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Brain Injury Consultation

Consultation for Counselors (and other professionals)
Whose Client/s Have Suffered Brain Injury

I offer consultation to counselors and other professionals with clients who have suffered (or show signs of) a brain injury. This complex, nuanced injury has a far reaching impact. Survivors are profoundly misunderstood, frequently missed and immensely isolated. They deserve providers who are brain injury informed and that's where I can help you. 

To my consultations, I bring a background of over ten years in the medical specialty of brain injury rehabilitation where I have seen hundreds of patients (ages four to 84) injured in a wide variety of ways, including the below:

Sub-concussive trauma (injury that doesn't meet full concussion criteria), concussions, mild traumatic brain injury, traumatic brain injury and acquired brain injury from motor vehicle accidents, soccer, football, snowboarding, cycling, assault, falls, Chiari malformation, Lyme's disease, rare genetic disorders, premature birth, difficult or traumatic birth (including the cord wrapped around the neck or reduced heart rate), heart defects, child abuse, orphanage deprivation, brain surgery, brain tumors, hypoxia during surgery and dental procedures, vitamin B12 deficiency, medication toxicity, mold exposure, seizures, neurologic conditions (such as multiple sclerosis), and many others. Many of these patients were referred to the medical clinic by neurologists, physical therapists, occupational therapists, osteopaths, primary care physicians, Progressive Rehabilitation Association (PRA), and OHSU (Oregon Health Sciences University).

To most effectively help your clients, there are several key things that are important to understand about brain injury. Firstly, injury to the brain is cumulative and to quote Dr. Bennet Omalu, who discovered and named CTE (Chronic Traumatic Encephalopathy), "There is no safe blow to the head." Brain injury occurs on a wildly varied continuum from the almost imperceptible to life altering, to being in a long-term coma. The vast majority appear normal to outsiders and go unrecognized. For closed-head injuries, symptoms may not appear for as long as 3 months after the incident making it hard to connect symptoms with the event. And, brain injury has an astounding power to impact almost every area of life in a way that few things can.  To add to all this, we have normalized it to such a degree that we see without recognizing injury. 

Let me unpack the above paragraph. 

Cumulative injury means that when it comes to the brain, every injury builds upon the last even if it has been decades, or if there were no noted or lasting symptoms. Every insult to the brain lays a foundation for a later injury to have a more lasting effect.  So, injury to the brain has to be viewed across a lifespan. The cumulative load of any particular person is part of why one individual can have a massive car accident and seem to walk away unscathed, while another person has a small fender bender with a significant impact to everyday life. Honestly, between innocent childhood bumps and bangs,  high fevers, child abuse, sports, car accidents I don't know how anyone evades some harm to the brain. It's more of a question of whether the threshold has been crossed to lasting symptoms or ones that can't be ignored. 

"No safe blow to the head." It used to be thought that your brain wasn't injured if a hit or a blow didn't meet concussion criteria. It also used to be thought that to sustain a concussion you had to have lost consciousness for a defined period of time. Science has shown for some time that both are not true, but it has been slow to filter into public and even medical awareness. Rather, the brain is tremendously vulnerable and fragile.

Although the brain is encased in a hard skull, it floats in fluid and moves within the skull. As pointed out in the movie Concussion (which is well worth watching), unlike many animals such as the woodpecker which wraps its tongue around its brain before hammering trees, the human brain has no such safeguard. Because of this, anytime the body experiences a blow or sudden acceleration or deceleration—even without the head hitting anything externally—internally the brain is jarred internally and hits the bony skull. This clip from Concussion poignantly illustrates this. 








Which brings me to our culture having normalized injury to the brain. There are phrases embedded in our very language such as, "Oh he just had his bell rung." or, "Shake it off!" We even chuckle or outright laugh at how hard someone was tackled in football. Our children play high risk sports including soccer, football, hockey, rugby, and snowboarding while their brains are still developing and therefore more vulnerable to injury. People talk about car accidents and say, "I walked away from it." And if I may be so brave, we fiercely support sports such as football, the violence of which causes as high as 90% of players to suffer Chronic Traumatic Encephalopathy which devastates their brains and lives. With so much culturally normalized, tragically we then don't realize the potential impact or recognize the symptoms when they appear. 

