Head Trauma and Traumatic Brain Injuries

I know of two people who have had head trauma and Closed Head Injury, TBI (Traumatic Brain Injury).

My Husband had the closed head injury and TBI and his story is being told later in this article.

A dear friend who I have had the pleasure of meeting recently also had a head injury. His name is Constant Walker and he said that he just fell off his steps and hit his head three times before being knocked unconscious. He describes his fall and his traumatic experience on his hubpage: I'm No Superman. It changed his whole outlook about life and his thinking.  He is still dealing with his physical injuries to his ear as well as some dizziness and other complications that are now in his life.

I suggest you watch the video below. It is chock full of information about Brain Injuries and also has examples of people who have had Brain Injuries and what they have and are going through.

If you know someone who has had a brain injury please be patient with them and love them with all your heart--no matter what happens. They need consistency and love and to know that someone is there for them when things get out of hand or frustrating. Sometimes that may be simply walking away for a few minutes, hours or days. Get into a support group for the both of you. They will teach you things and you will have others to talk to whom are going through similar things. Remember they may also come from the accident or injury as a totally different person. It isn't their fault and it isn't an ending but a beginning.

 There are many types of Brain Injuries.  For the sake of this article I will describe TBI, Open and Close Head Injuries, and The Levels of such, but for this article I will only describe the ones associated with this article.

This is what the Brain Injury Association of America has to say about Traumatic Brain Injury.

"A traumatic brain injury occurs when an outside force impacts the head hard enough to cause the brain to move within the skull or if the force causes the skull to break and directly hurts the brain.

• A direct blow to the head can be great enough to injure the brain inside the skull. A direct force to the head can also break the skull and directly hurt the brain. This type of injury can occur from motor vehicle crashes, firearms, falls, sports, and physical violence, such as hitting or striking with an object.
• A rapid acceleration and deceleration of the head can force the brain to move back and forth across the inside of the skull. The stress from the rapid movements pulls apart nerve fibers and causes damage to brain tissue. This type of injury often occurs as a result of motor vehicle crashes and physical violence, such as Shaken Baby Syndrome.

Definition: Traumatic Brain Injury

`Traumatic brain injury is an insult to the brain, not of a degenerative or congenital nature but caused by an external physical force, that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning. These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial maladjustment. Adopted by the Brain Injury Association Board of Directors, February 22, 1986. This definition is not intended as an exclusive statement of the population served by the Brain Injury Association of America. "

This is what the Brain Injury Association of America has to say about the Open and Closed Head Injuries.

"Open Head Injury

Open Head Injury If the force that hits a person's head is great enough, the skull can fracture or become out of place. When this happens, the person is described as having an "open head injury". This terminology is referring to the condition of the skull and not the brain. Separate terms are used to describe the condition of the brain. For example, a person may be described to have an open head injury with a severe traumatic brain injury.

Closed Head Injury

When a person receives an impact to the head from an outside force, but the skull does not fracture or displace this condition is termed a "closed head injury". Again, separate terminology is added to describe the brain injury. For example, a person may have a closed head injury with a severe traumatic brain injury. "

This is what the Brain Injury Association of America has to say about the levels of Brain Injury.

"Mild traumatic brain injury occurs when:

• Loss of consciousness is very brief, usually a few seconds or minutes
• Loss of consciousness does not have to occur—the person may be dazed or confused
• Testing or scans of the brain may appear normal
• A mild traumatic brain injury is diagnosed only when there is a change in the mental status at the time of injury—the person is dazed, confused, or loses consciousness. The change in mental status indicates that the person’s brain functioning has been altered, this is called a concussion.

Symptoms of mild traumatic brain injury:

• Headache
• Fatigue
• Sleep disturbance
• Irritability
• Sensitivity to noise or light
• Balance problems
• Decreased concentration and attention span
• Decreased speed of thinking
• Memory problems
• Nausea
• Depression and anxiety
• Emotional mood swings

 A moderate traumatic brain injury occurs when: 

• A loss of consciousness lasts from a few minutes to a few hours  
• Confusion lasts from days to weeks  
• Physical, cognitive, and/or behavioral impairments last for months or are permanent.  

Persons with moderate traumatic brain injury generally can make a good recovery with treatment or successfully learn to compensate for their deficits. 

