Traumatic Brain Injury
Rod was hurtling down a mountain single track on his mountain bike when he misjudged the bend in the track. He lost it and broke his arm. After one night in hospital he was discharged.
Peter was playing for his schools 1st XV in the penultimate rugby match of the season when he was tackled and broke two ribs. He was admitted for x-rays and discharged with a strapped torso and instructions not to play rugby for six weeks.
I was out in the mountains marking a route for an adventure race when we got stuck. In the process of pulling the 4X4 truck out of a mud hole a metal bar struck me in the face, shattering my left cheek, sinus cavity and eye socket. After two days in hospital, which included six hours of reconstructive surgery I was discharged.
Peter, Rod and I were happy that we weren’t injured seriously. None of us knew that we were suffering from TBI, also known as Traumatic Brain Injury and that the life as we knew it had already started changing dramatically.
Peter and Rod barely knew that they had taken a knock on the head. In the adrenaline rush of falling of his bike and the ensuing pain from his arm, Rod didn’t take the bump on his head seriously; besides, the painkillers took care of the headache.
Peter remembered knocking his head on someone’s knee as he went down in the tackle. He had a bit of a blank spot and felt a bit groggy, but it cleared up quickly.
In the USA 1,5 million people will be admitted for non-fatal TBI annually. It is estimated that a further 3 million sports related TBI incidents are never admitted. In South Africa 89000 new TBI cases are treated annually; in keeping with international statistics an estimated 200 000 sports related incidents are never reported.
Traumatic Brain Injury is classified based on the level of severity. Sports people will most likely suffer from Mild Traumatic Brain Injury (MTBI), which presents a unique framework primarily owing to the fact that you can suffer from MTBI without ever losing consciousness! Further to this the changes in the brain are microscopic and will not be seen on a CT or MRI scan; and worst of all, the symptoms can start manifesting as much as 2 weeks after the incident. A Scottish study found that 47% of people classified as having MTBI were disabled to some extend a year after the incident.
But what are the practical realities for Peter, Rod and I?
We can expect to have to deal with problems in our cognitive skills, such as impaired reasoning and problem solving skills. To make this worse there is also the possibility of not being able to express ourselves verbally.
Then we can also expect be irritable and emotional to the extent of suffering from depression.
The sum total is that we will be severely challenged in our abilities to cope with challenging situations, to plan and implement strategies or to stay focused and motivated.
To understand this we have to understand the neurology of TBI. What usually happens in brain injury at the cellular level is known as “axonal injury.” Axons are the microscopic nerve fibers of neurons, the brain cells that communicate with each other. This axonal injury can occur in localized areas or throughout the brain.
Axonal injury occurs as a microscopic tear along the myelin sheath surrounding the nerve fiber that is often followed by micro swelling and the formation of scar tissue. According to Kit W. Harrison, Ph.D., at the Houston Behavioral Health Associates.
The process of scarring, can take weeks, months, or even years, to complete. As the axon scars over, fewer and fewer impulses can be carried through the tough scar tissue, and the axon may begin to die and lose connectivity function over time. This accounts for a number of symptoms which could worsen with time.
For a business owner or any person in a position of authority and leadership TBI spells disaster. Within months the impact of the injury became evident as Peter was unable to complete his homework and started withdrawing from his friends. At home he was moody and quarreled with his sister for apparently no reason. Rod, as a senior manager tried to keep things together, but he wasn’t up to his normal creativity and his department started losing money owing to poor decision making. Senior management had no option but to retrench him.
As for me, as an adventure sportsman and founding member of the Adventure Racing World Series I was forced to sell my house at a loss and had the bank repossess my car after 8 months. My sports marketing business closed down shortly thereafter.
Most of my problems could have been avoided if I had known that I was suffering from TBI. My natural reasoning was impaired so I never thought to move in with a friend or family and rent my house out to cover the bond. I never told anybody that I was having problems with motivation and managing my company so nobody new or though t to help and this is the first step to keeping your life normal, which is vital to a quick recovery.
Traumatic brain injury is a silent epidemic and requires a pro-active response from people suffering from it, but even more so from friends and family identifying the possible symptoms in those they love.
If you think you are potentially suffering from TBI you have to tell those closest to you and get a specialized diagnosis. Unfortunately you cannot rely on an opinion from your GP; you have to see a neurologist.
To help with recovery you have to do three things. Firstly you have to start exercising; join a running club, not a rugby club! The cross motor exercises will hasten the recovery as it assists with the creation of new neurological connections. If you can’t run, join a walking club, but get out there.
Secondly you must eat healthily. A pro-brain diet excludes sugar and refined carbohydrates and is high in protein and Essential Fatty Acids such as Omega 3 and 6.
Lastly you have to hang in there. Recovery is an extended process and could take anything up to 8 years!
If you are in a position to think that a family member, friend or colleague might be suffering from TBI, you have to give them support and encouragement. Chances are that they are confused and feeling frustratingly helpless. If they are not helped to a correct diagnosis soon after the TBI incident they might lose self esteem, motivation and all confidence.
A comparative study in the USA came to the conclusion that a alarming proportion of homeless people could be in their current situation as a result of an incident of TBI in their past. Without help and support I believe that it is quite likely that I could have become a statistic. Your knowledge can make a difference.
