Apr 4, 2012

Traumatic Brain Injury (TBI) - Part III - Types

While this [link] explains the "effects" of a TBI, I feel that it better explains the 2 types (mild & severe) of a TBI, which is why I'm summarizing it and providing some personal observations after that. Yeah, this entry is going to be LONGER than normal because this is what needs to be most understood about TBIs.

Most are unaware of the range of a TBI or its overwhelming nature. TBI is common, and will be overlooked initially when the medical team is focused on saving the person's life. TBIs can be categorized into 2 levels: mild and severe. Let's talk a little about them. For more information, click on the links above.

Understanding Traumatic Brain Injury
A TBI is classified as mild if loss of consciousness, confusion and disorientation is shorter than 30 minutes. The victim may experience headaches, difficulty thinking, memory problems, attention deficits, mood swings and frustration. Even though this type of TBI is called "mild", the effect on the family and the injured person can be devastating. Unfortunately, the family and friends may be the recipients of the frustration of the victim, but they don't realize "why" they are. And, the victim doesn't realize that they are venting on them.

The most common mTBI is a concussion. Even though most sports require pads and helmets, it still occurs. Wearing a helmet helps prevent 60% of mTBIs, but they can still occur. I'll discuss more about helmets in the prevention entry. A key point to understand about a concussion is that the effects can last up to a year or more after the injury.

Common Symptoms of Mild TBI (mTBI):
  • Fatigue, sleep disturbances, memory loss, dizziness/loss of balance 
  • Irritability-emotional disturbances, depression
Other Symptoms Associated with Mild TBI (mTBI):
  • Nausea, loss of smell, sensitivity to light and sounds
  • Mood changes
  • Slowness in thinking
These symptoms may be delayed days or weeks before they show up.  They are subtle & often missed by the injured person, family and doctors. The victim "appears" normal. Family and friends notice changes in behavior before the injured person realizes there "is" an issue.

Frustration at school, work or when performing daily tasks occur. Trust me, I know... I've gone through this and continue to work through it. Unfortunately, it affects those around me too, and I'm not always aware of that until they point it out to me.

Understanding Traumatic Brain Injury
TBIs result in permanent neurobiological damage that can produce lifelong deficits to varying degrees. Severe brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury longer than 24 hours. Survivors may have limited function of arms or legs, abnormal speech or language, loss of thinking ability or emotional problems.

The impact of a moderate to severe brain injury can include difficulties with attention, concentration, being distracted easily and impulsive responses. Other key effects of a severe TBI are:

Speech and Language
  • difficulty speaking and being understood
  • slurred speech
  • speaking very fast or very slow
  • problems reading or writing
  • blurred vision, problems judging distance
  • decrease or loss of hearing, ringing in the ears (tinnitus)
  • loss or diminished sense of smell
  • Lack of motivation, irritability, aggression
  • Depression
  • Denial/lack of awareness
Another key thing not mentioned on most websites about TBIs is prosopagnasia (commonly called "facial blindness"). This is when a victim cannot recognize someone just by looking at their face. I know I suffer from this because I once spent an half an hour visually "searching" for a family member that had been standing 20 feet away from me the whole time, but I didn't recognize them. Yeah, this will probably be another blog entry.
The abnormal speech & slurred speech occur more often when the victim is tired or stressed. I have had several people approach me and ask me if I was drunk because my speech was slow, slurred, and not easy to understand. No, I hadn't been drinking, but the connections between the brain and the voice are stressed more, so it "sounds" like that I am.
When in a tired, stressed, anxious, or distracted environment, I have been overly impulsive (verbally) to things. A victim can lose their mental "filters" and end up saying or doing things they wouldn't "normally" have done before. It is because the connections between emotions and expression are stressed more than normal, and the person is not performing a mind check before they utter or do something. And when they DO utter them, they probably sound "drunk."
Sometimes there is a disconnect in the brain of a victim because they "know up here" what they are trying to communicate, but the signal never makes it to the tongue. There are times that I know what I am thinking, but the actual words don't come out of my mouth, and that leads to frustration when you have to ask someone what the word is for something as simple as a "doorbell," or "remote control." It leads to more frustration, but also personal embarrassment, which typically leads to even more emotional feelings related to self-esteem.
Sometimes the victim has more of a ROM drive brain but not a RAM drive brain (this is related to memory). I can tell you about things I cooked over a camp fire 2 decades ago, but I can't remember if I had breakfast this morning. Sometimes I wish I could use a PC code of "C:\del *.*" on my brain and just start over.

Part IV will be about recovery & rehab.

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  1. I like this very much. As a Roller Derby Girl i have suffered a few concussions and am now out on injury leave for a neck injury. I believe not enough people know about brain injuries and especially the after math. I have experienced all the things in a mild TBI and I was in class today experiencing the correct answer but not being able to get it out in time, very frustrating. the slurred speech, yup. I think it's imparitive that teams and coaches who are involved with contact sports understand and know what to watch out for in the after math of a TBI. Thanks for a great article from someone who has experienced these things, and not just some doctor spouting out verbatim a text book.

    1. Thank you for reading it. I began this series because a roller derby friend's nephew experienced a head injury playing lacrosse, but also because I've seen several heavy falls already this derby season. So, it was on my mind (ironic, isn't it) to write about TBI. You are right that a lot of coaches need to understand head injuries more. I did try to write it containing a touch of the facts, but more with a personal side because you are right, there is a LOT about recovery & rehab that isn't in the books. Thanks again.