Understanding Mild Traumatic Brain Injury (MTBI)

An Insightful Guide to Symptoms, Treatments and Redefining Recovey

Mary Ann Keatley, PhD, CCC, Laura L Whittemore

• Publisher: Clear Focus Press
• Year: 2019
• Print ISBN: 9780982409411
• eBook ISBN: 9780982409442
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

If you are a brain injury survivor or know someone who has experienced this life-changing event, this book was written for you. Since MTBI is considered an "invisible injury," it is often misunderstood and undiagnosed. This essential book describes the signs and symptoms as they show up in everyday life with a list of the latest treatment options. The intention of the authors is to inspire hope that brain injury survivors will get better, learn strategies to compensate, and discover their own resiliency and resourcefulness.

 

CHAPTER 1

Understanding Mild Traumatic Brain Injury (MTBI)

 

Traumatic Brain Injury has been labeled the “Silent Epidemic.”

 

It happens in the blink of an eye. In that instant your life is changed. It may have been caused by a fall, automobile or sports related accident or a blast injury from an explosion. Recovering from mild traumatic brain injury (MTBI) is a new experience not only for those who are injured but also for those caring people who want to help. The first step is to learn all you can about MTBI and to accept it as a starting point—a new beginning.

This book was created for you, your family, and your support system to increase awareness about brain injuries. It is our intention to empower you with the inside knowledge and wisdom gained from those who experienced MTBI and moved through the healing process, in order to survive, thrive and ultimately prevail in their lives.

Although mild traumatic brain injury affects millions of people and was recognized well over a hundred years ago, it is currently taking a position in the limelight. Numerous articles and TV specials are covering the effects of TBI on our Wounded Warriors returning from Iraq and Afghanistan. Many professional athletes are stepping forward to report the possible long-term affects from multiple concussions.

Use this book as a guide to navigate through the unknown territory of brain injury. What you are experiencing may be unknown to you and your loved ones, and it is also a new frontier in science and research. The innovations in science, computers and imaging are moving at lightening speed at the same time that there appears to be an acknowledgement and acceptance of this type of injury. Basically, we have a perfect cataclysm of science and humanity coming together to advance research and help solve the mysteries of brain injury and open new doors for recovery.

The ideas presented in this book are recommendations. It is essential that you consult a professional to develop a treatment program that is individually designed for your needs. Your brain is one of your most important assets and it is worth rehabilitating to improve the quality of your life.

 

Definition of MTBI

A mild traumatic brain injury (MTBI) is defined as a blow or jarring of the head that results in a disruption of brain functioning. MTBI has been labeled the “Silent Epidemic”1 Brain injuries can range from “mild” to “severe.” All brain injuries should be considered serious, and you should alert your physician about the symptoms you are having.

Mild traumatic brain injuries are usually called “closed head injuries” because there is a non-penetrating injury to the brain. This type of injury can be caused by whiplash, a blast injury, or hitting the head, resulting in bruising, stretching, and shearing of the axons and/or tearing of the tissues. For the complete medical definition of MTBI, refer to Appendix A.

Contrary to popular belief, you DO NOT need to hit your head to sustain a mild traumatic brain injury. A whiplash injury, where the head accelerates and decelerates without making contact, can cause a brain injury. There is also new research that indicates that concussions may be caused by blast waves from explosions. Studies being done at Johns Hopkins reveal that even if you were not hit in the head or knocked out, the indirect, powerful pressure waves caused by a bomb may affect the brain.2

 

MTBI Often Goes Unidentified or Misdiagnosed

Many times the brain injury is not documented during the acute stage, because physical pain overrides the awareness of MTBI. Following a concussion or MTBI, awareness levels may be reduced and you may not realize that you have suffered a brain injury. As the body begins to heal and you become more active, the head injury becomes more apparent.

The history of mild traumatic brain injury has been documented for more than a century. During the 1860s, it was discovered that individuals who were injured in railway collisions suffered from brain injuries. It was believed that their symptoms were caused by “nervous shock” to the spinal cord and the brain.3 More recent research notes that the symptoms of mild brain injury are much more serious than previously believed or shown through testing.4

The latest report from the Center for Disease Control (CDC) states that approximately 1.7 million people sustain a brain injury in the United States each year, and 800,000 of those are believed to be mild traumatic brain injuries. TBIs are increasing among children because of their involvement in sports.

