Have you ever been fascinated with a topic that you just start reading and consuming as much information as possible about that topic? Have you ever researched something to the point that you realized the more you know about that topic, the more you realize we really don’t know everything there is to know about that topic? There are a few areas of discovery and science that comes to mind like space, deep oceans, and the human brain, consciousness, and mind. Did you know that it is estimated that our brain uses roughly 60% of our daily glucose for energy? Roughly 15-20% of the body’s oxygen supply gets used by the brain. All while the average adult brain weighs in at only 3 pounds! Our brain is the body’s control center and is one of those things that we don’t really appreciate it until something goes wrong. Currently one area of growing scientific research and discovery is in what we are currently calling traumatic brain injuries, or TBI’s; you may be familiar with the term concussion, a concussion is a type of TBI. TBI’s can be caused by a hit, blow, bump, jolt, whiplash, or slosh of the head and/or body. Think of sporting events, car crashes, slip and falls, domestic abuse, and explosions to name a few. The brain is like jell-o inside the skull, quick moments of trauma causes the brain to bounce inside the skull, some times twisting, stretching, or breaking nerve fibers in the process, depending on which nerve fibers are damaged, and to what degree, dictates what symptoms are seen and if recovery is possible; for example if the frontal lobe is damaged we are likely to see issues with planning, anticipation, initiation, problem solving, judgment, awareness, mental flexibility, ability to filter responses, personality, and emotions, while if the temporal lobe is damaged we are likely to see issues with memory, learning, organizing, sequencing, hearing, and understanding language. Not only do we see this mechanical type injury in TBI’s, but we are finding there can be a chemical and metabolic change that occurs as a result of this injury. Between the mechanical, chemical, and metabolic changes from a TBI, we see many different expressions of the changes in function and communication.
What the stats say about TBI
- It is estimated that 15% of people who have had minor blows to the head, resulting in a concussion, will have chronic problems post injury.
- You do not need to loose consciousness to have a brain injury.
- An estimated 5.3 million Americans, or more than 2% of the population, currently live with identified disabilities caused by TBI.
- 2 million people sustain a brain injury every year, roughly every 15 seconds, roughly 5,500 people sustain a TBI every day, and TBI is a leading cause of death until the age of 44, and the 4th leading cause of death overall.
- Causes of TBI in the general population is roughly 50% from vehicle crashes, 10% from sports and recreation, 12% from firearms, and 21% from falls.
- Domestic violence has been shown to cause TBI’s due to things like a blow to the head, shaking of the body, falling and hitting the head, being strangled, near drowning, use of firearms, punch to the face, or being pushed against a wall.
- Males are twice as likely to get a TBI than females, and the highest age group is 15-24 yrs old.
- Generally the moderate to severe TBI’s, which represents an estimated 15% of all TBI’s, will be hospitalized and followed by the medical community, while 85% of the more mild TBI’s will be seen by ER or PCP and identified as a concussion but not followed up by the medical community in most cases.
Definitions, Signs, and symptoms of TBI
- Moderate to severe TBI is defined as documented loss of consciousness, potential skull fracture, days to weeks in a coma, loss of information for a period of time post event, with significant and chronic thinking, physical, and emotional changes.
- Mild TBI is defined as headaches, dizziness, slowed processing, forgetfulness, fatigue, sensitivity to noise and lights; 85% will have full recovery within 3-6 months, while an unknown number of people will never seek care.
- Most common signs of TBI: overall slow, clumsiness, change in vision, change in hearing, change in sense of smell, dizziness, headaches, fatigue, increased sensitivity to light and noise, reduced concentration, reduced visual attention, difficulty to multi task, slow thinking, slow reading, slow verbal and written responses, difficulty finding the right words, difficulty naming objects, disorganized communications, reduced ability to remember new information, difficulty learning a new skill, difficulty with speech, sensory problems, seizures, facial paralysis, sleep issues, disorientation, vertigo (loss of balance), nausea and vomiting, mood swings, insomnia (not able to sleep), memory loss, inability to talk without slurring, unable to hold onto things without dropping them unintentionally, ringing in the ears, loss of appetite, blood pressure variations, heart rate changes, and a change of reflexes.
- Changes in emotional, behavioral, or social changes with TBI: depression, anxiety, rebellious, impatience, difficulty working with others, increased risk taking, short fuse emotionally, intolerant, socially inappropriate behaviors, agitation, and increased impulsivity.
A brain injury affects who we are, the way we think, act, and feel, it can change everything about a person in a matter of seconds. Currently no single test is definitive to diagnosis TBI. A TBI diagnosis therefore is with a history, evaluation of eye movements, balance, sometimes brain MRI or CT, blood work, biomarkers, accelerometer, EEG, and gait. A thorough evaluation, by a healthcare professional who specializes in TBI, is the best, as you can have a concussion and still be able to do math but maybe have difficulty tracking with your eyes. Appreciate that once someone has a TBI, receiving a second TBI shortly after can have severe consequences. Which is why we are hearing more and more about these injuries and how to better handle them with our athletes. TBI treatments are a big area of scientific research. Currently TBI therapy can include things like balance training, color stimulation, sound therapy and stimulation, apps for visual stimulation, eye movement exercises, nutrition, blood work evaluation, exercises, sleep, gyroscope, rehab, surgery, hyperbaric oxygen therapy (HBOT), medications, counseling, and low level light therapy. On the more experimental side MAPS, or Multidisciplinary Association for Psychedelic Studies, has been working on experimental therapies which include pharmaceutical-grade MDMA (which is the main ingredient in the club drug known as ecstasy or molly) assisted Psychotherapy; understand that MDMA is a Schedule I drug so this is not something to take lightly.
As you can imagine having a TBI can be life changing, frustrating, and sometimes difficult to diagnose, but there is hope of healing. Once even diagnosed, treatment has its own challenges due to costs, insurance coverage, access to specialists, and sometimes necessary traveling. One aspect that isn’t often discussed is the challenges of the family and loved ones around those with TBI’s and what they go through as they help, as best they can. All in all, appreciate there are some things that are in our control and there are some things in life that are not in our control, like accidents, car crashes, slip and falls, etc. When participating in high risk activities wearing appropriate helmets and other safety equipment can help reduce risk of TBI’s. Until next time, yours in health.