Functions of the Brain    Mild Traumatic Brain Injury    Diagnosis of Mild Traumatic Brain Injury

   Depression & TBI   Mild Traumatic Brain Injury Issues   10 Myths About Traumatic Brain Injury    Resources   Resources for Veterans

TBI

According to the Centers for Disease Control and Injury Prevention, 2.5 million people sustain a traumatic brain injury (TBI) each year. The leading causes of TBI are: 

• Falls (40.5%)
• Other/Unknown (19%)
• Struck by/against events (15.5%)
• Motor Vehicle-traffic crashes (14.3%)
• Assaults (10.7 %)

A Healthy Brain
To understand what happens when the brain is injured, it is important to realize what a healthy brain is made of and what it does. The brain is enclosed inside the skull. The skull acts as a protective covering for the soft brain. The brain is made of neurons (nerve cells). The neurons form tracts that route throughout the brain. These nerve tracts carry messages to various parts of the brain. The brain uses these messages to perform functions. The functions include coordinating our body systems, such as breathing, heart rate, body temperature, and metabolism; thought processing; body movements; personality; behavior; and the senses, such as vision, hearing, taste, smell, and touch. Each part of the brain serves a specific function and links with other parts of the brain to form more complex functions. All parts of the brain need to be working well in order for the brain to work well. Even “minor” or “mild” injuries to the brain can significantly disrupt the brain’s ability to function.

An Injured Brain
When a brain injury occurs, the functions of the neurons, nerve tracts, or sections of the brain can be affected. If the neurons and nerve tracts are affected, they can be unable or have difficulty carrying the messages that tell the brain what to do. This can change the way a person thinks, acts, feels, and moves the body. Brain injury can also change the complex internal functions of the body, such as regulating body temperature; blood pressure; bowel and bladder control. These changes can be temporary or permanent. They may cause impairment or a complete inability to perform a function.

FUNCTIONS OF THE BRAIN

 

The brain is divided into main functional sections, called lobes. These sections or brain lobes are called the Frontal Lobe, Temporal Lobe, Parietal Lobe, Occipital Lobe, the Cerebellum, and the Brain Stem. Each has a specific function as described below.

Parietal Lobe Functions Sense of touch Spatial perception Differentiation (identification) of size, shapes, and colors Visual perception Occipital Lobe Functions Vision Cerebellum Lobe Functions Balance Skilled motor activity Coordination Visual perception Brain Stem Functions Breathing Arousal and consciousness Attention and concentration Heart rate Sleep and wake cycles

Frontal Lobe Functions Attention and concentration Self-monitoring Organization Speaking (expressive language) Motor planning and initiation Awareness of abilities and limitations Personality Mental flexibility Inhibition of behavior Emotions Problem solving Planning and anticipation Judgment Temporal Lobe Functions Memory Understanding language (receptive language) Sequencing Hearing Organization

Injuries of the left side of the brain can cause:

• Difficulties in understanding language (receptive language)
• Difficulties in speaking or verbal output (expressive language)
• Catastrophic reactions (depression, anxiety)
• Verbal memory deficits
• Impaired logic
• Sequencing difficulties
• Decreased control over right-sided body movements

Injuries of the right side of the brain can cause:

• Visual-spatial impairment
• Visual memory deficits
• Left neglect (inattention to the left side of the body)
• Decreased awareness of deficits
• Altered creativity and music perception
• Loss of “the big picture” type of thinking
• Decreased control over left-sided body movements

Diffuse Brain Injury (The injuries are scattered throughout both sides of the brain) can cause:

• Reduced thinking speed
• Confusion
• Reduced attention and concentration
• Fatigue
• Impaired cognitive (thinking) skills in all areas

 MILD TRAUMATIC BRAIN INJURY

Definition

The term “mild brain injury” can be misleading. The term “mild” is used in reference to the severity of the initial physical trauma that caused the injury. It does not indicate the severity of the consequences of the injury.

Read Kimberly’s story on Page 6  TBI_Today_Vol_7_No_1 and Anne’s story who both sustained a mild to moderate traumatic brain injury and the challenges they faced in understanding this injury.