 Severe brain injury occurs when a prolonged unconscious state or coma lasts days, weeks, or months. Severe brain injury is further categorized into subgroups with separate features:

• Coma 
• Vegetative State
• Persistent Vegetative State
• Minimally Responsive State 
• Akinetic Mutism 
• Locked-in Syndrome  

Coma  Coma is defined as a state of unconsciousness from which the individual cannot be awakened, in which the individual responds minimally or not at all to stimuli, and initiates no voluntary activities.

• Persons in a coma appear to be asleep, but cannot be awakened 
• There is no meaningful response to stimulation. 

Persons who sustain a severe brain injury can make significant improvements, but are often left with permanent physical, cognitive, or behavioral impairments. Department of Defense and Veteran’s Head Injury Program & Brain Injury Association of America (1999). Brain Injury and You.  Vegetative State (VS) Vegetative State (VS) describes a severe brain injury in which:

• Arousal is present, but the ability to interact with the environment is not. 
• Eye opening can be spontaneous or in response to stimulation 
• General responses to pain exist, such as increased heart rate, increased respiration, posturing, or sweating 
• Sleep-wakes cycles, respiratory functions, and digestive functions return 

There is no test to specifically diagnose Vegetative State; the diagnosis is made only by repetitive neurobehavioral assessments. Giacino, J. & Zasler, N. (1995). Outcome after severe traumatic brain injury: Coma, the vegetative state, and the minimally responsive state. Journal of Head Trauma Rehabilitation, 10, 40-56.  Persistent Vegetative State (PVS) Persistent Vegetative State (PVS) is a term used for a Vegetative State that has lasted for more than a month.

• The criteria is the same as for Vegetative State

The use of this term is considered controversial because it implies a prognosis. Giacino, J. & Zasler, N. (1995). Outcome after severe traumatic brain injury: Coma, the vegetative state, and the minimally responsive state. Journal of Head Trauma Rehabilitation, 10, 40-56.  Minimally Responsive State (MR) Minimally Responsive State (MR) is the term used for a severe traumatic brain injury in which a person is no longer in a coma or a Vegetative State. Persons in a Minimally Responsive State demonstrate:

• Primitive reflexes  
• Inconsistent ability to follow simple commands 
• An awareness of environmental stimulation 

The frequency and the conditions in which a response was made are considered when assessing the meaningfulness or purposefulness of a behavior. Giacino, J. & Zasler, N. (1995). Outcome after severe traumatic brain injury: Coma, the vegetative state, and the minimally responsive state. Journal of Head Trauma Rehabilitation, 10, 40-56.  Akinetic Mutism 

Akinetic Mutism is a neurobehavioral condition that results when the dopaminergic pathways in the brain are damaged. Damage to these pathways results in:

• Minimal amount of body movement 
• Little or no spontaneous speech 
• Speech which can be elicited (For example, the person can answer a question if asked, but otherwise does not voluntarily start saying anything). 
• Eye opening and visual tracking 
• Infrequent and incomplete ability to follow commands 
• Vigilance and agitation for Frontal Akinetic Mutism 

Akinetic Mutism is different from the Minimally Responsive State because the lack of movement and speech with Akinetic Mutism is not because of neuromuscular disturbance.  Giacino, J. & Zasler, N. (1995). Outcome after severe traumatic brain injury: Coma, the vegetative state, and the minimally responsive state. Journal of Head Trauma Rehabilitation, 10, 40-56.  Locked in Syndrome Locked in Syndrome is a rare neurological condition in which a person cannot physically move any part of the body except the eyes. The person is conscious and able to think.

• Vertical eye movements and eye blinking can be used to communicate with others and operate environmental controls.   

Brain Death  Brain death can result from a very severe injury to the brain. When brain death occurs, the brain shows no sign of functioning. The physician performs a specific formal brain death examination.  For information and resources about brain injury, please contact the Brain Injury Association of America’s Helpline at 1-800-444-6443"

After watching that very informative video you know have some kind of idea as to who and what kinds of brain injuries are and how they can affect different people in totally different ways.

One can have a brain injury just by falling down and hitting their head, like my friend Constant Walker did. One can also get head injuries by being in Car Accidients.

They are now finding out that those soldiers who are coming from war zones such as Iraq and Afghanistan have come back with mild traumatic brain injuries.which they think can cause the Post Traumatic Stress Disorder.

