush through it. A little time of school is better than permanent disabilities or handicap!
  • Also, make sure the child understands his/her condition and adapts to the needs accordingly. Read and discuss information about concussions and the care needed to reach complete recovery. Consult the doctor regularly for updates on the child’s recovery. Encourage the child to speak in order to clarify doubts. Everyone needs to be on the same page in order to move together towards holistic healing.
  • Support the child as s/he struggles to get back with his/her school routine. Limit the time spent on strenuous mental activities. Also, reduce physical exertion, at least during the treatment phase. Take the teachers and facilitators into confidence about the child’s injury, and ask them not to pressurize the affected child. Each and every bit of care goes a long way in relieving stress while ensuring speedy recovery.

Cognitive Disorders after Traumatic Brain Injuries

Cognitive Disorders after Traumatic Brain Injuries

The ability to think, act or know is known as cognition. This includes everything from talking, to listening, understanding to analyzing, remembering and storing information in the brain. Whether you are planning, thinking of what needs to be done or communicating the idea to someone, it all comes under the heading of cognition. Since it is directly related to the brain, cognitive disorders can take place when an individual attains a Traumatic Brain Injury, also known as TBI.
When anyone has faced some kind of trauma, there are some resulting effects on the cognition, which can include some hindrance in talking, language, attention span etc. Here are some of the problems or disorders that can occur when TBI takes place.

Concentration or Attention Span Issues

A victim of TBI may find it difficult to concentrate or pay attention to anything specific immediately after the injury. Depending on the severity of the injury, this condition may last from a few hours to weeks. This may also manifest physically, when the person is unable to sit or walk for long periods and tires out too quickly. The best way to avoid getting more confused or tiring out too soon is that the patient should only be engaged in one task at a time. In the immediate days after the injury, the patient should only try simple and easy to follow tasks so that they don’t feel overwhelmed.

Speech and Language Issues

Anyone who has had TBI can also come across speech and language issues like,

• slurring of the words
• difficulty communicating how they feel
• not being able to find the right words
• problems understanding tones or meanings of what others are saying
• having a hard time focusing on long conversations
• headaches when trying to communicate

Again, the severity of the injury would decide how long this issue lasts. The best way to handle the problem is to work with a speech therapist who would be able to advice on how to progress one day at a time.

Storing and Remembering Information

This is another difficulty that patients of traumatic brain injuries face. Not only do they find it tough to remember all the information from the past, they find it demanding to store new information in their brains. Memorization improves with time and patients should start with learning simple, routine tasks. They can also use memory aids, notebooks and daily task lists to help them remember things.

Cognitive Fluency

brain gears
The human mind is a complex entity, and the way it works is even more perplexing! A recent breakthrough in the field of psychology suggests cognitive fluency plays an important role in creating individual perceptions. Here’s what you need to know about cognitive fluency and the way it impacts your life and decisions!

What Do You Mean By Cognitive Fluency?

Simply put, it is considered as the ‘ease of understanding’. According to modern psychology, if you perceive something to be simple and easy, you are more likely to indulge in it. Several factors contribute towards your perception; nevertheless, these help you assign a specific difficulty/do-ability rating to the task at hand.
The way information is organized and displayed plays a pivotal role in this regard. This includes (and is not limited to) the fonts, vocabulary, and word choices. Here’s an example to clarify.
It is easier to trust medicines with simpler names as compared with those that are difficult to pronounce – the human mind associates ease-of-reading with ease-of-trusting. In the same way, complex and unreadable menus are typical for fine dining restaurants because they give an impression of quality, luxury and fine taste.
For the most part, it is a subconscious decision on your behalf, but it comes into play quite often throughout the course of your life.

Implications for Cognitive Fluency

The easier it is for you to read and understand a piece of information, the more believable and do-able it is. There has been ample research in the field to support this claim. This phenomenon has great implications for different specializations.
For businesses, cognitive fluency translates into higher sales and revenues. If it is made easier for customers to understand and use a product or service, it will inherently compel them to purchase. The concept applies to name choices as well – the simpler they are, the better they will yield!
For medical science, improving cognitive fluency can help alleviate the doubts and anxieties people usually face while undergoing treatments. This can actually help in improving the outcome of medical routines.
On the whole, cognitive fluency plays an important role in decision-making. If it sounds simple and doable, the human mind will automatically encourage you to perform. Most people label it as the intuition. This goes a long way in defining your future!

