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Response-able mtbi/concussion management

Posted Mar 02 2012 9:31am

I’ve been thinking a lot, lately, about how we respond to mTBI / concussion, thanks to the increasing reporting about injuries and discussion in the media and online. While I do feel it’s absolutely necessary to realize the seriousness of concussion / mild traumatic brain injury and seek to prevent them whenever possible, I think it’s equally necessary (if not moreso) to figure out how to deal with them after the fact.

This is where the challenges come in. Because in the domain of concussion response, we get into some “soft science” with every individual being different, and a whole host of issues coming up that can’t be handled with pure testing and prescriptions and a set protocol. I have my own mTBI recovery protocol, but that might not be appropriate for others. It works for me — amazingly well — but it might not work for anyone else in quite the way it works for me. So, we get into some gray areas, and we go from the hard sciences to the soft, from the doctor and trainer and coach to the counselor or rehab therapist.

Or we don’t go to anyone else at all. For countless individuals, a traumatic brain injury (whether from a car accident, a fall, or a sports injury) means wandering into a swamp of confusion and crossed signals and mixed messages, and if you don’t have an active and able advocate, you can fall through the cracks of the system so very easily, and spiral down into a malaise of progressive ruin. Whether or not we get help when we need it, is anyone’s guess, and it’s largely a question of luck and being hard-headed enough to not stop when everyone is telling you to give up and start acting like a normal person again.

Our (American) society, for all its eager lust after concussion/brain-injury-inducing activities, is surprisingly ill-equipped to deal with the consequences of brain injury.  Maybe it all throws back to the “good old days” of frontier life, when life was hard and rough and tumble, and being able to take a hit and get up and go back into battle or back to work, was the order of the day. I think in many ways, for all the advances we’ve made in how we live our lives, there is still something of the rugged adventurer in the American spirit. And with rugged adventure comes injury, sometimes death. But hey, that’s all a part of being one of us, right?

We have a strangely Darwinian streak, we do, and if it weren’t for the medical advances of the last century, it would probably help to thin the herd and keep only the fittest in the game.

The problem is, we’ve gotten far too soft to uphold that rugged old ideal. We’re too in love with our flat-screen t.v.s with the multi-function remote. We’re too in love with our convenience stores, our take-out, our fast-food, fast-everything. Hell, we don’t even like to get off the couch anymore. Drop any of us in the midst of the world where our great-grandparents lived, and we wouldn’t last a week. The reality shows about modern people “trying” to live like pioneers or colonists just ooze evidence of our evolutionary weakening.

And yet, we think that we can — and should — continue to play according to the rules of yester-year.

And we think we can continue with the same responses that we had for TBI in years gone by — just suck it up, and just — as Kobe Bryant said recently –”… deal with it and try to heal up as quickly as you possibly can, and get back on the court.”

More on Kobe Bryant’s flawed response to concussion later. For now, I’m talking about the rest of us.

Warning: I’m gonna rant a little bit now. So, cover your ears or look away or scroll to the very bottom of this post, if you don’t want to hear me go off on the ridiculous levels of intolerance for people who’ve experienced concussion / brain injury.

The rest of us think that a knock to the head won’t make any difference at all. Look at the movies — Bruce Willis took a bunch of hits to the head in a number of movies, and his character was still standing — and he won. Just about any action movie, really, will show repeated head trauma doled out like nobody’s business, and all the characters just kind of take it in stride. Even The Hangover II (spoiler alert, if you haven’t seen it) shows suburban middle-class guys who probably haven’t ever “roughed it” getting pounded by monks and other fighters, yet they manage to figure out how to get everything to turn out to their advantage.

Everywhere you look in the media, you’ve got people getting their heads slammed without any sign of consequence. In sports, too, we have athletes making a career out of pounding their heads against each other (or a ball) and everything turns out fine eventually. Supposedly. That’s what we’re told, anyway. We’re learning differently now.

But my real beef is with our society having no tolerance whatsoever for concussed/tbi folks who turn out to think and experience life differently after their injury than before. Our memories get turned around. Our thinking processes slow. Our ability to comprehend changes, as do our moods and our ability to manage them. Our behavior changes — sometimes dramatically. And more. All thanks to insults to our brain. Adding insult to insult to injury, society has its “norms” which lock us into expected types of behaviors — or else. And our immediate social circles lock us into expectations that we dare not violate, lest we be shunned and treated like we’re retarded — or worse.

See, here’s the thing — brains change. People change. People’s brains change over time, injury or no, and having a rigid, brittle attitude about how people should and should not act and behave, just screws everything up for everyone. What would it take for people to be just a little more tolerant and accepting? What would it take for our friends and family to cut us a friggin’ break and not get all up in our sh*t when we don’t remember things exactly, or we have trouble with ongoing fatigue? This is the thing about TBI that makes me the most nuts — all it would take is a little tolerance and acceptance of differences in how we are now vs. how we were then, to set the stage for some real healing and recovery.

But no, people have these rigid expectations of how we “should” be and behave and respond. And if we step outside that, they just can’t handle it anymore. Talk to just about any TBI survivor, and you’ll likely hear about how a bunch of their friends just kinda evaporated when they got hurt. If I want to be generous towards the “deserters” as I call them, I can say they just felt frightened and vulnerable and wanted to give us our space. If I’m feeling less generous, I can say they just can’t handle the admittedly challenging job of revising their opinions about who we are and what we are capable of doing/being in life. Why would anyone want to change their opinions?

Okay, rant over.

My real point is that , if we’re going to develop a truly intelligence response to concussion  / mild tbi, we need to make room for differences, and we need to make room for change. I’m talking about making room for people to be vulnerable and in need of assistance for a while. I’m also talking about making room for the possibility that they can — and will — improve, get better, learn new ways of doing things and being and living in the world. Because what’s even worse than not being accepted because you suddenly need more help, is being relegated to a category of “disabled” just because your brain is in flux..

Our brains are always in flux. But too often the people around us just give up on us, and think, “Oh, brain damage — well, so much for them” and we end up limited by others’ expectations. The one hope some of us (me included) have is to pay no attention to the expectations of others and just keep going according to our own internal compass, even if it’s a little wonky at the start.

I’m running out of time and I need to head out to work, but I just wanted to put this out there.

More later.



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