The Impact of Traumatic Brain Injury: The Short and Long View

Moderate to severe traumatic brain injury, also referred to as “TBI” significantly impacts not only the injured person, but her family, friends, and even health care providers. What can those supporting a brain injured loved one expect?

The quick answer is that friends, families and supporting health care providers must be ready to expect anything. There is no “typical” tramatic brain injury. How a person response to brain injury depends on several factors, including the severity of the initial injury, the part of the brain injured, and the type of function affected by the injury itself. Everybody is unique, and the response to this kind of injury will also be unique.

Recovery times vary, and the notion of “recovery” may be a bit misplaced. For those suffering moderate to severe tramatic brain injury, the initial treatment involves stabilizing the patient, and preventing further harm. Only after this initial treatment phase do potential long-term effects of a traumatic brain injury come to the surface.

Some of the long term effects include:

Cognitive Function

This refers to the “workhorse” function of the brain, like paying attention, concentrating on a task, and remembering new information. A traumatic brain injury could affect a person’s ability to focus on a task, recall basic information, and find and form the words necessary to communicate. Some people may focus too long and hard on a simple or problem, and others may act more impulsively, going with the first idea of how to solve a particular problem when they might be better off considering consequences.

Executive Function

We are the “executives” of ourselves, and have control on how we react to what happens in the world around us.  This includes reacting to social cues, and using our creative process.  Every day, our brain helps us react to an immense amount of information, and a traumatic brain injury can affect these higher functions. How long do you engage in a conversation with a friend? Should you give your friend time to respond or ask questions? How close to you get to a person when you are talking with them? These are the subtle skills that we learn to help us navigate through the world, but with a traumatic brain injury, we could lose some ability to process the subtle cues of everyday life.

Mood and Behavior

A traumatic brain injury will often affect the parts of the brain that control the social and emotional part of the "self." A significant traumatic brain injury may cause a subtle or significant change in personality. A person recovering from this kind of injury may become socially blunt, exhibit dependent behaviors, mood swings, irritability, or lethargy. Some traumatic brain injury patients are much less inhibited.

There is also the issue of a lack of insight, or the inability to compare pre-injury to post-injury behavior. This sort of “denial” may be a psychological defense. In other words, a person coping with a brain injury may not be able to emotionally accept the significant change in their life, and as a result, chooses not to recognize the profound change in their mental makeup as a result of the injury. In other cases, the cause may be more organic, due to actual pathological damage.

Sensory Change

Our brain and nervous system allow us to receive vast amounts of information through our vision, sense of touch, hearing, and positioning in space. A traumatic brain injured person may have persistent visual changes, including the inability to track visual material, loss of parts of the field of vision, or a loss of ability to actually perceive what they are seeing.

Part of the brain also controls our ability to sense our position and space, or in simpler terms, keep our balance. Many times, a brain injury may affect a person’s ability to maintain balance, and result in chronic vertigo or dizziness.

Some brain injury patients even report a change in their sense of smell, taste, and touch.

Movement

Physicians often refer to a loss in the abilities to move about as “motor changes.” An injured brain may send incorrect messages to muscle groups, resulting in ongoing, involuntary muscle contraction, or spasticity.  Significant injuries to the brain also can cause partial paralysis, trouble speaking, or loss of bowel and bladder control.

Difficulty of Prediction

The difficulty in predicting long-term outcome from dramatic brain injury depends on many factors, but as much as anything else, it is simply because everybody is different. A person who works a physically demanding job is going to be affected one way. If a person works in a sedentary environment, they will be affected in another way. A father or mother with significant responsibilities may face different challenges then a high school student who is facing the challenges of entering adulthood.

What Can You Do?

Initially, the main focus is getting appropriate initial medical care. After the “acute” phase, new challenges arise, and often involve therapies aimed that regaining cognitive and emotional improvement, and managing long term issues.

In some cases, the goal is not total recovery, but instead, improvement, and adaptation.  For example, if a person moving forward from a brain injury suffers from memory deficits, daily dairies, smart phone reminders and input from family and friends can make for an effective work around.

Forecasting and planning for long terms needs is often necessary.  When recpresenting brain injured clients in auto injury claims or workers' compensation claims, we have worked with life care planners to help us document future medical needs. 

As with any significant life challenge, a person facing the future with a brain injury has a choice.  Some will consider their situation dire and devastating, and others will see the situation as a part of life, and may even see new opportunities and options.

If you or a loved one is facing the challenges of a traumatic brain injury, we are here to help.  Call us at 503-325-8600 with questions.  Even if there is no legal issue we can help you with, we have resources to help you move forward.