The CDC also reports that 1.1 million are treated and released from emergency departments, but the actual number of people with TBI, who are not seen in emergency rooms or do not receive care, is unknown. An estimated 5.3 million Americans are living with TBI related disabilities. The greatest number of traumatic brain injuries are caused by falls followed by motor vehicles accidents.

Brain injuries are cumulative in nature. In other words, if you suffer more than one concussive injury over time, the effects may accumulate and even a small impact to the head, may manifest as a more serious injury.

Neurological examinations and brain imaging studies, such as MRI and CT Scans, may be normal even if you have sustained a brain injury. However, your doctor may have ordered these tests in the beginning to rule out other medical conditions. Newer imaging tests, such as PET Scans or SPECT Scans, have proven to be more informative for this type of injury. The field of neuroimaging is changing rapidly so be sure to consult your doctor to determine which tests would be most beneficial.

Although the injury may be “invisible” to the outside observer, MTBI usually has a number of symptoms, such as nausea, dizziness, vomiting, sleep disturbance, blurred vision, sensitivity to light and sound, fatigue, etc. Emotionally you may feel a shaken sense of self and out of control. Very often there is an overlap of symptoms of Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD).

 

 

 

CHAPTER 2

Post Traumatic Stress Disorder (PTSD)

 

A neuropsychological evaluation from a neuropsychologist helps to delineate symptoms of depression, PTSD and MTBI.

 

Survivors of TBI are particularly susceptible to major depression, generalized anxiety disorder, and posttraumatic stress disorder.1 PTSD frequently co-exists with mild traumatic brain injury and has many of the same symptoms. PTSD is defined as a disorder that develops after a distressing psychological event that is outside typical human experience. It is characterized by re-experiencing or reliving, over and over again, painful or stressful situations. Examples of traumatic emotional events that can cause PTSD include wars, accidents, physical and mental abuse and natural disasters (hurricanes, earthquakes). Even rescue workers and first responders, such as firefighters, EMTs and police may experience secondary traumatic stress disorder. Medical workers, such as ER doctors, nurses, psychologists, therapists and caregivers have been known to experience compassion fatigue.

The symptoms of PTSD may include nightmares, flashbacks, avoiding stimuli associated with the trauma, recurring memories, poor concentration, trouble sleeping, anger, exaggerated responses, and hypervigilance.

Since the symptoms of PTSD and MTBI can be very similar and may overlap, it is essential to identify all of your symptoms and receive appropriate treatments. A neuropsychological evaluation from a neuropsychologist helps to differentiate between the symptoms of PTSD and MTBI.

By looking at the symptoms and biology of trauma, we can begin to understand PTSD. In 1997 Dr. Peter Levine wrote a book entitled Waking the Tiger: Healing Trauma. In this book he talks about the body’s reaction to threat and/or trauma. An individual may respond to a traumatic experience by fighting, fleeing or freezing.

Fight or flight responses are also known as acute stress responses. Dr. Levine reports that when an individual is threatened and their attempts to fight or flee seemingly fail, they may move into a freeze response, otherwise known as immobility. Also, if the energy that is created by this threatening situation is not discharged from the nervous system through fighting or fleeing, this can lead to more intense reactions of rage, helplessness or terror. When these feelings build up to a certain “level of activation that overwhelms the nervous system,” the immobility or freeze response may take over.2

Signs of activation may include rapid, shallow breathing, rapid heart rate, muscle tension, and racing thoughts. Individuals who suffered brain injuries accompanied by post traumatic stress described these feelings of overwhelm and heightened startle responses to sound, light, smell and/or motion. For example, if you are already in a state of high activation, a simple knock on the door or someone walking up behind you can cause a significant startle response.

Hypervigilance is like being in the state of “intense alertness at all times…”3 If an individual cannot identify the source of the threat, their internal response to what appears to be dangerous will continue and could possibly become amplified. This in turn may increase the intensity of the freeze response, and the person may become hypervigilant, perceiving or feeling danger in many situations where none exists.

