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A relatively small percent of individuals with TBI experience seizures. For most of these, the initial onset of seizures occurs soon after injury. For others, the onset may take place up to several years post-injury. Two types of seizures may occur. Major motor seizures refer to what were once called grand mal seizures and involve loss of consciousness and vigorous, uncontrolled movement of the major muscle systems. Local motor seizures do not lead to loss of consciousness and involve less muscle movement. Some individuals with TBI use anticonvulsive drugs to prevent seizures or stop them during the course of a seizure.
If motor areas of the brain are damaged, the person with TBI may experience varying degrees of physical paralysis or spasticity, affecting a wide variety of behavior from speech production to walking. Damage to brain tissue can also evidence itself in chronic pain, including headaches. Also, evidence is growing that hormonal, endocrine, and other body systems are affected by the brain injury. Consequently, the individual may lose control of bowel and bladder functions, may sleep poorly, may fatigue easily, may lose appetite for food or be unable to control eating, and/or may be unable to regulate body temperature within normal boundaries. Women with TBI often experience menstrual difficulties. Some of our research on post-TBI health and medical issues is discussed in TBI Consumer Report No. 1.
The TBI Research Center at Mount Sinai is conducting research to help people with TBI who experience fatigue. A description of this study is found at Rehabilitation Trials.
Why are we poor at predicting outcome?
The severity of the injury and the resulting direct effects on the individual's body systems may not predict the amount of impact in a person's life. This follows, first and foremost, because each of us draws in different ways on differing parts of our brains. For example, a severe injury to the frontal brain area may have less impact on an agricultural worker's job performance than a relatively mild frontal injury would have on a physicist's work. In sum, the meaning of the various patterns of injury and the associated changes in any person's life will depend on preinjury lifestyle, personality, goals, values, resources, as well as the individual's ability to adapt to changes and to learn techniques for minimizing the effects of brain injury.
We know in general that the variability of patterns of change associated with brain injury are shaped by many factors: the severity of injury and age at injury, time in coma, time since injury, length of PTA, the resources and services available to the injured person, the barriers met or advantages offered within different social contexts, the social and role demands that exist within the individual's life, and so on. How these factors work, in what ways, and how often is not clear. We know that TBI hits people differently, but have less knowledge of the number of people that experience various types of consequences and the specific factors affecting this.
What can I do to help the process of recovery?
Immediately after injury, friends and family who want to help should focus on insuring that the injured person receives medical care that will minimize the effects of injury. This usually means that the person should be receiving care in a medical center that specializes in trauma care. This topic is covered more fully in another question, What Is the Course of Treatment for Those with Moderate/Severe TBI?
Once issues of life-and-death have been addressed, the person's functioning as a cognitive, emotional, and social entity comes to the fore. The individual is faced with many or a few of the possible changes described in preceding questions.
It has been suggested (by Kay and Lezak in 1990) that "recovery" is a misnomer and that "improvement" better describes what happens in the long run after TBI. The word recovery may, inappropriately, suggest that the effects of TBI will disappear, similar to symptoms vanishing when we recover from a cold. With TBI, some of the effects may truly dissipate after one year, two years, or more, but more frequently these long-term changes linger on, subtly or not so subtly, changing only slowly, if at all, over the life course.
What must be kept in mind at all times is that impairments that are due to injury of brain tissue can be helped through reeducation of the individual and through modification of the environment. Thus, for example, although the brain circuits involved in memory may never function in the ways and at the levels found before injury, remembering (a necessary skill in day-to-day life) may be improved by the individual's learning compensatory skills, such as using a daily diary to remember appointments, and by adjusting parts of the environment (alarm clocks, computer reminder programs, and family members) to jog memory.
The boundary of improvement is set by the individual's ability to learn new ways of doing things or to relearn formerly familiar skills. Since the brain mediates all learning and the brain is damaged, learning is often slow and/or incomplete.
The major role for friends and family at this stage of recovery is to help find resources that will help the injured person in addressing emotional, cognitive, physical, and behavioral challenges. A variety of resources are available on this Web site, including publications, linkages to other Web sites and information about rehabilitation trials that may help people with cognitive difficulties, mood disorders and fatigue.
From Mount Sinai Medical Center. www.mssm.edu.
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This article is actually quite encouraging! I am a year and four months past my severe TBI, after which I was unconscious for eleven days. I am an honor graduate of Harvard and was a college professor until my injury, so it's nice to be encouraged by the acknowledgment that while my life is very different now, it's far from over, and I can still find ways to be valuable and contribute.
Feb 13th, 2011 12:53am