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Getting the Facts Straight About Mild Traumatic Brain Injuries

 March 22, 2018

By  Deborah L Weiner Katz, OTR/L, CCM, CLCP

The term ‘mild traumatic brain injury’ is problematic in and of itself. It may be distinguishing itself from other types of traumatic brain injury but there is nothing mild about it. If anything, the distinction is an attempt to highlight injuries that may go undetected. Last year, Canadian researchers published an article that went so far as to suggest that auto insurance adjusters and defense lawyers have been misrepresenting such injuries and their severity. It is time we learn the facts about mild traumatic brain injury.

What is it?

A mild traumatic brain injury is what most people call a concussion. It is the most common type of traumatic brain injury. The American Congress of Rehabilitation Medicine defines it as “a mild injury to the head that results in a brief period of unconsciousness followed by impaired cognitive function”. What follows is an array of symptoms collectively referred to as post-concussion syndrome, or PCS.

What are the effects?

The symptoms referred to as post-concussion syndrome include headaches, fatigue, depression, anxiety and irritability. The long-term cognitive impairment shows effects on executive function, learning and memory, attention and processing speed.

There are immediate effects. A single concussion is all it takes to disrupt the neurological mechanisms that control cognition. Just one mTBI can affect white matter, which refers to areas of the central nervous system that affect learning and brain function. Concussions are followed by something called a ‘neurometabolic cascade’. This cascade of events creates a severe energy crisis in the brain, which can lead to cell death and neuronal function. This then leads to the loss of consciousness, blurred vision, and the imbalance typically associated with traumatic brain injury. During this phase, the injured individual must avoid further blows to the head. Any additional trauma during this period could result in cerebral edema. Swelling would increase, preventing oxygen and glucose reaching the brain. Without adequate blood supply to the brain, the result would be a stroke.

What facts have been debunked?

Coaches today may know better but those of us who are older can remember being told to “shake it off” or “walk it off” in response to just about any sports injury. That advice was by no means based on fact but putting it behind us was a good start. So, what facts have been debunked by mTBI research?

First, there is the statistic that only 15% of individuals with a first-time concussion experience post-concussion syndrome. The truth is that half of individuals with a single mTBI demonstrate long-term cognitive impairment. Also, it has been believed that symptoms fade after three months, in the majority of individuals. However, some individuals have been reported to experience symptoms beyond the first year following their injury.

If your initial thoughts upon reading this were of sports-related injuries, that is understandable. Just don’t forget about car accidents. The Centers for Disease Control and Prevention (CDC) has a whole host of statistics on its Traumatic Brain Injury & Concussion page about the relationship between auto accidents and traumatic brain injuries. More than half of all reported traumatic brain injuries are caused by automobile accidents.

There is a reason why you are instructed to sit perfectly still following a serious car accident and to not move if you suspect even the slightest injury. Traumatic brain injury in auto accidents are typically caused by either a blow to the head or whipping of the head back and forth causing axonal shearing and collision of the brain with the skull. You might recognize that last injury by the name it is more commonly referred to by: whiplash. As for blows to the head, objects like steering wheels and windshields are the usual suspects. However, there may not be an open wound to the skull. The sheer force of the accident alone can cause the brain to collide against the internal hard bone of the skull. Contusions and brain hemorrhages may not be visible at the time of injury.

How do I learn more?

We specialize in traumatic brain injuries. Whether it be legal support, case management or medical consultation, our services are just a phone call or an e-mail away. On our website, we have written a great deal about the challenges facing those who have experienced a TBI, like in the article entitled The Storm That Follows a Traumatic Brain Injury. We delve deeper into concussions and brain trauma in professional football, see here and here. Children and their vulnerability to TBIs are always a pressing concern, as addressed here and, in a follow-up, here. We even follow legal developments regarding TBIs and auto accidents, which you can read about here. Continue to visit this blog for more information on these subjects and our services.

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