The Centers for Disease Control as part of its Report to Congress on Mild Traumatic Brain Injury in the United States developed the following definition of mild brain injury:

A case of mild traumatic brain injury is an occurrence of injury to the head resulting from blunt trauma or acceleration or deceleration forces with one or more of the following conditions attributable to the head injury during the surveillance period:

• Any period of observed or self-reported transient confusion, disorientation, or impaired consciousness;
• Any period of observed or self-reported dysfunction of memory (amnesia) around the time of injury;
• Observed signs of other neurological or neuropsychological dysfunction, such as—
  • Seizures acutely following head injury;
  • Among infants and very young children: irritability, lethargy, or vomiting following head injury;
  • Symptoms among older children and adults such as headache, dizziness, irritability, fatigue, or poor concentration, when identified soon after injury, can be used to support the diagnosis of mild TBI, but cannot be used to make the diagnosis in the absence of loss of consciousness or altered consciousness. Further research may provide additional guidance in this area.
• Any period of observed or self-reported loss of consciousness lasting 30 minutes or less.

The definition focuses on the actual injury or symptoms, not the possible consequences. For many people, there are challenges in getting an accurate diagnosis and treatment, especially when there is no documented or observed loss of consciousness. There does not need to be a loss of consciousness for a brain injury to occur.

What Happens in a Mild Traumatic Brain Injury?

 

The brain is not a hard, fixed substance. It is soft and jello-like in consistency, composed of millions of fine nerve fibers, and “floats” in cerebral-spinal fluid within the hard, bony skull. When the head is struck suddenly, strikes a stationary object, or is shaken violently, the mechanical force of this motion is transmitted to the brain.

When the head has a rotational movement during trauma, the brain moves, twists, and experiences forces that cause differential movement of brain matter. This sudden movement or direct force applied to the head can set the brain tissue in motion even though the brain is well protected in the skull and very resilient. This motion squeezes, stretches and sometimes tears the neural cells.  Neural cells require a precise balance and distance between cells to efficiently process and transmit messages between cells.  The stretching and squeezing of brain cells from these forces can change the precise balance, which can result in problems in how the brain processes information

Any time the brain suffers a violent force or movement, the soft, floating brain is slammed against the skull’s uneven and rough interior. The internal lower surface of the skull, pictured to the left, is a rough, bony structure that often damages the fragile tissues within the brain as it moves across the bone surface. The brain may even rotate during this process. This friction can also stretch and strain the brain’s threadlike nerve cells called axons.

Although the stretching and swelling of the axons may seem relatively minor or microscopic, the impact on the brain’s neurological circuits can be significant.  Even a “mild” injury can result in significant physiological damage and cognitive deficits.

Another mechanism of injury involves changes that occur in the neuron’s ability to produce energy for the cell’s vital functions in structures called mitochondria. An initial increase in energy production occurs followed by a dramatic decrease that affects the ability of the cell to produce structural proteins to preserve the diameter of the axon. This change occurs gradually after the time of impact and may be responsible for the delay in symptoms sometimes observed.

As a person recovers, the cells re-establish the precise balance needed to ensure effective information processing, but this may mean some compensation or adjustments to the neural cell’s original alignments. The more often neural cells must compensate or adjust to injury, the more likely the task takes longer and may not be as complete. For example, when a person sprains or fractures an ankle, professionals recommend cold/heat treatments, rest and supports (i.e., cast, brace) and specific exercises to help the ankle adjust to the injury and recover maximal function. Depending on the severity of the ankle injury (i.e., sprain, fracture) and what is required after recovery (i.e., long distance running, ballet), the injury to the ankle can disrupt a person’s life.

Obviously, a human brain is much more complicated than an ankle. Yet, similarly, rest, supports (i.e., compensations, modifications) and “exercises” (i.e., therapies, education) for the brain may be recommended to rehabilitate and restore useful function. Depending on the severity of the injury and what the person needs to do (i.e., care for a family, return to work or school, manage a large company), a mild brain injury can disrupt a person’s life for a short period of time or even longer.

Diagnosis of Mild Traumatic Brain Injury

Due to the diffuse and subtle nature of mild brain injury, it is common for typical neuroimaging (CT scan or MRI’s) to show no evidence of injury. The damage to the brain is a real injury. The limitation of these brain imaging technologies is they often cannot detect mild brain injury. Mild brain injury can often damage the “white matter” of the brain. “White matter” consists of the axons of neurons (connections) in the brain. This is much harder to capture or visualize using common types of brain imaging.

