The following article is the first of a multi-part series on Traumatic Brain Injury (TBI). Stay tuned for part 2 of this ground-breaking series tomorrow here on Liberty Nation.
Historically, TBI has received insufficient national public policy attention and support. TBI is the signature injury of the military conflicts in Iraq and Afghanistan and among NFL players. As such, TBI has gained the attention of elected officials, military leaders, policymakers and the public.
Traumatic Brain Injury (TBI), the technical name for a concussion, is one of the leading causes of death and disability among children, adolescents, and adults. While we do not know the number of people with TBI who receive no medical care, of the approximately 1.4 million who go to the hospital, 50,000 die, 235,000 are admitted for medical stabilization and treatment, and 1.1 million are treated and released annually in the United States. Often called the ‘Silent Epidemic,’ millions of American families have had to face the challenges raised by brain injury.
The Centers for Disease Control and Prevention define traumatic brain injury as, “craniocerebral trauma associated with neurological or neurophysiological abnormalities, skull fracture, intracranial lesions or death.” TBI leads all causes of death for Americans under age 44, and one-third of injury-related deaths are associated with it. Until the recent use of individualized Transcranial Magnetic Stimulation (iTMS) there was no actual treatment for mild to moderate traumatic brain injury. But new technology is bringing hope and results.
The most frequent causes of TBI differ based upon gender and age at injury. The age groups at highest risk are the very young (0-4 years old), teenagers, and elderly persons. Firearms and motor vehicle collisions are the leading causes of TBI in those under 75 years of age, and falls are the leading cause of those 75 and older. Males are about 1.5 times as likely as females to sustain TBI. Overall, the leading causes of TBI are falls (28%); motor vehicle traffic crashes (20%); impact injuries (struck by/against) (19%); and assaults (11%).
Sports activities, workplace injuries, domestic violence, child abuse, and active military duty are all potential causes of TBI. Blasts are presently the leading cause of TBI for active duty military personnel in war zones in Iraq and Afghanistan, with well over 30,000 affected. The risk for repeat TBI is three times greater for a second injury; and after the second injury, the risk is eight times greater for a third injury. Unfortunately, injury effects maybe cumulative resulting in increasing symptoms and worse outcome after repeated injuries, as seen in blast-related concussion in wartime, and athletes and contact sports.
Guidelines are presently available through the Brain Injury Association of America to assist parents, coaches, and trainers in better managing sports concussion. The military continues to develop enhanced methods of in theater and post-deployment screening to check for TBI to reduce the risk of cumulative injury from a repeated recurrence of a blast concussion. But the issue remains serious.
The symptoms of traumatic brain injury fall into three broad areas– physical, cognitive, and psychosocial or behavioral challenges. Physical symptoms include seizures, motor control and coordination problems, paralysis, spasticity, tremor, dizziness and much more. Physical recovery often responds to rehabilitation and stabilizes first, whereas, the cognitive and psychological changes contribute to more lasting adversely affected skills in areas such as attention, concentration, learning, memory, processing speed, visual perception, language (aphasia), motor planning and time perception. Advances in cognitive rehabilitation and increased scientific and funding support for cognitive treatments continue to improve TBI outcomes.
The All-Important Frontal Lobe
The most troubling cognitive symptoms that emerge with an injury to the frontal lobe of the brain, the region directly behind the forehead and eye sockets, which is the most commonly injured region in car crashes and falls. The frontal lobe does not fully develop until after puberty, warranting repeat and thorough assessment in adolescents for youngsters who sustained childhood TBI. The cognitive functions of the frontal lobe are referred to as ‘executive functions,’ as they reflect the kinds of activities where decision-making skills are located. These executive functions are also necessary for achieving adolescent and young adult developmental milestones and independence in the community.
Executive functions include but are not limited to: working memory (the ability to multi-task), initiating, organizing, planning, prioritizing, goal setting and problem-solving. Frontal lobe related cognitive problems, especially impaired awareness can make rehabilitation and recovery much more difficult. Whether after TBI or in other life situations, if someone does not know how to play their strengths, spot their weaknesses and know when to ask for help, loss of jobs and relationships failures may occur, leading to anger, irritability and depression.
While anger, irritability, and depression may be common reactions after brain injury, such psychosocial problems are far broader and more complex. Behavioral symptoms are in some instances caused by the TBI itself, as regions of the brain may be directly damaged or have a disruption in patterns of electrochemical activation. Other times, psychosocial symptoms emerge from the person’s reaction to having the injury, and the confusion and change that ensues. TBI may also cause pre-existing psychological or substance abuse problems to recur or increase. Impaired self-awareness has roots in frontal lobe injury, but may mimic a psychological reaction called denial.
Thanks to a great deal of medical research coupled with technology, TBI is being addressed and in many cases alleviated with a new protocol that is delivering startling results. More on that in part 2 tomorrow here on Liberty Nation.
Lorraine C. Silvetz, MSW is Director of iSynchrony based in Oakton, VA and Executive Director of Global Stress Initiative a program for the treatment of veterans and their families launched in 2010 under the auspices of the International Committee Against Mental Illness (ICAMI) which is led by Robert Cancro, MD, Chairman Emeritus of NYU Langone's Department of Psychiatry.