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Sequelae and Intervention Following Head Injury

Posted Jan 08 2010 12:00am

A great section from Neuropsychology and the Assessment of Mild to Moderate Head Injury by Dennis P. Swiercinsky, Ph.D. Note:  “Sequelae” means

The American Heritage® Dictionary of the English Language, Fourth Edition

I usually call them “after-effects”. My comments are in italics below.

A mild head injury, such as from a fall, an automobile accident, or a work mishap, often brings the person to the attention of a physician or a hospital emergency room.

But sometimes this doesn’t happen. Sometimes we can’t get help, whether we refuse it, or people don’t realize something significant took place.

If there are no complications or other injuries apparent, the person is checked over and sent home, perhaps with a prescription for pain relievers and a checklist to watch for any complications that might develop.

I wonder if the checklist shows what to do, if the complications arise. Seems like that would be helpful.

Without timely, appropriate, and comprehensive follow-up diagnosis, education, and treatment, the lingering problems from uncomplicated head injury can mushroom into seemingly relentless frustration.

True – and that’s what often happens with MBTI survivors. Even moderate TBI survivors, who get no (or inadequate) medical treatment, can end up without adequate follow-up diagnosis, education, and treatment. And how those lingering problems add up…

Underdiagnosis or misdiagnosis of the multiple cognitive, behavioral, and somatic complaints following head injury is common. Ultimate recovery and maintenance of a positive attitude toward recovery, as well as adjustment to the emotional trauma of the event that caused the injury, depend on early, appropriately intensive, and comprehensive intervention.

It’s a nice thought, that early, appropriately intensive, and comprehensive intervention is a possibility for people, but TBI happens so frequently, and so few people are adequately aware of it and its “wrinkles” that it seems like hanging your hat on early intensive and comprehensive intervention is a set-up for failure — or perceived failure.

Too often, symptoms are acknowledged by health care providers but are understated or minimized.

Amen to that! My doctor thinks it’s okay for me to not get a full 8 hours of sleep a night. And I can’t tell you how many doctors and healthcare folks have shrugged off my issues — pain, fatigue, etc. It’s maddening.

The urge to get persons back to work too soon and without comprehensive understanding of the injury often creates emotional and cognitive obstacles and usually worsens the symptoms and outcome due to creation of stress, greater discomfort, chronic re-injury, and feelings of distrust and resentment.

Yeah, we’re all supposed to get back to work immediately. What makes this particularly dangerous, is that a person who has recently experienced a TBI is depending on the assistance and guidance of those around them, to help them deal with everything. We’re friggin’ brain-injured, for heavensake! The fact that education and treatment so often fall into our own hands — the very people who need help — strikes me as the ultimate irony. And yet, so many of us are put in that position. We cannot even get help, lots of times, unless we push for it. Of course, it’s difficult to push for it, when your reasoning faculties and your cognitive abilities have taken a hit.

Educating the patient, family, employer, case manager, and others involved in the lifestyle changes caused by brain injury is of extreme importance.

Yes, because like I said above, the survivor is the one in need of help — and should not be the one holding the reins of the team of horses. Making a recent TBI survivor resposible for their own diagnosis and care and survival is like asking someone who is legally blind to drive a team of  Budweiser Clydesdales down a busy boulevard. They may be able to do it, but it’s a crapshoot. Someone who isn’t brain-injured needs to be at the helm, and they need to be properly educated. Preferably, everyone in the survivor’s immediate circle of influence.

Everyone needs to understand that even though no bones may be broken, no cuts sustained, and that the injured person may look and talk just fine, there is real injury.

And people need to be a lot less afraid of brain injuries. Probably the biggest hurdle to me getting help and support from anyone in my life around my TBI’s is their mortal fear of the prospect of brain injury. It’s mighty difficult to discuss your needs and your situation with people who are frozen like deer in headlights at the sound of the words “traumatic brain injury”.

The complex injury involving cerebral contusion and diffuse axonal injury within the brain, trauma and stretching of cervical muscles and supportive tissue, abrasion within the cervical vertebrae, soft tissue injury to muscle and circulatory structures of the head, chronic muscle strain due to guarded behavior in response to pain, changes in cerebral circulation and perfusion, and potential neurochemical and neurotiming changes in brain function provides the foundation for a host of behavioral, emotional, and cognitive changes.

So, how do we educate people about this? How?! It’s a lot to consider and take in — how can we get the right information to people who need to know, in ways they can actually understand it?

Diminished self-confidence, negative self-reference, inflexibility, desire for withdrawal, slower thinking, emotional unpredictability, and frustration intolerance stem from the complexity of injury.

Yes, they do. And it’s a vicious, self-perpetuating cycle that we get sucked into. The more it’s allowed to escalate and continue, the worse things get… Sometimes until it can’t possibly get any worse…

If the patient, family, employer and others do not understand the injury and its consequent dynamics, unreasonable expectations, charges of malingering, and inappropriate treatment will typically follow. Failure to understand and appropriately treat mild to moderate brain injury can result in prolonged and less than desirable ultimate outcome.

Yes, yes, and yes. All true.

The good news is, it’s possible to recover from late-effect TBI’s, even if you never received adequate medical care or diagnosis or assistance. And it’s a difficult thing, and a pain in the butt to have to do it yourself, but with focus and intention and the right information, it IS  possible to get back on track and reclaim your life after TBI.

Like the folks at Give Back Orlando, Dr. Swiercinsky actually takes seriously the cognitive-behavioral impact that even a mild TBI can cause. And the mention of the long-term effects that are less than desirable gives me hope, as well.

The main issue I have with what Dr. S says, is the feeling that all is lost, if you don’t act quicly. People have been having head injuries since the beginning of time. Millions of us have them every year. And yet, we’re still here. Granted, there’s a lot we can do to improve our lot — and we have a long way to go, to fully understand how best to treat and support TBI survivors. But all hope is not lost, if you didn’t get immediate, intensive, extensive help.

I’m living proof that survival is possible, even with precious little help from the rest of the world. I’m not recommending it to anyone — it’s much harder than it should be — but it is  possible.

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