The Two Paths of TBI
The most common problems after a TBI can be behavioral, cognitive, or both. Learn more.
Let's start at the beginning. There are two paths that a brain injury can take, and sometimes both paths get disrupted. The first path is a behavioral path, and there you can see significant mood disorders. You can see behavioral dyscontrol, emotional dysregulation, and the likes. So a child may be more agitated. They may be more prone to temper issues. They may--at one extreme. And then at the other extreme you may see depression. You may see social withdrawal. In both of them you may see a lot of anxiety. So that's kind of the emotional path that you can see with a brain injury. The cognitive path is that there are really four distinctive signs of cognitive impairment that are secondary to the brain injury. The most unique is memory problems. One of the defining characteristics of a TBI that differentiates it from LD is that you don't see kids with LD with gross memory impairments. The second defining characteristic is executive dysfunction. Now, executive dysfunction isn't one thing, okay? And so you can see scattered impairments in executive dysfunction. So some kids may have difficulty shifting from one thing to another. Some kids may have difficulty dual-processing. Some kids may have difficulty reasoning. Other kids may have difficulty abstracting information. Some people--kids may have difficulty responding to feedback. So it's not--executive dysfunction doesn't refer to one thing, and I think that's one of the misunderstandings about executive function. It's not a single skill, like reading. So that's the second defining characteristic. Then you have impairments that overlap with other forms of LD, so you have attention issues and you have processing speed issues, that kids with TBI are not fast; they're slow. And it can take them--I've seen kids who, you give them a paragraph, standard time on the paragraph to read or to do a reading exercise, maybe four minutes. It could take a child with a TBI 12 minutes to do that. They can read; they don't have any problem reading. Reading isn't functional.
Posted on BrainLine March 15, 2011.
Wayne Gordon, PhD, ABPP/Cn, is the Jack Nash Professor of Rehabilitation Medicine and associate director of the Department of Rehabilitation Medicine at the Mount Sinai School of Medicine. He is a neuropsychologist and the director of the Mount Sinai Brain Injury Research Center.
Produced by Noel Gunther, Ashley Gilleland, Victoria Tilney McDonough, and Brian King.