Here is what is said about the PTSD:

Soldiers' Head Injuries May Contribute to PTSD

by Alix Spiegel

"Traumatic brain injury has been labeled the signature injury of the Iraq war. It's estimated that between 10 percent and 20 percent of soldiers who have served in Iraq have suffered from this kind of wound.

Now, a new study published in the New England Journal of Medicine suggests that even minor traumatic brain injuries, like concussions, may be associated with long-term health problems, specifically post-traumatic stress disorder, or PTSD."

In another article it says:

"Traumatic Brain Injuries in Soldiers Often Go Undetected

By Jason Margolis

Since Operation Iraqi Freedom began two years ago, the Department of Defense reports that more than 1,500 U.S. soldiers have died and more than 11-thousand American troops have been wounded. Among the most debilitating wounds are traumatic brain injuries. One of the nation's leading brain treatment centers is the Veteran's Affairs hospital in Palo Alto, California. Within the confines of the One of the nation's leading brain treatment centers is the Veteran's Affairs hospital in Palo Alto, California sprawling VA campus, veterans of World War II and the Vietnam war work on rehabilitation alongside returning soldiers from Iraq and Afghanistan."

Any age can get a traumatic brain injury. Babies are not exculded in this category because "Shaken Baby Syndrome" is a Traumitic Brain Injury that leads to death.

 In an article on Medical News Today research has been done and found that Moderate Alcohol Helps You Survive Brain Injury.  You can read the full article there.  Some of what is in that article:

"The study is published in the Archives of Surgery and was led by Dr Homer Tien, trauma surgeon at the Sunnybrook Health Science Centre in Toronto.  Dr Tien and his team looked at 16 years of trauma registry data from 1988 to 2003 describing patients admitted with traumatic brain injury (TBI) due to blunt head trauma, resulting from a road accident for example. They analysed the results of 1158 patients according to their blood alcohol level: None (0 milligrams per decilitre, 0mg/dL), low to moderate (under 230mg/dL), and high (230mg/dL and above)."

When I met my husband in 1996 his mother told me of a accident that he had in September 1984.  Back then he was working as a counselor for a Boy's Home in Texas.  This was his first job after graduating from college.  He still is a counselor and has gone on to get a second degree and his Social Workers License. 

He was on his way home from work and a tractor trailer plowed into the back of him and he was ejected out of his car and was found in a tree. He wasn't wearing a seat belt.  I don't know why and he probably doesn't remember.  It was a hit and run. As pastor had seen the accident and tried to get the guy's license number but being as it was a hit and run he failed to get it.  The tractor trailer was long gone by then.  He was the one that got the ambulance there and made a report to the police when they arrived.  .

Once they got my husband to the hospital they called his parent's and told them specifically to take their time because he wasn't going to live past that night

He was transportd to one hospital in a M.A.S.T. suit and you can view how one is put on here. It is used to control bleeding and other factors when a person is injured below the abdomin. He was transported to another hospital with better facilites to meet his needs. 

On arriving his injuries included: severe hypovelemic shock, when the heart cannot pump enough blood into the body, closed head injury, punctured lung due to a broken rib, internal bleeding due to laceration of the spleen, which had to be removed, several lacerations of the bladder which were sewn up and his rectum was ripped open.  When someone tells you they are going to rip you a new a** my husband can tell you truly what that is like (haha).

He had many surgeries to repair the damage of his organs. and to rebuild his urinary and excretory organs including a temporary clolostomy.  He was only 24 years old when this happpened!

He was in a coma for 10 days. Before the accident he worked at as a Boy's Counselor in a Group Home like setting. When he woke from his coma he thought that he was one of the boy's that he was counseling. I don't know how long this lasted but this gives you and idea of what his brain was like coming out of this horrible accident.

After being released he was sent home with his parents and they took care of his recuperation and rehabilitation. All his exterior and interior body parts were healing just fine, though it too a lnog time.  What they couldn't see was the way that his brain had been damaged and/ or how it was healing.  Back in 1984 they didn't know much about TBI's or Closed Head Injuries. They knew physically what it did to the brain. The didn't know how it affected the brain and the person. They didn't even realize when it would affect the person or for how long.