There are newer, more sophisticated imaging technologies that show promise in more effectively capturing the damage that occurs in a mild brain injury. However these imaging technologies are currently much more expensive, and are not as readily available. Some of the newer imaging techniques include:

• Positron Emission Tomography (PET)
• Single Photon Emission Computerized Tomography (SPECT)
• Functional Magnetic Resonance Imaging (fMRI)
• Diffuse Tensor Imaging (DTI)

Neuropsychological assessment is typically used to assess the functional impact of a mild brain injury. This assessment is normally done when some type of brain dysfunction is suspected. A mild brain injury is often initially diagnosed by evaluation of the symptoms a person reports after sustaining the injury.

The assessment is comprised of a wide range of tests that objectively measure specific brain functions. Testing includes a variety of different methods for evaluating areas like attention span, orientation, memory, concentration, language (receptive and expressive), new learning, mathematical reasoning, spatial perception, abstract and organizational thinking, problem solving, social judgment, motor abilities, sensory awareness and emotional characteristics and general psychological adjustment. The neuropsychological evaluation can be used as a starting point for a plan of rehabilitation. It can assist brain injury professionals in identifying specific cognitive areas that have been damaged, as well as those areas still intact. You can read more about neuropsychological evaluations and brain injury from the American Psychological Association.

What Can I Do if I Have a Mild TBI?

Understanding the changes that have occurred from a brain injury is an important part of the recovery process. This makes education and awareness crucial for both the person with a brain injury as well as family and friends. The person with an injury and others need to understand that a “mild” brain injury can result in changes in thinking and memory that can affect a person’s ability to return to their life. While a person can “look fine,” brain injury is an invisible injury.

Research has shown that education and information about the possible consequences can be helpful to the person with an injury and family members. Some basic symptoms for family and friends to be aware of include:

Early Symptoms:

• Headache
• Dizziness or vertigo
• Lack of awareness of surroundings
• Nausea with or without memory dysfunction
• Vomiting

Later Symptoms:

• Persistent low grade headache
• Lightheadedness
• Poor attention and concentration
• Excessiveness or easy fatigue
• Intolerance of bright light or difficulty focusing vision
• Intolerance of loud noises
• Ringing in the ears
• Anxiety and depressed mood
• Irritability and low frustration tolerance

If you suspect you have a mild brain injury, contact a brain injury professional to help with the diagnosis and treatment of a brain injury. Also contact the Brain Injury Association in your state. State Brain Injury Associations will have information to share and can connect you with support groups, programs and professionals who understand the injury.

Mild Traumatic Brain Injury Issues

 Important caveats to share with families and those who have sustained a mild traumatic brain injury…

The recovery from a mild injury is not always quick.

• For mild brain injury, the issues are the same as moderate to severe brain injury.  While there are general guidelines for recovery, there can be wide individual variations in the timeframe for recovery. It can take several weeks, or several months for symptoms to fully resolve.

Recovery is often uneven.

• There will be “good days” and “bad days.”  This is normal in recovering from a brain injury. An important thing to keep in mind: on the “good days”, people want to get as much done as they can. Often, this can lead to overdoing it, which can bring back symptoms that were previously gone. Even on the good days, it is important to give yourself more time to complete tasks, and to listen to your body.  You cannot “tough out” a brain injury.

Create the best possible environment for recovery.

• Substances like caffeine, alcohol and nicotine can affect a person with a brain injury much more than it did before the injury. Be aware of the possible consequences of alcohol on recovery post injury.  It is recommended to abstain from alcohol consumption during the recovery period post injury. You can read more about alcohol use and recovery from a brain injury at the Ohio Valley Center for Brain Injury Prevention and Rehabilitation.

Give yourself more time to complete things.

• Issues like fatigue, attention and memory issues can cause delays in completing tasks that were easily done before the injury.  Allowing additional time to do things like laundry, menu planning, shopping, bill paying can help. Thinking out the steps needed to complete tasks and writing them down can be helpful too. Better planning can decrease stress and anxiety.

