Neurocognitive Disorder: Life after Brain Damage

Imagine going to work after spending time at the park with your family. Everything went well until the driver was driving faster than usual in the pickup truck. Suddenly, you're in the hospital and your life is changing forever. Three weeks later you wake up, doctors explained that its a miracle your alive. That's what happened to my friend, she had a brain injury that caused her world to reverse. She now sees the world in a different lens and has had to make many different adjustments because she may have lost a part of herself, she has gained something better. In the most interesting way, the accident has changed her life. She was a blunt volatile person with the only astigmatism as an impairment before her accident. Now she has over 16 bolts and a metal plate that connects her head to her body. She wouldn't be able to move without this hardware and could die. She also had 7 strokes and 2 seizures. Because of this trauma, she has had nerve damage on her entire left side of her body, she has less than 15 percent of her vision. She was recently told that due to retinal degeneration, her left eye will not be able to see by the end of the year. She is told that her body can only take so much, and she needs to be careful because if she has another stroke or seizure she will surely die. She is no longer able to do things that normal 25-year-olds can do on a daily basis such as driving or drinking. She also has large gaps in her memory. She has gained so much knowledge from this incident, however. She is a warrior of traumatic brain injury and she appreciates this. She's no longer volatile either. She's understanding but reserved because she's still trying to learn how to navigate the world. She has learned how to use her weakness in her favor. She is navigating the world with her hearing, touch, and sense of smell. She learned how truly blessed we are, and how we take this for granted. She was distracted and angry in the first week, not because she was in a bad accident and almost died, but because her family and friends had to suffer because of the possibility of her death. Free to see her little sister who was 7, however, she knew she had to buck up because she needed her to be strong. She has fought hard to get back to normal. She soon learned that the normal she was striving for was not something she could achieve or want. She fought to be the best she could be and live to see her sister graduate from high school.

According to Medline Plus, the definition of Neurocognitive disorder is a general term that describes decreased mental function due to a medical disease other than a psychiatric illness. One of the many Neurocognitive disorders is brain injury. Traumatic brain injury usually results in a severe blow to the body or head. An object, like a bullet or a shattered piece of a skull, that enters into the brain tissue can cause traumatic brain damage. Moderate traumatic brain damage may temporarily affect your brain cells. Greater trauma can lead to bleeding, torn tissue, bleeding and other physical damage to the brain. These injuries can cause complications or death on a long-term basis.

Causes - Falls: Falls from bed or ladder, down stairs, in the bath and other falls are the most common cause of traumatic brain injury overall, especially in older adults and young children. Vehicle-related collisions: collisions involving vehicles, motorcycles or bicycles and pedestrians involved in such accidents are a common cause of traumatic brain injury. Violence:gunshot injuries, domestic violence, child abuse and other assaults are common causes. Shaken baby syndrome is a traumatic brain injury caused by violent shaking in infants. Sports injuries: Traumatic brain injuries can be caused by sports injuries, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports. These are especially common in youth. Explosive blasts and other combat injuries: In active-duty military personnel, explosive blasts are a common cause of traumatic brain injury. Although it is not yet well understood how the damage occurs, many researchers believe that the pressure wave passing through the brain significantly disrupts brain function. Traumatic brain injury also results from penetrating wounds, severe blows to the head with shrapnel or debris, and falls or bodily collisions with objects following a blast.

Symptoms - Cognitive: amnesia, inability to speak or understand language, mental confusion, difficulty concentration, difficulty thinking and understanding, inability to create new memories, or inability to recognize common things. Muscular: instability or stiff muscles. Mood: anger, anxiety, apathy, or loneliness. Whole body: blackout, dizziness, fainting, or fatigue. Gastrointestinal: nausea or vomiting. Sensory: sensitivity to light or sensitivity to sound. Eyes: dilated pupil, raccoon eyes, or unequal pupils. Speech: difficulty speaking or slurred speech. Also common: persistent headache, a temporary moment of clarity, bleeding, blurred vision, bone fracture, bruising, depression, loss of smell, nerve injury, post-traumatic seizure, or ringing in the ears.

Treatment - Mild injury: mild traumatic brain injury usually requires no treatment other than rest and over - the-counter pain relievers to treat headache. However, for any persistent, worsening or new symptoms, a person with a mild traumatic brain injury usually needs to be closely monitored at home. He or she may also have doctor appointments for follow-up. The doctor will indicate when it is appropriate to return to work, school or recreational activities. It's best to limit physical or thinking activities that make things worse until your doctor advises it's OK. Most people gradually return to normal routines. Immediate emergency care: Emergency care for moderate to severe traumatic brain injuries focuses on ensuring that the person has sufficient oxygen and adequate blood supply, maintaining blood pressure, and preventing further injury to the head or neck. People with severe injury may also have other injuries that need to be addressed. Additional treatments in a hospital's emergency room or intensive care unit will focus on minimizing secondary damage due to inflammation, bleeding or reduced supply of oxygen to the brain. Medications: Medicines to limit secondary damage to the brain immediately after an injury may include diuretics, anti-seizure medicines and coma-inducing medicines. Surgery: Emergency surgery may be needed to minimize additional damage to brain tissue. Surgery can be used to address the following problems: removing clotted blood (hematomas), repairing skull fractures, bleeding in the brain, and opening a window in the skull. Rehabilitation: Most people who have suffered a severe brain injury will require rehabilitation. They may need to relearn basic skills like walking or talking. The goal is to improve their ability to perform daily activities. Therapy usually starts at the hospital and continues at an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The type and duration of rehabilitation is different for everyone, depending on the severity of the brain injury and what part of the brain has been injured.. Rehabilitation specialists may include: Physiatrist, Occupational therapist, Physical therapist, Speech and language pathologist, Neuropsychologist, Social worker or case manager, Rehabilitation nurse, Traumatic brain injury nurse specialist, Recreational therapist, and Vocational counselor.

