June is brain injury awareness month 

By Kshef Kamran, June 29 2023—

June 1 marked the start of brain injury awareness month and now is the time to address the severity and types of brain injuries that can be inflicted. 

A traumatic brain injury (TBI) can be a result of blunt force trauma, closed head injuries or a penetrating head injury. Globally, TBI is the leading cause of disability, and by 2031 it is expected that the most common neurological condition affecting Canadians will be TBI. In Canada, two per cent of the population lives with a TBI and annually there are 18 000 TBI-related hospitalizations. In the United States, approximately 1.7 million individuals suffer from a TBI — older adolescents ranging from 15 to 19 years old and seniors above the age of 65 are the most likely to attain a TBI. The number of traumatic brain injuries is staggeringly high nationally and being educated on this ailment is crucial in helping the people suffering from this injury through the path of recovery. 

Just as there are varying degrees of injuring a bone such as a fracture or breaking a bone there are similar differences among brain injuries that exist with mild, moderate and severe TBI. Generally, a mild TBI does not result in a prolonged loss of conscious state. However, if it does, it is short-lived and less than 30 minutes. Individuals suffering from moderate TBI can be unconscious for anywhere between 30 minutes to 24 hours. A TBI that results in a loss of consciousness for more than 24 hours is considered severe. To determine the type of TBI physicians use the Glasgow Coma Scale (GCS). The three parameters that are assessed by the GCS include eye, verbal and motor responses. A mild TBI correlates with a GCS score of 13 or higher, a moderate TBI is represented by a score of 9 to 12 and a score of 8 or less represents a severe brain injury. 

There are also different types of brain injuries. Concussions are the most common type of brain injury and are used synonymously with a mild TBI. Blunt force trauma and closed head injuries are the leading cause of concussions.  When the brain moves around within the skull concussions occur which can be a result of motor vehicle accidents, falls or workplace accidents. If an object penetrates through the skull to the brain the cells die which can lead to a swelling, a stroke and a loss of oxygen flow to the brain. 

Another type of brain injury is anoxic brain damage which is caused by a lack of oxygen to the brain since the absence of oxygen after four minutes kills the brain cells. Contusions occur when the brain swells and may lack oxygen after colliding with the inside of the skull. Brain injuries are not always localized to a single area as in a diffuse axonal injury (DAI) which occurs when the brain shifts within the skull and long connecting fibers are torn from the brain. 

No two brain injuries are the same; each individual experiencing the injury does so in different ways. The most commonly afflicted area is the frontal lobe which is the largest lobe in the brain. As its name suggests it is located at the front of your head, and it is responsible for executive functions such as: emotions, motor control and speech. Another area of the brain that is the most affected is the temporal lobe which sits behind the ears. It is the second largest lobe and is crucial for memory and auditory assessment. Therefore, symptoms that are frequently recorded can include: cognitive impairment, sensory assessing difficulties and seizures. For a mild TBI the symptoms that follow can be: headache, ringing in the ears or fatigue. Although, for moderate to severe TBI the symptoms can be similar to those of a mild TBI, but more aggressive and frequent. 

Furthermore, persistent post concussive syndrome (PPCS) is when the symptoms of a traumatic brain injury persist longer than three months.Research has depicted that when a mild TBI leads to PPCS there can be long lasting effects on memory, cognitive, and executive functions. 13 to 62 per cent of the patients diagnosed with a mild TBI suffer from PPCS. The continuation of symptoms from a TBI can have a staggering effect on an individual’s quality of life by impeding social skills and the ability to concentrate on work. 

Treatment for PPCS is being developed and improved. Currently it is limited to different forms of medication, therapy and attempts at treating the symptoms. It is crucial to understand that a brain injury is complex and can improve, however, it can also remain and continue to affect the individual. Thus, as families and friends of those who have suffered from a brain injury we too have a significant part to play in the recovery of those suffering from injuries that may seem invisible to us and we can start by doing the following: 

1. Blame the symptom, not the person

As an outsider, understanding the complexities of a brain injury can be difficult because unlike breaking a bone generally you can not see a brain injury. When healing an injury the physician will often recommend avoiding straining that muscle, joint or bone and refrain from moving or using it as much as possible. However, there is no way for you to not use your brain which further complicates the recovery process. To assist in the recovery of someone who is suffering from a brain injury the primary element that you could do as a friend or family member is to understand that every component of the brain is responsible for a very specific and particular role. 