Professional help is important.

• It is important to understand the effects of a brain injury. The injury itself can impair the ability of a person to accurately assess their abilities.  And once problems are identified, often a person with a mild brain injury struggles with figuring out effective strategies to compensate for problem areas. Working with a trained brain injury professional can help identify specific problem areas, and can help implement effective strategies. You do not need to figure out brain injury all on your own.  There are useful books and resources available.

Support groups can be helpful.

• Brain injury can be isolating.  People say things like “you look fine,” with the implication that you should be fine. It is an invisible injury. Sometimes talking with others who have experienced similar experiences can help a person with a brain injury understand they are not the only one dealing with these issues. Contact the Brain Injury Association in your state to find out about support groups or other resources that may be useful to you.

Mild Traumatic Brain Injury and Concussion

• It is important to understand that a concussion is a physical injury to the brain that causes a disruption of normal functioning just like any other physical injury disrupts your normal functioning. For example, some ankle injuries (i.e., sprains and fractures) are more disruptive than others, just as some brain injuries are more disruptive than others. The better we understand any injury, the better our chances are for a speedier and healthier recovery.
• For the majority of people who sustain a concussion, a full recovery is possible with appropriate diagnosis and management.
• The Brain Injury Association has a Concussion Information Center, with in depth information about the management of concussion.

DEPRESSION AND TRAUMATIC BRAIN INJURY

BrainLine.org – Preventing, Treating, and Living with Traumatic Brain Injury

Problems Caused by TBI

• Any injury to your brain — even if it is mild — can cause problems such as headaches, ringing in your ears, mood changes, or trouble remembering or thinking for long periods of time. You may have found that your sleeping habits are different or that you feel tired more often.
• Even several months or years after your brain injury, you may notice other difficulties, including depression or anxiety.

What is depression?

• Depression is more than feeling sad every now and then. It is normal for someone who has had a TBI to feel sad by the problems caused by this injury. But for some people, those feelings can extend beyond normal feelings of sadness. People with depression feel sad, lack energy or feel tired, or have difficulty enjoying routine events almost daily. Other symptoms include difficulty sleeping, loss of appetite, poor attention or concentration, feelings of guilt or worthlessness, or thoughts of suicide.

Depression is a serious but treatable problem that should not be ignored.

• Many people require some form of treatment by a doctor or other health care professional to relieve their depression.

How common is depression for people with TBI?

• Research has found that patients with TBI are more likely to experience depression than those who have not had a brain injury.
• For every 10 people who do NOT have a brain injury, approximately one person will have depression.
• For every 10 people who DO have a brain injury, approximately three people will have depression.

What increases my risk of depression?

• The risk of depression after a TBI increases whether the injury is mild, moderate, or severe. Researchers cannot say if age, gender, the part of the brain that was injured, or the type of injury makes depression more likely.

How soon after my injury might I become depressed?

• Researchers do not know when depression is most likely to occur after TBI. Some people experience depression right after their injury, while others develop depression a year or more later. It is important to tell your doctor about any symptoms of depression you may be having even if it has been a while since your head injury. Your doctor or health care professional will ask you a series of questions or have you fill out a questionnaire or form to see if you have depression.

How can I tell if I am depressed?

There are ways to tell if you are depressed.

• Feeling down, depressed, or sad most of the day.
• Changes in your sleeping habits, such as sleeping poorly or sleeping more than usual.
• Losing interest in usual activities such as favorite hobbies, time with family members, or activities with friends.
• Increasing your use of alcohol, drugs, or tobacco.
• Not eating as much or eating more, whether or not you are hungry.
• Strong feelings of sadness, despair, or hopelessness.
• Thoughts of suicide.

You may not notice some of these symptoms, but people living and working around you may see them. You may want to ask the people close to you if they notice these signs in you.

What should I do if these symptoms start to occur?

• Tell your doctor or health care professional as soon as you or others around you notice any symptoms.
• If you have suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255 or go to www.suicidepreventionlifeline.org for help.

UNDERSTANDING YOUR CHOICES

How is depression treated?