Stigma - People with disabilities routinely experience discrimination relative to people without disability even when there is no outward suggestion that they deserve less opportunity, support or friendship. Survivors’ of brain injury may internalize public stigma and develop self-stigma, resulting in them believing stereotypical information about their injury or illness, impacting recovery. Furthermore, survivors of brain injury may experience stigma in different ways depending on whether they have visible markers of injury or not, and whether they choose to disclose or not disclose their injury. Stigma is extremely common for TBI survivors. Particularly in her case, she gets so much talk because of how deadly her injuries were. Questions like, “oh really? Hmmm you don’t act like it,” or she gets others who tell her, “you probably didn’t have too bad of injuries.” Either way it’s frustrating for her, but she just lets them say or do the things they do. She knows in due time she will show them the effects of her injuries and how she has turned it into a strength. That’s not to say that it doesn’t hurt to hear these things. However, she just turns it into a teaching moment.

Risk factors: Children, especially newborns to 4-year-olds, Young adults, especially those between ages 15 and 24, Adults age 60 and older, and Males in any age group. My friend is a Latina woman who doesn’t fit that category for the risk factors. Scientific research has shown that female and male brains differ in more than 100 ways in structure, activity, chemistry, and blood flow, and so it is logical that damage to the brain would also manifest differently in women and men. However, research on brain injury, including sport concussion research, has long been viewed from a masculine perspective, partly because of the findings that TBI generally occurs about twice as often in males as in females. While research shows that women may have different injury rates, symptoms and recovery rates, the medical community still has no female-specific guidelines, protocols, care plans or educational resources for women with brain injury, including concussions. Since more men than women suffer brain injury, a woman and the people around her are likely to know more men than women who have had concussions and could judge by the male experience of their symptom and length of recovery. As a Latina woman, she already had to work twice as hard to be where she is today. Unfortunately, she has to work three times as hard because of her brain injury. She faces discrimination for being Latina, but she also faces stigma with having TBI.

Whether a brain injury changes one’s life for the better or the worse is down to chance. Brain injury changes you, and the only certainty is that things are going to be different. You are changed by a brain injury. Our minds are wondrous and mysterious. All we are and do, all we feel and believe, are the products of our neural pathways of electric signals. When disastrous events tamper with our minds, like a car accident or a stroke, our personalities become rearranged as if a burglar ribbled through her drawers. For the outsider, nothing may appear robbed. But the house owner knows it has an intruder. We know that frontal lobe injuries can make you shortsighted and irritable and cause impulse, such as gambling. We know that the parietal lobe damage causes aphasia or language problems. But there is still a good deal we can't understand, or do not want to know. While we no longer ban discussions on brain functions as a public moral threat, the reality of a life-changing but invisible injury is an old-fashioned scandal. Understanding the trauma of our brains enables us to dig into the coal face of human identity. It is not a warm-hearted story most of the time. She lost everything, and it's quite essential, and she often doesn't even know, which often is one of the biggest tragedies. She believes her life changed for the better. She thinks that because now she has experienced a part of the world that many are not privileged to experience. With this experience and her motivation for change, she can now fight for those who are seen as disabled. She can educate people about their abilities and how we really can tolerate so much more than the stereotypes that we are compared to.

Following brain injury, emotional and physical healing can take a long time. I learned that people with TBI, try to take the path of healing and try to accept the unfair tragedy that came to be. No two brain injuries are the same, because no two people are the same. Our lives have been shaped by different experiences and we have developed different coping mechanisms. The acceptance that others could not truly ever “understand” the pain of people with TBI was freeing for her. Anyone who has a TBI or has a loved one who has had one knows that it is mostly a silent injury that affects every part of their life. I learned that some people are understanding and supportive of her and those who really didn't even try to understand or help her. TBI’s are mentally and physically exhausting, but often times, others cannot see that. While it was a hard time for her, she learned who her friends truly were by all of the kindness and support they gave her. She is so thankful for those who went on this hard journey with her and continue to do so.

Also, that people with TBI have a hard time adjusting to try to be as normal as possible. Although, they know normal is far from possible they try their best to make it each day. People should understand and realize how hard things are for people with TBI because they take things for granted. There's no cure for brain damage; it doesn't grow like hair and it doesn't fade like scars. The effects are a daily, lifelong process that could mean something different to everyone such as veteran or football players. It is therefore up to her to demonstrate to people what she needs. Ultimately, understanding what they see is up to them.

References

https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

http://www.pinkconcussions.com/new-page-1