What We Don’t Understand About Head Injuries and How It’s Hurting TBI Victims
Every year in the United States, there are approximately seven million head injuries. Nearly all of these — an estimated 94.5% — are categorized as mild. However, this classification is misleading because it does little to portray the full extent of a mild brain injury’s impact. Mild is defined as “not severe,” which suggests that someone who experiences such an injury would not be significantly affected. This could not be further from the truth.
Even mild traumatic brain injury (TBI) often has lifelong presentations for injured people. So, it goes without saying that moderate and severe TBIs have a tremendous impact.
What do we Know About TBIs?
How much do we really know about the human brain? Not very much, as it turns out. Despite the many remaining unknowns, there has been significant progress. We know that concussions and head injuries pose a significant risk and that risk multiplies with repeated injuries. A better understanding of the dangers of concussion and TBIs has led to improvements in sports safety. The standard in high-impact sports of “if in doubt, sit them out” stems from the concern of sustaining another concussion while still recovering from a previous head injury.
This increased understanding is good news for athletes, as well as other people who experience a TBI, but there continue to be problems with our approach to TBI symptoms and treatment. Because of the nature of brain injuries, symptoms can run the gamut, adding another layer of complexity to identifying and addressing these injuries. Acute symptoms of TBI, such as loss of consciousness, confusion, nausea, and headache, tend to be more well-known than their chronic counterparts. This societal awareness also equates to societal acceptance. Additionally, immediate signs of TBI are given the weight and importance they are due.
Chronic symptoms, on the other hand, are not just overlooked; they are ignored. Symptoms like depression, anxiety, mood dysregulation, and lethargy are common long-term challenges caused by TBI. Despite the prevalence of these symptoms, society and much of the medical field do not take them seriously. Why is so little attention given to these chronic conditions that plague TBI sufferers?
Chronic Symptoms and the Long-Term Effects of TBIs
A major determinant of the symptoms someone will experience after a TBI is the location of the trauma. Different sections of the brain control different functions and processes. For instance, the left side of the brain deals with logic and speech, while the right side of the brain controls visual processing, among other things. An injury to the front of the head could cause issues with judgment, planning, and impulse control.
There are a wide range of symptoms and complications that can be caused by head injuries, including:
- Headaches
- Seizures
- Memory loss
- Inability to perform routine tasks
- Balance problems
- Sleep disturbance
- Sensitivity to light and sound
- Concentration problems
- Changes in the ability to smell and taste
- Muscle stiffness
- Uncontrolled movements
- Loss of fine motor skills
- Changes in appetite
- Inability to control bladder or bowel functions
- Inability to regulate body temperature
- Aphasia
- Slurred speech
- Vision loss
- Hearing loss
- Paralysis
Additionally, TBIs increase the chance of developing Alzheimer’s disease, dementia, Parkinson’s disease, and various other neurodegenerative problems.
There are also behavioral and emotional symptoms that present the additional challenge of societal intolerance, including:
- Loss of motivation
- Aggression
- Depression
- Anxiety
- Dependency
- Irritability
- Mood swings
- Changes in personality
- Chronic fatigue
- Executive function challenges
When someone exhibits symptoms like these, it is not uncommon for them to be written off without a deeper investigation into why this behavior is occurring. TBIs are far from the only condition that causes symptoms like loss of motivation and fatigue. Other conditions, such as mononucleosis and Lyme disease, can make people feel tired and disinterested in daily tasks, yet few readily viable cures are available. When presenting a cluster of symptoms, physicians rarely suggest testing or searching for these specific ailments.
People with symptoms like these often get blamed for their behavior, told that they’ve changed or asked what happened to the old version of them. They are told to stop being lazy, calm down, or just get over it, despite the fact that they have no control over their brain injury symptoms.
The medical field and society as a whole are neglecting this pervasive problem. TBI’s classification as an invisible illness and silent epidemic is hindering progress, too.
TBI as an Invisible Illness
An invisible illness is one that is not easily visible to others. Chronic conditions that impact affected individuals’ daily lives but are not understood or even recognized by other people are invisible illnesses. TBI is considered an invisible illness because the symptoms may go unnoticed by everyone but the person experiencing them and because there is still considerable misunderstanding surrounding the symptoms and the full impact of TBIs.
Invisible illnesses are not just brain injuries or mental health conditions, although many brain and psychological disorders are classified this way. Diabetes, autism spectrum disorder, and early stages of multiple sclerosis are also considered to be invisible illnesses. Epstein Barr Virus is an invisible illness, highly contagious and mimics symptoms of depression, as does Lyme Disease.
The reality of life with an invisible illness is different for everyone, but the isolation and emotional burden are often significant. It can be challenging for many people to have access to the accommodations and medical care they need even when their disability or disorder is visible, so this difficulty is multiplied when others cannot see signs of the illness.
Challenges of TBI Diagnosis
Even though many of the symptoms of TBI are invisible, the dangers of head injuries are well-known. However, despite improvements in the understanding of TBI in the last five decades, little advancements have been made to diagnostic procedures. The Glasgow Coma Scale is a tool that was developed in 1974 and is widely used around the world to assess the level of TBI, ranging from mild to severe. This test does not provide any insight into the long-term or chronic effects of head injury. It merely tests the immediate, acute symptoms of eye response, verbal response, motor response, and pupil reaction.
There are other alternatives that can be useful as additions to medical providers’ arsenals when diagnosing and assessing the severity of TBI, including brain SPECT imaging. Single-photon emission computerized tomography (SPECT) imaging is lauded by many as one of the best ways to identify how an injury has affected the brain. It detects blood flow and activity in the brain, allowing for a more accurate diagnosis and subsequent treatment plan. Other scans cannot test or monitor how the brain is functioning like the SPECT can.
The psychiatric field, however, has failed to welcome SPECT with open arms, in part because of the rigidity and challenges of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Because neuroimaging patterns were not directly correlating to DSM diagnostic categories when SPECT first made an appearance in psychiatry, the test was dismissed as being not useful for clinical applications.
SPECT imaging’s inability to perfectly align with DSM categories is less a problem with the test’s accuracy or usefulness and more an issue with the DSM’s grouping of symptoms. Essentially, DSM diagnoses include symptom clusters, and the neurobiology of mental disorders rarely aligns with these categorical groups.
Even though so much is still unknown about the brain and how it functions, it is clear that increased awareness and understanding of the myriad ways injury impacts the brain’s processes is needed. We should stop villainizing, dismissing, and insulting people who struggle with chronic TBI symptoms. This is the only way that they will get the medical services and support they need.