Depression is usually treated two ways:

• Personal counseling with a special kind of health care professional. This is called “psychotherapy” (pronounced si-koh-THER-uh-pee).
  • In psychotherapy, you and a trained health care professional talk about your symptoms and how to develop ways to deal with them.
  • You might meet with your therapist weekly for several months or longer, depending on how you feel.
• Medicines called “antidepressants” (pronounced an-tee-dee-PRESS-uhnts).
  • Several types of antidepressants are used to treat depression and anxiety.
  • You might need to take these medicines for several months or longer, depending on how you feel.
  • Many times, people need both psychotherapy and medicines.Researchers do not know the specific benefits and harms or side effects of psychotherapy and antidepressants for people with TBI. However, both psychotherapy and antidepressants have helped people with depression.

Are there any side effects from antidepressants?

All antidepressants can cause side effects.Researchers do not know if the side effects are different for people with TBI than for other people who take antidepressants. However, research found that for some people antidepressants can cause:

• Stomach or intestinal pain and diarrhea.
• Weight gain or weight loss.
• Nausea and vomiting.
• Sexual problems.
• Trouble sleeping or sleepiness during the day.

Talk to your health care professional about the possible side effects of antidepressant medicines.

One special concern for people with TBI is how antidepressants may affect other medicines they take for their brain injury. It is important to tell your doctor or health care professional about other medicines you take.

Your Health Care Professional Can Help You Decide

Tell your health care professional:

It is important that you contact your health care professional when you experience:

1. Changes in sleeping or eating habits.
2. Frequent feelings of sadness, hopelessness, anxiety, or panic.
3. Disinterest in your favorite activities.
4. Thoughts about suicide.

Ask your health care professional:

Here are some questions you may want to ask your health care professional if you are going to be treated for depression or anxiety following your brain injury:

1. How often should we check to see if I am developing depression or an anxiety disorder?
2. How long do you think I will need psychotherapy or medications to treat these problems?

In conclusion, depression compounds a traumatic brain injury and can not be separated from the injury itself. Each person’s traumatic brain injury is as unique as his/her own finger prints. Therefore, no one can be given the same treatment or diagnosis. Depression tends to be a caveat to a TBI and must be taken seriously, as it affects a person’s ability to heal and recover from trauma. This is because depression changes a person’s perception of the world through a lens of sadness, hopelessness, and incubating a victim mentality.

Treatment of depression is critical in order to give depressed individuals positive coping skills and strategies so they can be in control of their own health and wellness. Taking ownership of their mental health brings control back to their chaotic world in a more positive light. It is important that individuals of depression and traumatic brain injuries feel safe, have shelter, food, and comprehensive medical care. At this juncture, they should be surrounded by people who support them in their healing and recovery.

Often times, Post Traumatic Stress Disorder (PTSD) will develop out of the trauma, due to the horror and recurring significance of the experience. In these instances, the events may compound the depression even further. Make no mistake, chronic depression is an insidious mental illness and can be catastrophic to one’s life if not treated properly and immediately by a professional who is an expert in this field.

• 10 Myths About Traumatic Brain Injury

As with all traumatic brain injuries, common myths arise in understanding people who have them and the behaviors they may exhibit, even though they still look fine in appearance. Never assume you know a person by their looks alone. Having an invisible disability creates more challenges, barriers, and frustrations for a person to overcome than for those whose disability is visible. Listed below reveals some myths that are linked to those with traumatic brain injuries caused by war, vehicular accidents, and/or falls.

1. You cannot have a TBI without loss of consciousness.  

• Historically, there has been some disagreement about the need for loss of consciousness to be able to diagnose TBI. However, with recent advances in TBI assessment and treatment, both medical and mental health communities are moving in the same direction by acknowledging that TBIs can present differently, and that one does not have to lose consciousness in order to be diagnosed with a TBI.

2. My Kevlar will prevent the worst head injuries.

• There have been many changes in modern warfare that are impacting today’s warfighter. For example, enemy tactics have changed, exposing service members to increased blast injuries, all of which can cause TBI during combat. However, there have also been advances in both personal body armor and armored combat vehicles as well as emergency medical care, resulting in service members surviving blasts and attacks that would have been fatal in previous wars. However, while the body is protected, the brain remains vulnerable, resulting in increasing TBI rates among this generation of veterans. For example, a Kevlar helmet might be able to prevent objects from penetrating the brain, but it is not always useful in preventing closed head wounds, such as concussions, which brings us to the next myth.

