What is mild TBI?
"Mild TBI" is defined by lesser levels of brain damage, as indicated by only brief or no loss of consciousness. Nevertheless, mild injury is important to discuss for four reasons:
- Although the negative consequences of mild TBI tend to disappear more or less quickly for most people who have mild injuries, some research suggests that about 15 percent continue to suffer symptoms that can be severely debilitating. Thus, "mild" injury may be anything but mild.
- Those who receive a blow to the head with brief (or no) loss of consciousness are often sent home from the hospital with assurances that they are just fine. However, this may or may not be the case, and when not the case, this misinformation about no long-term problems may have devastating effects, as the person remains unaware of the basis for his or her altered ability to function.
- Some individuals who have experienced a concussion or whiplash, or a brain injury with brief loss of consciousness, do not enter the health care system at all. In effect, they assure themselves that they are just fine and don't require help. However, long-term problems may emerge and often do not get attributed to the injury, leading to the negative effects referred to above.
- Mild injuries often occur through the physical abuse of children/spouses or in the jarring of sporting events. The negative effects of such injuries may not emerge immediately in clinically detectable or functionally meaningful form, except as the effects accumulate with repetition of the injury. The beaten wife or the sacked quarterback may be fine, although damage has occurred at the neural level; negative consequences in day-to-day life will appear unless repeated injuries are prevented.
What problems emerge after a mild TBI?
Mild TBI can be a problem for two reasons. First, the cognitive, physical, and emotional effects may not disappear and, in themselves, create problems. These consequences of mild injury are often similar to those described above with respect to moderate and severe injuries. Second, the psychological disruption created by these consequences can add to (or occasionally outlive) the original problems experienced after injury. One might ask, Why is this psychological disruption not also a problem for people with moderate or severe injuries? The difference with mild brain injuries is that neither the injured person nor his/her social network expects any negative effects of the whiplash or concussion. Medical experts have told them, "Go home, watch for problems, but really, you'll be just fine." Or, the injured person has written off the blow to the head as not even worth the effort of seeking medical help. On the other hand, with more severe injuries, expectations of negative consequences are commonly held by health care providers and by members of the injured person's social network. These expectations are reinforced through an intense medical experience, validating that something bad has happened.
What happens to the individual with mild TBI after the injury? As Kay points out, individuals with mild injuries can live out several possible scenarios. Good outcomes occur whenever the dysfunctional consequences of TBI totally and relatively quickly disappear or the individual finds ways to easily accommodate any functional deficits that emerge. This type of recovery assumes that the individual with TBI is an educated consumer. In other words, the person has a clear understanding that problems may occur, the type of problems to expect and that these problems may or may not disappear, but can be accommodated.
Often the individual with a mild TBI returns to his or her daily life after the injury with very little if any awareness that the head injury will have ramifications — short-lived probably, but perhaps long-term. To individuals in this situation, they notice out of the blue that in big and little ways they are no longer able to do what came easily before. "For no reason that I can see, what I know about myself is no longer true." These inexplicable difficulties, which they do not associate with the "blow to my head," can lead the person to feel that he or she is losing it.
As was mentioned above, good outcomes for individuals with minor TBI require their learning in very clear terms what can be expected in the days, weeks, and months following injury. As problems in functioning emerge, they also need to obtain assistance in learning how to compensate for deficits, as is further discussed in other questions.
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.
This information is from www.tbicentral.org, the website of the Traumatic Brain Injury Research Group at Mount Sinai School of Medicine funded by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education (Grant Nos. H1)