Sadly, what most people associate with brain injury is the extreme end. This results in many individuals remaining unidentified, causing them to suffer alone without adequate medical care or counseling support.  To add to the difficulty, survivors often cope in silence, mask, minimize, and dismiss what they live with. And, many haven't been diagnosed and may not even have identified for themselves what connects the seemingly disparate symptoms they live with.


However, what is often missed is that even if someone didn't have an open-head injury and there has been no noticeable impact to intelligence or social graces—the majority of patients that I saw—the effects can still be severe and utterly devastating. Cumulative sub-concussive trauma, concussions, and minor traumatic brain injuries can affect everything from finances and career, to relationships, hobbies, sleep, and the ability to tolerate visually and sensorilly complex places such as grocery stores, tolerate light and motion, and basic quality of life and health. Often, the impact is all of the above. 

If my writing sounds urgent and passionate, it is because I have sat with hundreds of patients living with the long-term effects of cumulative injury. The percentage of these patients who had permanent disability insurance that would step in into the gap has been less than 1%. So while their lives and health were in tatters, many have to attempt to work through immense pain and brain fog which didn't allow the critical rest for the brain to heal. Not to mention that these individuals also often have to fight insurance to cover the very basics of their care. 

With my background, I can help you better understand the nuances and complexity of brain injury, recognize signs and symptoms (many not commonly known) and ongoing losses, identify potential areas of impact, teach you techniques for how your client can prevent symptom spirals and brain crashes, understand common areas of difficulty in the workplace, relationships, hobbies, and social relationships; possible resources that may further healing, and more. 

To help you identify clients who may be living with some form of brain injury, below I have compiled some of the paths to injury and symptoms, many of which are not commonly known. I've also included common myths that can obscure identifying potential clients or patients who have lingering effects.


Common Myths

There are a lot of misconceptions about brain injury. Here are a few that come to mind.

  • You have to hit your head to injure the brain. There are two fabulous clips from the movie Concussion that illustrate the myth of this well: Evolutionary Protection, and Brain in a Jar.

  • If the MRI or CT scan was clean, no injury occurred

  • Concussions require a loss of consciousness

  • Concussions symptoms always resolve in hours or weeks. 

  • If the brain has been injured there are always symptoms

  • Your brain can fully heal after a concussion or injury to the brain

  • After 1-2 years, that is the most healing that can occur

  • Brain injuries are primarily severe (i.e. open head wound, loss of capacity to speak).

  • Contact sports are safe to play. I highly recommend watching the movie Concussion.

  • Helmets prevent concussions

  • You have to hit your head to be injured

  • You have to blackout to meet concussion criteria

  • Sports such as soccer and football don't have a long-term impact on the brain

  • Return to Play rules ensure it's safe to return to play

  • Mild Traumatic Brain Injury means the symptoms and life impact are mild. 

Paths to Brain Injury

  • A difficult or traumatic birth, especially where heart rate or oxygen was affected such as a cord wrapped around the neck.

  • Premature birth

  • Concussions, even if symptoms appear to have resolved

  • Subconcussive trauma—injury to the brain that doesn't meet full concussion criteria

  • Car accidents (regardless of whether the head physically hits anything)

  • Air bag deployment

  • Sports: especially soccer, football, hockey, snowboarding, and waterskiing, as well as other sports such as baseball (fastball anyone?), rock climbing (falls even if the head doesn't physically hit anything), and cycling (being driven off the road or hit by vehicles).

  • Surgery—research indicates that anesthesia can have similar effects as a concussion

  • Hypoxia or loss of oxygen: this includes heart attacks, choking, and low oxygen during surgery or dental sedation. 