3. If there is no bleeding, you do not have to worry about having a TBI.

• There are different types of traumatic brain injuries, particularly open (penetrating) and closed (blunt) head wounds. Open head wounds occur when the skull and the brain’s dura mater, or outermost protective membrane, is penetrated, perhaps by a gunshot or missile. This type of head trauma will likely result in some visible, external bleeding, demonstrating outward signs of injury. Other complications of open head wounds include direct tissue damage, contusions, and axonal shearing, with secondary complications of anoxia (lack of oxygen), hemorrhaging (excessive bleeding), infection, and swelling.
• However, simply because one cannot see external bleeding, does not mean there is no cranial bleeding or damage. The skull does not have to be penetrated in order for there to be significant damage to the brain. In fact, most head wounds are closed or blunt traumas. With closed head wounds, there is no skull compromise. Closed head wounds can result from bruising at the impact site, bruising opposite the impact site when the brain “bounces” to the other side of the skull, microscopic lesions, damaged fiber tracts, hemorrhaging, hematoma (internal bleeding that exerts pressure in the skull), edema (swelling which exerts pressure on brain tissue), and intracranial pressure. These brain injuries may not result in any external or visible bleeding, but will still result in some very serious damage to the brain, which can have a lasting and pervasive impact.

4. If the person looks fine after a blast or impact, then they are fine.

• While a person could be fine after a blast or impact, it is also possible for a person with a TBI to be walking, talking, and conscious after the blast or impact. As indicated above, the individual could have a closed head injury with no outward signs of damage. These injuries are often overlooked as the most severe and life-threatening injuries are addressed first after a blast or impact. However, individuals with a concussion or mild TBI could still have internal damage with pervasive and lasting neurological and psychological issues. What is particularly important to consider is that symptoms of TBI are often so pervasive and subtle that the individual experiencing the symptoms may not even recognize them as symptoms of TBI. They may just feel like something is “off” or they are just different somehow after the blast.

5. Mild TBIs are not that debilitating.

• TBIs, including mild TBIs, can have subtle, but long-lasting and pervasive consequences for neurological and psychological functioning. This means that a TBI can have cognitive and social consequences, ranging in severity. Some effects of the TBI can be coped with easier than others, which may continue to have a very real impact on the individual’s life for a long time. Physical symptoms of mild TBI include loss of consciousness, amnesia, headaches, nausea, vomiting, dizziness, balance problems, sensitivity to light or noise, changes in vision and hearing, fatigue, and sleep difficulties. Cognitive symptoms of mild TBI include confusion, forgetting, poor concentration, changes in speech, slowed thinking and behavior, poor organization, lack of awareness, problems with information processing speed, and efficiency. Emotional and behavioral symptoms of mild TBI include personality changes, mood swings, apathy, little motivation, irritability, aggression, agitation, impulsivity, dependency, passivity, loss of sensitivity and concern, anxiety, and depression. Furthermore, symptoms can interact with and exacerbate one another. For example, sleep deficits impact concentration and increase irritability.

6. If a TBI does not show up in brain imaging, then it does not exist.

• Neuroimaging can be helpful, particularly with moderate or severe cases of TBI. However, in the majority of mild TBI cases, neuroimaging is not able to detect structural differences. As such, structural scans, such as MRI and CT scans, often appear “normal.” This sometimes happens when slight structural differences, such as axonal shearing, are too subtle to detect in these scans. However, a TBI may still result in functional changes to the brain. That is to say, an injury does not have to make large, visible changes to the brain’s structure to result in functional changes in how the brain operates.
• Some neuroimaging scans are better than others at detecting differences in function of the brain. Functional imaging — such as functional MRIs and PET scans — has been demonstrated to show the effects of concussion and mild TBI, however, it appears to be most often used within a research context, and not within the clinical settings. More typically, neuropsychological testing is used in clinical practice to document the functional impact of these types of injuries and develop treatment recommendations.