The most common component of the brain that is injured is the frontal lobe which is responsible for executive functions such as emotions, motor control and speech. Therefore, if a brain injury occurred in this area the result can be emotional irregularities including depression or anger. Thus, understanding that it is not the fault of the individual suffering from the brain injury that they are experiencing these symptoms and being patient with them can help in their recovery. 

2. Help them organize their tasks 

Due to the cognitive impairment that can be a result of brain injuries, everyday tasks can be overwhelming and excessively difficult. Trips to the grocery store or chores around the house may seem physically or mentally taxing after a brain injury. A means of helping them can be to assist them in organizing their tasks by making lists, prioritizing tasks and making a schedule with allocated breaks depending on the task’s difficulty. It is important to take frequent breaks after having a brain injury as that provides the brain with time to rest after use similar to providing time for muscle recovery after exercising. 

However, there is a difference between helping and over-helping where instead of assisting with organization you complete all of their tasks. By overstepping out of love for the individual experiencing the injury it can have adverse effects to their recovery where they feel less motivated to achieve their goals knowing that someone else can complete it for them. You can start by helping the individual organize their tasks and steadily let them take more control as they become more comfortable. Assisting with the process of organizing their tasks can be beneficial not only to the recovery of the individual, but also help to regain the individual suffering from a brain injury’s independence. 

3. Be there for them for treatment 

Following a brain injury there can be various appointments to attend to the family doctor, neurologist or physiatrist just to name a few. Therapy can be an exhausting experience at times, therefore, driving them when you can and listening to how they are feeling before and after treatment can provide the individual suffering from a brain injury with an outlet to voice their feelings. Having to go to various clinics and converse with different doctors can be mentally and physically taxing — by driving them they have one less thing to worry about and can conserve their strength for the treatment. Physicians provide a lot of information regarding treatment plans and post-treatment symptoms so being present for the treatment may allow you to remember details that may have been missed. Lastly, often at-home exercises or techniques are provided and requested to be completed thus being present at appointments can help you understand the post-treatment protocol or exercises to be completed. 

4. Learn the triggers 

For mild to severe TBI patients the common triggers can include but are not limited to bright lights, loud noises or crowded places and other elements that contribute to overstimulation. When someone you care about is suffering from a TBI, making a mental note of their triggers can help them slowly adjust to their everyday life while also recognizing their limits. For instance, if going to a social gathering together, be aware if the music is too loud or if flashing lights are too strong and if it becomes too much then help by providing a break or politely leaving the event if necessary. However, to recover and overcome the symptoms some exposure to triggers can be good, but the goal is not to push them into an overwhelming state or to put them in a situation they are not comfortable handling. 

5. Continue to educate others 

There is more information that is constantly being researched regarding traumatic brain injuries. Another asset that can benefit the recovery of impaired brain health is to continue to learn and educate yourself on the matter. The University of Calgary’s Hotchkiss Brain Institute is an internationally known facility that organizes research and education to improve brain health and quality of life. It is important to spread information from reliable sources to educate others and bring awareness to brain injuries and it’s associated symptoms. With misinformation being spread at times, ensuring that you use verified content when educating others is crucial. 

Annually 500 out of 100 000 individuals experience a TBI which equates to 165,000 Canadians a year or one person every three minutes. This makes it entirely possible to encounter an individual that is experiencing a TBI since the frequency is staggeringly high. As a result, understanding certain techniques and strategies to help a loved one recover from a TBI can be beneficial to their path of healing. It is essential to bring awareness to brain health since similar to any organ it can be injured, though unlike a bone with a cast these injuries and the symptoms can be unknown to others around them. Overall, it is important to educate yourself and others beyond brain injury awareness month to help those that may be suffering in silence.