“Arno just does not get it. He does not process, he is quick to action, and then he goes from being so angry to being so apologetic and crying. I don’t get it and it’s so frustrating.” Marlene, a clinician at the HOPE clinic, said this to Rodis, the consultant, working with them on new strategies for managing challenging patients and clients. “Marlene, this sounds very frustrating and challenging. Arno seems to fit the description of someone affected by Traumatic Brain Injury. Let us take some time and delve into Traumatic Brain Injury (TBI) and its persisting form known as post-concussion syndrome.”
“Challenging” is a term we use loosely, one that may have different meanings based on comfort level and the level of experience and training. However, there is a particular patient subgroup population, so “unpredictable,” so “labile,” and so “aggressive” one minute, then so “kind and nice” the next. This subgroup describes individuals affected by Traumatic Brain Injury (TBI).
Since 30% of all deaths result from a traumatic brain injury, and injuries related to TBI account for 153 individual deaths on a daily basis, becoming familiar with the “ins and outs” of TBI is essential in best serving our patients and clients. Below are five important facts all clinicians need to know.
1. Preventive measures are key:
TBI, also known as an intracranial injury, can be conceptualized as damage to the brain from an external force. Millions of individuals suffer brain injuries every year, and half resulting from motor vehicle accidents (MVA) in the age group of 15 to 24. Other causes include falls, the leading cause for those older than 65. Violence is the leading cause for TBI in those aged 4 and younger; sports and combat injuries are the additional common causes. Education and advocacy are therefore a good place to start when we follow the principle of prevention.
2. The diagnosis formulation is multidisciplinary based:
Individuals may not realize that an injury has happened, and unfortunately symptoms may not appear until weeks later. Symptoms can also vary and can be of a wide range. They can be divided into physical, sensory, neuropsychiatric and cognitive. The diagnostic process usually consists of a comprehensive history, a neurological examination, brain imaging, cognitive evaluation, and multi-specialty based evaluations. A whole multidisciplinary team based approach is required for an accurate diagnostic formulation.
3. The data is astonishing:
There are specific sets of the population that are more vulnerable to TBI. They include, children of four years old or younger, young adults of 15-24 years of age, adults older other than 60, and males more often than females. Some of the complications and comorbities include and are not limited to seizures, headaches, and infections, as well as executive functions impairment. Others include, behavioral and personality changes, emotional lability, and mood and anxiety, and memory impairment, in addition to posttraumatic stress disorder. TBI is a major cause of disability and death, and all clinicians need to be as informed as possible, in order to best help our patients and clients as we are able to. Going forward, when you think of TBI, think about the 2 million individuals affected in the US, every year, and about the 50, 000 people who die every year.
4. Post-concussion syndrome is the persisting form:
Fifteen percent (15%) of those who sustain a TBI will have persistent symptoms lasting beyond three months – a condition known as post-concussion syndrome or post-concussive syndrome. These symptoms are generally the same as described above for TBI, including cognitive, behavioral, personality, physical, and other neuropsychiatric symptoms. The explanation for why the other 85% who sustain TBI do not develop post-concussion syndrome remains unclear. What is certain is that our ongoing education efforts for our patient population can make a big difference around prevention.
5. Post-traumatic stress disorder is a common comorbidity:
One criterion to diagnose PTSD is the occurrence of a traumatic event. While everyone who undergoes a traumatic event will not necessarily develop PTSD—actually, less then 7% will—for those who do, the suffering experienced is tremendous. It is therefore our responsibility to screen and rule out PTSD, in each one of our patients and clients with a history of TBI.
“Arno just does not get it. He does not process, he is quick to action, and then he goes from being so angry to being so apologetic and crying. I don’t get it and it’s so frustrating.” Marlene, a clinician at the HOPE clinic, said this to Rodis, the consultant, working with them on new strategies for managing challenging patients and clients. “Marlene, this sounds very frustrating and challenging. Arno seems to fit the description of someone affected by Traumatic Brain Injury. Let us take some time and delve into Traumatic Brain Injury (TBI) and its persisting form known as post-concussion syndrome.” And so, he did.
A common enough condition and an important one requiring all of us as clinicians to arm ourselves with the needed tools to continue making a difference in the lives of our patients and clients, especially those affected by Traumatic Brain Injury.
References:
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McCaffrey RJ (1997). “Special issues in the evaluation of mild traumatic brain injury”. The Practice of Forensic Neuropsychology: Meeting Challenges in the Courtroom. New York: Plenum Press. pp. 71–75.
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Department of Defense and Department of Veterans Affairs (2008). “Traumatic Brain Injury Task Force”.
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McDonald, S.; Flanagan, S.; Rollins, J.; Kinch, J (2003). “TASIT: A new clinical tool for assessing social perception after traumatic brain injury”. Journal of Head Trauma Rehabilitation. 18 (3): 219–38.
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Arlinghaus KA, Shoaib AM, Price TR (2005). “Neuropsychiatric assessment”. In Silver JM, McAllister TW, Yudofsky SC. Textbook of Traumatic Brain Injury. Washington, DC: American Psychiatric Association. pp. 63–65.
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Ponsford, J.; K. Draper; M. Schonberger (2008). “Functional outcome 10 years after traumatic brain injury: its relationship with demographic, injury severity, and cognitive and emotional status”. Journal of the International Neuropsychological Society. 14 (2): 233–42.
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Williams C, Wood RL (March 2010). “Alexithymia and emotional empathy following traumatic brain injury”. J Clin Exp Neuropsychol. 32 (3): 259–67.