Learning Differently – Auditory Processing

Sometimes subtle differences in the way children process language can cause setbacks in learning and socializing. Luckily, there’s a lot that can be done to help.

Does your child often misunderstand what you or others say? Is your child struggling in school? These may be symptomatic of many learning difficulties, but could spell auditory processing problems. Though the word auditory would lead you to think that this is a hearing problem, auditory processing can be present without any hearing difficulty at all and with average to above average intelligence.
Auditory processing is the technical term used to describe the brain’s ability to rapidly take in and interpret sensory information in the order in which it occurs. Problems in this area may make it more difficult for a child to express himself verbally or to make the connection between certain sounds and letters.
Speech is made up of rapidly changing elements of sound. Phonemes (the smallest units of sounds that differentiate meanings of words like pat vs. bat) are made up of specific combinations of sounds. Auditory processing allows us to distinguish between the different phonemes, the building blocks upon which words, sentences and grammar depend. If a child does not automatically recognize each sound, he will most likely have trouble learning sound-letter relationships.
Also as we speak words, the elements in them, change quickly. When a child cannot process these sounds rapidly, the incoming message may lose something in the translation.
These problems may have a profound affect on a child’s ability to read and write. They may interfere, for instance, with a child’s ability to make sense of bits of grammar that are brief in duration – plurals, past tense, pronouns, etc.

Related Language Difficulties

Auditory memory difficulties may go undetected until a child reaches six to eight years of age, especially in the absence of other speech, language, and learning difficulties. This child may forget the directions easily. When he is young, working a group, he can easily watch others to figure out what to do. But when he is older and independent work is expected, the difficulty may emerge. A child who has this problem may be able to comprehend what a story is about while listening, but may have difficulty remembering newly introduced words, character’s names and/or details of the story.

Sequencing requires putting things in the right order. As children reach the first and second grades, the brain becomes more conscious of order (left/right, beginning/ending, first, middle, last). A child with an auditory processing/sequencing deficit may be able to tell you bits and pieces of a story or event, however he often cannot start from the beginning and tell you what happened in an organized and logical way. Sequencing difficulties can affect spelling too.

Some behaviors of children “at risk” for auditory processing problems:

• often misunderstands what is said
• difficulty following directions or comprehending conversations
• frequently daydreaming or is inattentive
• expressive language difficulties
• difficulties listening in the presence of background noise
• problems with phonics
• word finding and/or naming difficulties
• use of empty or non-specific language
• problems organizing thoughts or stories
• difficulty maintaining eye contact when listening or speaking
• needs verbal directions repeated
• has reading, spelling and other academic problems

A Light at the End of the Tunnel

Children at risk for possible auditory processing problems are being identified at earlier ages. If a parent suspects a problem, it is critical that the child be evaluated to determine if any language and/or processing difficulties are present. It is also essential that parents, teachers, tutors and therapists work together as a team so that they can more effectively bridge any gaps in the child’s academic performance, and maximize the child’s potential.
Prognosis is excellent with appropriate intervention. Treatment may consist of traditional one-on-one approaches that target areas of weakness and/or new computer technology. It is possible, studies of the brain tell us, to train the brain to more accurately distinguish between stimuli occurring at progressively higher processing speeds.
Once parents and teachers understand that a child has auditory processing difficulties, there are also small changes they can make in the way they present information that will make it easier for the child to process it. They can, for instance, slow down their rate of speech, pause between statements, and emphasize key words to enhance processing skills. Using visual cues paired with the auditory information would also help. A lot can be done on both ends – intervention with the child and training of the teacher and parent – that will help make learning less frustrating and more rewarding for a child with auditory processing problems.

Sharon Pollack is a licensed speech language pathologist, a certified brain injury specialist
and the director of Cognitive Bridges in Memphis, TN