Since I was not there before and after the acident I had no idea what changes had occured. I was told bits and peices from his family members and his close friends. Nt until we married in 1997 did I realize what I was in for and it was a shock to say the least.

In the video it mentions about anger and frustration. When I firt met him he didn't seem angry and was very loving. After we got married things changed and at the time I didn't know what the heck was going on. This may sound strange, he was to live so that we could find each other. I had always had this feeling like where and how long did he wait for me.

There were things that he did or didn't do that just didn't make sense in the first years of our marriage and so I did some research into this TBI thing and his Closed Head Injury. I still dind't understand for quite a while what was really missing. I was at the point of divorcing him but then something kind of clicked and it became a mystery that I had to find out the answer too..

Thisg that would make him go off the deep end were like talking with my hands. Just moving them al about would send him in fits of anger and he would pick me up and put me in the shower, fully clothed, to calm "me" down. Let me tell you these were scary times. When you love a person sometimes you are the one who has to change. I changed because I knew that there was somthing not quite right with that action and so I do not talk with my hands too much anymore. Since that change he hasn't exhibited that anger anymore.I was told by his friends and family members that he was never like this before the accident. This was something I had to work with him on and change myself to accommodate something that he wasn't even aware of.

Another thing that he does when he gets frustrated and excited about is stutter. Now if he was talking to me in a normal tone and about everyday things he doesn't stutter. Often times when he gets to stuttering alot in a conversation with someone else I will interject and tell him to take a deep breath. That usually stops the stuttering. I don't think he did this before the accident either and it is something that I help him on kind of like an unspoken thing becasue until now I never told him what it was that he was doing. Maybe he already knows.

There is something else that is missing that we can't put our finger on. While taking the exit exam for his last degree he fail it twice. The college does not give it back to you so that you can see your mistakes unless you ask for it. When you get the copy of the test you can hardly even see the writing on the page. Somehow I got to get a writing from him and I saw the problem. His friend, who was attending the same classes as he) and I talked to the college administration about getting extra provisions to do write his exit exam.  The hoops they put you through to get a degree are somewhat rediculous. 

What was happening is he can speak well, but his thoughts or how they cameout on a written paper are not equaling to each other.  He can't see the difference to this day.  When he writes his ver tenses and his pronouns don't match up and are all wrong.  His thoughts or the writing of his thoughts don't match up with what he writes on the paper.  It is hard to explain because it is hard to deseminate what it is tht is going on or missing.  There is no flow to what he writes and he is unable to see that.  He can speak it, but not write it.  I have helped him get his second degree by writing some of his homework and research papers.  This didn't show up until well after his accident so there is no corrective action to take this long after the event.  This is why I say they still don't know what, when or how a brain injury will affect a person or the duration.  He will have this the rest of his life.  I am happy to help him, although it took alot of anguish and emotional pain to go through, .............................I now understand.

I Am No Superman

http://hubpages.com/hub/Dealing-With-Invisible-Disability-But-You-Look-Well

 Just hitting your head on something may not seem like much, but keep a watch on the person andyourself becaseu it may be a smooth ride or a very bumpy one.  There may be things that you just won't notice for months or even years.  The strides the medical and research in this field is getting much better at recognizing this they didn't know before.  Get into a support group and find out as much as you can about this.

Here are some links for you to peruse:

~~~~~~~~~~~

Brain Injury Association of America

http://www.biausa.org/

~~~~~~~~~~~

National Institute of Neurological Disorders and Stroke --TBI Information Page

http://www.ninds.nih.gov/disorders/tbi/tbi.htm

~~~~~~~~~~~

Mild Traumatic Brain Injury

http://www.neuroskills.com/tbi/injury.shtml

~~~~~~~~~~~~~

The Perspective Network

The Perspectives Network, Inc.'s  primary focus is positive communication between persons with brain injury, family members/ caregivers/friends of persons with brain injury, those many professionals who treat persons with brain injury and community members in order to create positive changes and enhance public awareness and knowledge of acquired/traumatic brain injury.

http://www.tbi.org/

~~~~~~~~~~~~~~~~~~

TBI Support Groups

http://www.headinjury.com/linktbisup.htm

~~~~~~~~~~~~~~~

Mind Menders Support Group

The Mission of Mind Menders is to empower survivors of  brain injury as they learn, work, and play in the community.

http://www.angelfire.com/ia/tbinterchange/