Traumatic Brain Injuries: The Silent Epidemic

Take a moment to look around you right now. Within just a few moments, you’ll likely be able to call to mind the names of many of the items in your immediate surroundings. Some of those things may even evoke an emotion or two. Now imagine that those abilities were hindered. Perhaps you aren’t able to accurately come up with the name for “book” or “office”. You may know that the object is something you read or that the place is somewhere people work but you just can’t identify the right word. Or you could even be disconnected from your emotions, have incessant headaches, or even occasional seizures. These symptoms are some of the varied symptoms that can be experienced by individuals who have had traumatic brain injuries, and in fact, are some of the more mild symptoms.

While any traumatic injury to the body can be seriously life changing, sustaining a traumatic brain injury (TBI) is possibly the most complex. TBI is a result of forceful contact to the head, and can cause the life of the individual who sustained the injury as well as the loved ones to be altered, in some cases, for the rest of their lives. There are other ways to sustain brain injuries, such as the result of a stroke, viruses or other illnesses; however, those injuries are called Acquired Brain Injuries, or ABI.

Our brains are critical to virtually every factor of our lives, from how we respond to stimuli to how we feel and even how we move. Patients who sustain a TBI often have problems with cognitive functioning (i.e. planning, memory, decision making, information processing, thinking), as well as communication, behavior, and mobility, although clearly each case is decidedly unique. In reality, once an individual sustains a TBI, nearly any of the functions of the body can be impacted, from eating to sleeping to sexual functions. In addition, as the body regulates our sense of well being, our more complex functions can also be altered, such as the ability to process emotions or to accurately and appropriate communicate with others.

TBI is typically classified as mild, moderate, and severe; however, even cases of minor TBI can result in major alterations in the life of the patient. For instance, the individual may lose the ability to evaluate and process data and to be able to make decisions. There is a wide variety of symptoms that may present after the TBI has been sustained, from loss of the ability to move freely to the loss of short-term memory, to the loss of the ability to interact socially well with others.

The incidence of TBI in America will almost certainly surprise you. In fact, incidents of TBI occur 6 times more frequently than Multiple Sclerosis, spinal cord injuries, HIV/AIDS, and breast cancer combined. TBI is often called the “silent epidemic” in part because the general public knows so little about it in addition to the fact that the TBI can go undiagnosed and misunderstood by peers, employers, and families of the injured person.

The leading causes of TBI are:

• Falls (28%)
• Motor vehicle crashes / traffic accidents (20%)
• Being struck by or against objects (19%)
• Assaults (11%)

Once a head injury has been sustained, the patient should immediately be seen at a hospital that deals with trauma. Patients that have mild TBI may be then referred to other programs and centers that specialize in TBI. Patients that have serious TBI may be sent to surgery or other acute care depending on the extent and nature of the injury.

The following groups are at particular risk for sustaining a TBI:

• Males are almost twice as likely as females to sustain a TBI.
• Infants and children between 0 – 4 as well as adolescents between 15 – 19 are the two age groups who are the highest risk.
• Adults 75 and older have the highest rates of TBI-related hospitalization and death.

It’s important to note that blasts are a leading cause of TBI among troops that are in active war zones. Our soldiers have heavy body armor that often can protect the vital organs from harm, however a large number of our soldiers are returning home with TBI.

The emotional toll on the individual who sustains a TBI as well as their loved ones can be traumatic. There is often anger and depression as a result of the injury as the individual tries to come to term with what has happened and the resulting effects. Even more, the long-term physical, cognitive and behavioral effects from the injury are the factors that most often prevent the individual from being able to return to work or re-integrate with the community. Long-term depression, substance abuse and even suicide can be risks for individuals with TBI. Particularly for those individuals who sustain the TBI as a result of substance abuse, often there is a high risk for that abuse to continue once the individual has been stabilized and has begun the process of recovering from or adapting to the TBI.

The care team of the individual is critically important and is often comprised of several members. While there has a been some resurgence of interest in trying to repair the brain itself within the scientific community, the primary focus for many years for TBI patients is to provide the therapies that will enable the individual to make the most of what abilities remain and can be strengthened. Some of the specialists who may be involved include:

• Neurologists – doctors who specialize in the treatment of nervous system disorders
• Physiatrists – specialists who are medical experts in rehabilitation medicine
• Occupational, Physical, Speech and Language Therapists – specialists who will work with the patient to regain skills
• Vocational Rehabilitation Experts – specialists who will work with the patient on job skills
• Behavioral Analysts – specialists who will work with the patient on behavioral problems
• Neuropsychologists – Psychologists who will focus on thinking skills and behavior problems
• Case Managers or Care Coordinators – Specialists who will assist in finding and accessing programs and services for the patient

The specialists will often work in tandem with one another, learning from and assisting their colleagues in identifying how precisely the patient is recovering. The process of helping a person with TBI can be very rewarding as well as a process that provides the unexpected. As you might imagine, many individuals with TBI may say or do things that are unexpected. In order for the specialists to be able to perform effectively, they must not internalize or take those things personally. For most of the individuals who work in this field, the rewards are plentiful as they experience the progress of their patients as they work to get better.

There is no question that TBI causes a toll on the individual, the family, and the finances. The recovery time can be extensive and the costs for rehabilitation and care are often very high. There are resources, however, that provide a variety of assistance and support. There are also many excellent rehabilitation centers that specialize in helping TBI and ABI patients within Michigan.

• The Brain Injury Association of Michigan: www.biami.org (They also created a Veteran’s Program in 2007 to specifically address the needs of the soldiers returning from Iraq and Afghanistan.)
• The National Brain Injury Information Center: 800-444-6443
• www.Brainline.org
• The Southeastern Michigan Traumatic Brain Injury System: www.semtbis.org

Langlois JA, Rutland-Brown W, Thomas KE. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta, Ga: Centers for Disease Control and Prevention; Jan 2006.

Defense and Veterans Brain Injury Center (DVBIC). [unpublished]. Washington (DC): U.S. Department of Defense; 2005.