  • "Normal" childhood bumps and bangs (i.e. falling out of a highchair)

  • Chemo or radiation

  • Brain surgery

  • Brain tumors

  • Neurological conditions, such as multiple sclerosis

  • Childhood abuse and trauma (i.e. shaken baby)

  • Blacking out

  • Seizures

  • Chronic migraines

  • Falls

  • Assaults​

  • Bumping the head on common things such as car doors, cabinets, light fixtures

  • Things falling on the head

  • War (especially blast exposure)

Common Signs and Symptoms​

While not a comprehensive list, below is a collection of common symptoms that together form the hallmark of brain injury. If someone has light sensitivity—perk your ears up. If your client also experiences motion sensitivity (hands moving, crowds, riding/driving in a car, watching action movies, being on a boat, watching waves, difficulty with escalators), it's time to start thinking about the possibility of some level of injury to the brain. If either of these trigger headaches or nausea—stop in your tracks and start inquiring more. 

Even if your client cannot identify a cause, if a number or many of these symptoms are experienced, chances of some level of brain injury are high. Because brain injury is cumulative, there may not be any one significant moment to point to but rather a collection of smaller incidents. Additionally, because many insults to the brain are discounted or normalized, or injury occurred years prior, your client may not even think to mention significant events. ​

  • Photophobia (light sensitivity)

  • Headaches/migraines

  • Dizziness/vertigo/disequilibrium

  • Reduced balance or confidence in balance

  • Sensory overwhelm

  • Difficulty reading (i.e. loss of interest or avoidance; loss of place, skipping words/lines, reduced comprehension, re-reading, slower speed)

  • Fatigue, discomfort, strain, pain, or headaches when reading

  • Visual motion hypersensitivity (especially riding in cars, being in a crowd, or people talking with their hands)

  • "Grocery Store Syndrome" (difficulty with visually and sensorially complex environments)

  • Difficulty with screens/computer vision syndrome

  • Unspecified Visual Disturbances (this unique to the individual, but is often seen with the eyes closed at night or at the point of exhaustion. This can appear as lines, colors, stars, fireworks, et cetera)

  • Slurred speech, especially when exhausted

  • Being or feeling less articulate

  • Brain fog

  • Mild to extreme exhaustion

  • Intermittent or persistent difficulty with finding words (often masked well with thoughtful pauses)

  • Taxed by conversating (this may cause exhaustion or even migraines)

  • Nausea

  • Difficulty reading (headaches, eye fatigue, nausea, reduced fluency, reduced word decoding or recognition, poor comprehension, flat expression, skipping words or lines, difficulty tracking, overwhelm with a full page of text...)

  • Reduced memory 

  • Hyperacusis (auditory sensitivity)

  • Difficulty scrolling

  • Symptomatic with high contrast patterns (such as black and white tile floors)

  • Symptomatic with patterned carpet (especially if colorful)

  • Reduced or poor depth perception

  • Avoids or fears escalators

  • Fear of heights

  • Avoids or fears elevators

  • Difficulty crossing bridges

  • Difficulty with light/dark patterns (i.e. sunlight through tree or the trusses of a bridge)

  • Avoiding driving on the highway

  • Double vision

  • Accidentally breaks things

  • Clumsy

  • Drifting to one side while walking

  • Leaning off center forwards or backwards

  • Startling easily (sometimes particularly on one side, or equally)

  • Reduced peripheral awareness (cars, people, or objects may appear to come out of nowhere)

  • Trouble timing crossing a road

  • Change in ability to spell

  • Change in facility with jigsaw puzzles

  • Change in navigational or directional skills

  • Head pressure

  • Discomfort, pain, or pressure in or around the eyes

  • Needing to ground or heighten proprioception (i.e. dragging a finger or hand along a wall, or suddenly wearing scarves, hoodies, or high neck shirts/sweaters). 

  • Disrupted sleep

  • Emotion dysregulation

  • Impulsivity

  • Depression

  • Suicidality 

Less Common Brain Injury Symptoms Include:

  • Change in color perception

  • Change in taste

  • Change in temperature regulation or sensation

  • Stuttering, especially when tired

  • Feeling the nerves (i.e across the face, often related to the injury site)

  • Reduced or poor lymphatic drainage

  • Change in linguistic accent

  • Commotio Retinae (this can be caused by airbag deployment)

If what I have written here has been of help, I invite you to consult with me. 

Let's Talk!

Schedule a consultation session and see if we're a good fit.
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