7. Recovery from TBI is a straightforward, quick process.

• While most individuals with a concussion or mild TBI achieve full recovery within a couple of days to a month, there are individual differences in recovery rates and trajectories. These individual differences vary based on the injury itself, the co-occurrence of other physical injuries or mental health conditions (such as post-traumatic stress disorder), and how the individual responds following the injury. Recovery focuses on the symptoms of TBI that can be treated and managed using an interdisciplinary approach tailored to the individual. Recovery is more variable for individuals with a moderate or severe TBI, however, most improvement occurs within one to two years, facilitated through more intensive treatment and rehabilitation. In sum, recovery trajectories for TBI vary from individual to individual. For many, recovery can be an ongoing process characterized by setbacks and frustrations.

8. If you have a TBI, then you have PTSD, too.

• PTSD and TBI have a lot of overlapping symptoms, and frequently co-occur with one another. This is likely because blasts, impacts, and other incidents that result in TBI are frequently traumatic in nature. It is often difficult to tease apart the two diagnoses and symptoms that are caused by physical damage due to the blast itself, psychological distress due to the trauma of the blast, impact, or both. However, there are distinctive symptoms that can help confirm if an individual has either or both diagnoses.

RELATED: 8 COMMON MYTHS ABOUT PTSD DEBUNKED »

• Symptoms that are common of both TBI and PTSD include sleep difficulties, fatigue, irritability, anger, aggression, thinking and memory difficulties, changes in personality, mood swings, hypersensitivity to noise, and withdrawal from school, work, and family activities. Symptoms distinct to PTSD include avoidance, intrusive memories, hypervigilance, physiological arousal, increase startle response, flashbacks, and nightmares. Symptoms distinct to mild TBI include headaches, dizziness, vertigo, reduced alcohol tolerance, and sensitivity to light. TBI and PTSD have similar neurobiological foundations, and their symptoms have been found to be mutually exacerbating. As such, distinguishing one from the other and providing an accurate diagnosis and helpful treatment plan is sometimes challenging, however, the two diagnoses are, in fact, distinct from one another.

9. Neuropsychological testing will not be that helpful for someone who has a TBI.

• Neuropsychological testing can provide individuals with information about changes in their cognitive functioning, their strengths and weakness, and information about strategies to help offset their weaknesses. It can also provide extremely valuable information to assist recovery from a TBI, including measuring intelligence, attention, memory, language, processing speed, visuospatial skills, and executive functioning. However, it is usually best to wait to complete a full, comprehensive assessment until recovery has tapered off and improvements are stabilized to get the most accurate picture of post-injury functioning.

10. Individuals with TBI can no longer work, or would at least require lots of expensive accommodations.  

• Individuals with TBI can still work and be effective employees in a wide variety of different jobs, including military jobs. Work accommodations are often in the best interest of both the employee and employer. Accommodations are often simple to emplace, and do not cost much time or effort on the part of the employer. For example, an employee might dim the lights, use larger fonts, remove distractions, take regular breaks, implement organizational skills, or take notes in meetings, among many other potentially helpful changes. In fact, many of these accommodations are tools utilized by many employees without a TBI to optimize their work performance in the same way.

In conclusion, there are many misconceptions about traumatic brain injury that contribute to misunderstanding of both the injury and individuals with the injury. Becoming aware of these myths may help friends and employers to better understand what is going on for someone who experienced a TBI.

FINDING MORE INFORMATION

If you are having trouble finding information, feel free to contact Brain Injury Association of America either via e-mail, or through our toll free Brain Injury Information Center at 1-800-444-6443. You are not alone.

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ADDITIONAL RESOURCES

• CDC Concussion Booklet
• Road to Rehabilitation -Concussion and Memory
• TBI Guide, an online book about brain injury and recovery written by a neuropsychologist.

Brain Injury Association Marketplace Books

• Brain Injury Survival Kit
• In Search of Wings
• Remind Me Why I’m Here
• Brainlash: Maximize Your Recovery from Mild Brain Injury
• Brain on a String
• Shaken but not Stirred

RESOURCES

• Depression After Brain Injury

• The information in this section comes from the report Traumatic Brain Injury and Depression.

• It was produced by the Vanderbilt University Evidence-based Practice Center through funding by the Agency for Healthcare Research and Quality (AHRQ). Information about the side effects of antidepressants comes from the report Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Depression. It was produced by the RTI International–University of North Carolina Evidence-based Practice Center through funding by AHRQ.

