Normalization of Brain Injury

Our culture has normalized injury to the brain. It is embedded in our very language with phrases like, "Oh he just had his bell rung" and "Shake it off!" We laugh at and cheer on hard football tackles and knock-out punches in MMA and boxing. Our children play high risk sports including soccer, football, hockey, rugby, and snowboarding while their brains are still developing and more vulnerable to injury. After car accidents, we say, "I walked away without a scratch." And if I may be so brave, we fiercely support sports such as football, which cause a disturbing number of players to suffer Chronic Traumatic Encephalopathy (a progressive brain disease set in motion by chronic, repetitive head injury).

 

With so much not only culturally normalized, but celebrated (!), we tragically don't identify the injury or recognize the symptoms when they appear. 

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If parents fully understood what happens to the brain in contact sports, particularly football, and the long-term implications I honestly believe that no parent who holds the well-being of their children at heart, would ever allow their child to play. 

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The Continuum of Injury

Perhaps because of the visceral horror that it evokes in our bodies, the most common image of brain injury is the extreme.

 

Let me give an example. In college, a friend's cousin was in severe motorcycle accident. Recklessly riding at 160 MPH on a gravel road, he got a speed wobble that crashed him full speed into a telephone pole. Astoundingly, he lived, but he broke nearly every bone in his body, was life flighted and in a coma for several months. Those are the stories that stick with us. 

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But far more common, brain injury is the face of people all around us. People whose intelligence and social graces mask their symptoms. The effects, nevertheless, can be utterly devastating. Cumulative sub-concussive trauma, concussions, and minor traumatic brain injuries can affect everything from finances and career, to relationships, hobbies, sleep, 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. To the uninformed, this collection of symptoms, and the ways individuals cope with them, looks very strange.

 

These patients often go undiagnosed or misdiagnosed and are repeatedly missed, dismissed and gaslit by the medical community, partners, family, friends, employers and colleagues. 

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The Breadth of Impact

Many have to attempt to continue to work, while their lives and health are in tatters, so they didn't lose their home. This, in turn, doesn't allow the brain the critical rest needed to heal. Frequently, survivors have to change jobs, take reduced hours or are fired. Many with long-term or permanent injuries are denied repeatedly by disability. Not to mention that these individuals typically also have to fight insurance for coverage of the very basics of their medically necessary care. At home, their relationships are under duress. Their partners become caregiver and their children lose a parent. Outside of the house, friends are offended that their friend doesn't go out to social events anymore. Hobbies that once provided respite and replenishment now cause motion sickness or headaches.

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Brain injury can rob a person of nearly everything.

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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.

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​Identifying Brain Injury

Below, I've compiled common myths that can obscure identifying the presence or lingering effects of brain injury, common paths to injury and common symptoms (many of which are not widely known outside of realm of concussion specialists).

 

Common Myths

• 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. 

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Paths to Brain Injury

• A difficult or traumatic birth (i.e. cord wrapped around the neck, reduced oxygen/heart rate).

• Premature birth

• Concussions, even if symptoms appear to have resolved

• Subconcussive trauma—any hit, bump, bang, jarring or acceleration/decleration of the brain that doesn't meet full concussion criteria

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

• Air bag deployment

• Sports: especially football, soccer, hockey, snowboarding, and waterskiing, as well as roller derby, 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)

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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. 

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Even if your client cannot identify a cause, if a number or many of these symptoms are experienced, chances of some level of 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. ​

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• 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 tired or exhausted

• Being or feeling less articulate

• Brain fog

• Mild to extreme exhaustion

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

• Taxed by conversation (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 

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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

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

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