An example of hypervigilance is when individuals with PTSD are triggered by a situation and perceive it as a threat. They identify the threat as coming from outside of themselves, when it is really an internal feeling of arousal. Even if the outside threat is identified and dealt with, the intensity of the internal arousal is so great that hypervigilant behaviors continue.

Recommended treatments for PTSD may include medication, psychological counseling, Eye Movement Desensitization and Reprocessing (EMDR), brain spotting, Somatic Experiencing, cognitive rehabilitation, and physical therapy.

 

 

CHAPTER 3

What Are the Signs and Symptoms of MTBI?

There is nothing mild about a mild traumatic brain injury.

Brain injuries cause a constellation or group of symptoms that affect overall functioning. Heightened sensitivity to the environment is a common symptom of MTBI.

The following list of symptoms are often associated with MTBI:

Physical symptoms may include:

• Headaches

• Heightened awareness of physical aches and pains

• Nausea, vomiting

• Loss of balance

• Vision problems, blurred vision

• Difficulty reading

• Dizziness

• Loss of sex drive

• Loss of energy

• Easily fatigued

• Sensitivity to light, sound, touch

• Sleep disturbance

• Decrease in senses of smell and taste

• Difficulty with choking and swallowing

Emotional symptoms may include:

• Depression

• Mood swings

• Fearfulness

• Apathy, lack of interest, lack of concern

• Low motivation

• Gullibility

• Feeling easily overloaded

• Anxiety, frustration

• Difficulty managing emotions

• Hypervigilance, exaggerated startle response

• Sense of helplessness

• Loss of sense of self, low self-esteem

• Nightmares

• Anger, sudden outbursts

• Mania, excessive excitement

Cognitive or thinking symptoms may include:

• Memory loss, forgetting appointments

• Short attention span, easily distracted

• Slowed thinking and longer response time

• Disorientation, confusion

• Brain fatigue, feeling as if in a fog

• Forgetfulness, misplacing things, forgetting previously learned skills

• Difficulty driving, getting lost easily

• Inability to recall words

• Spelling difficulty

• Impaired comprehension, difficulty following conversations

• Difficulty thinking in noisy environments

• Inability to organize thoughts

• Inability to multitask, perform two or three things at once

• Inability to start or finish tasks

• Inability to inhibit certain behaviors—excessive shopping, gambling

• Difficulty with abstract thinking

• Inability to focus on reading, watching TV, computer tasks

For a more detailed self-assessment, please refer to the Functional Symptom Questionnaire in Appendix B. This questionnaire is a valid and reliable tool used to recognize typical symptoms caused by mild traumatic brain injury. It is extremely valuable in measuring your progress over time. Take this assessment tool now and again every 3 to 6 months to track your healing progress and to pinpoint areas that need attention. Remember, the healing process is unique to everyone and the physical, emotional, cognitive and thinking abilities improve at different rates.

Research completed on the questionnaire reve...

Table of contents

• CHAPTER 1 Understanding Mild Traumatic
• CHAPTER 2 Post Traumatic Stress Disorder (PTSD)
• CHAPTER 3 What are the Signs and Symptoms of MTBI
• CHAPTER 4 Sports Related Concussions
• CHAPTER 5 The Important Role of Brain Filters
• CHAPTER 6 Baby, You Can Drive My Car
• CHAPTER 7 Helpful Tips for Family Members and Caregivers
• CHAPTER 8 New Attitudes and Latitudes
• CHAPTER 9 Medical Professionals Who Treat MTBI
• CHAPTER 10 Feed Your Body, Feed Your Brain
• CHAPTER 11 How to Improve Memory and Thinking Skills
• CHAPTER 12 What Is Biofeedback and Neurofeedback?
• CHAPTER 13 Redefining Recovery
• CHAPTER 14 What Are My Insurance and Legal Rights?
• CHAPTER 15 Hey, Do I Get My Old Life Back?
• CHAPTER 16 What’s the Good News?
• APPENDIX A: Medical Definition of MTBI
• APPENDIX B: Functional Symptom Questionnaire
• APPENDIX C: Medication Record
• APPENDIX D: Record of Health Care Professionals
• APPENDIX E: Helpful Questions for MTBI Survivors Family Members, and Caregivers
• Endnotes and References
• Resources
• About the Authors
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