• For a copy of either of these reports or for more information about AHRQ and the Effective Health Care Program, go to www.effectivehealthcare.ahrq.gov.

• Additional information for this guide came from the Medline-Plus Web site, a service of the U.S. National Library of Medicine and the National Institutes of Health.

• This site is available at Medline Plus Traumatic Brain Injury

• This summary guide was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX.

• Brain Association of America, Living With Brain Injury

• Brain Association of America, Mild Traumatic Brain Injury

• 10 Myths About Traumatic Brain Injury

• Brain Injury Medicine: Principles and Practice, Nathan D. Zasler, MD, Editor, Douglas I Katz, MD, Editor, Ross D. Zafonte, DO, Editor, 2007, Demos Medical Publishing.

• Mild Traumatic Brain Injury: A Therapy and Resource Manual Green, B,  Singular Publishing, 1997

• Textbook of Traumatic Brain Injury Jonathan M. Silver (Editor), Stuart C. Yudofsky (Editor), Thomas W. McAllister (Editor), 2004 American Psychiatric Press

• Horn, L.J. & Zasler, N. (1996). Medical Rehabilitation of Traumatic Brain Injury. Hanley & Belfus, Inc: Philadelphia, PA.

• Kay, T. Brain Injury Association of America. Mild traumatic brain injury, 1999.

• Shirley Ryan AbilityLab #1 U.S.NEWS RANKING

• TIRR Memorial Herman #2 U.S. NEWS Ranking

• What is Brain Injury/Photo of Cognitive Deficits

RESOURCES FOR VETERANS

• VA’s PTSD Program Locator

• VA provides world-class health care to eligible Veterans. Most Veterans qualify for cost-free health care services, although some Veterans must pay modest copays for health care or prescriptions. Explore your eligibility for health care using VA’s Health Benefits Explorer tool and find out more about the treatment options available to you.

• • PTSD Directory Guide for Veterans
    

  • Mental Health Resources for Veterans
    

• Vet Center

• Vet Centers are community-based counseling centers that provide a wide range of social and psychological services, including professional counseling to eligible Veterans, service members, including National Guard and Reserve components, and their families. Counseling is offered to make a successful transition from military to civilian life or after a traumatic event experienced in the military. Individual, group, marriage and family counseling is offered in addition to referral and connection to other VA or community benefits and services. Vet Center counselors and outreach staff, many of whom are Veterans themselves, are experienced and prepared to discuss the tragedies of war, loss, grief and transition after trauma.

• Free Grants for Veterans

  Our website provides comprehensive details on grants for veterans. These grants are given away for free, and they could help low income veterans with bills, mortgage, rent, housing, college, and medications . Please note that grants are only given for veterans who can prove financial difficulties. Apply for multiple grants to ensure your needs are met.

  We offer information on the following :
  (1) grants for rent (2) housing assistance (3) help with bills (4) education grants (5) medical bills grants (6) business grants

• Military TBI Centers of Excellence  

  To accomplish the mission, TBICoE supports, trains and monitors service members, veterans, family members and providers who have been, or care for those who are affected by traumatic brain injury.

  TBICoE works at the macro-level, screening and briefing service members heading into theater, performing pre-deployment provider training at military hospitals and clinics, gathering data mandated by Congress and DOD, and overseeing research programs. TBICoE develops educational materials for military and civilian providers, and for service members, veterans, and their families.

  The DOD has further solidified TBICoE’s role by naming it the Office of Responsibility for these tasks:

  • Creation and maintenance of a TBI surveillance database

  • Creation and distribution of the Family Caregiver Guide

  • Design and execution of a 15-year longitudinal study of the effects of TBI in Operations Enduring and Iraqi Freedom service members and their families

• Testing Labs

• We are an educational web resource with hundreds of easy-to-read lab testing guides, all reviewed by our Medical Review Board of experts.

• We also offer confidential, secure and convenient online lab test ordering powered by our laboratory partners.We offer consumers direct access to laboratory testing through our network of laboratory partners. We continue to strive to enable consumers to advocate for their health by providing them with learning guides and access to products that make lab testing accessible, convenient and affordable.