Variability in brain injury recovery: Improving your odds

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Written for the Brain Injury Association of America (BIAA)

Rose is a board-certified obstetrician-gynecologist in a small but busy independent practice. Funny, smart, and dedicated, this mother of two was out walking her dog when a car jumped a curb and struck her on the sidewalk. The impact threw her to the ground; she was knocked unconscious and remained nonresponsive for nearly 15 minutes. The medical advice she received included complete brain rest. Rose strictly adhered to her doctors’ orders. She rested at home, rescheduled social situations, avoided computer work, and allowed her brain time to heal. Four months later, Rose was back in the birthing room delivering babies without any limitation on her professional capabilities.

Evelyn is a beloved newscaster and television personality. For decades she anchored a news desk and produced countless insightful and informative special features she delivered on-air. She was on her way into work one winter morning when she lost her footing on an icy driveway and struck her head. Dazed, she picked herself up and continued her day. Under the bright lights and amidst the chaos of a busy newsroom, Evelyn delivered the news in a fog. She continued to do so, day after day, resolute that she was not going to let her brain injury defeat her. Eventually, though, Evelyn’s brain injury was too great a foe, ending her storied career.

Rose and Evelyn are smart, capable, successful women with vastly different long-term outcomes from their trauma-induced brain injuries. Why? No one knows for certain. But there are steps people with traumatic brain injury (TBI) can take to increase their odds of a better and more complete recovery.

Facts About the Brain

Brain function requires billions of its individual cells, called “neurons,” to communicate with each other. In addition to its nucleus or cellular core, each neuron has extensions that reach out to other neurons to share “neurotransmitters,” the chemicals that carry the information vital for brain function. These extensions are “axons,” which send neurotransmitters away from the neuron, and “dendrites,” which bring neurotransmitters into the neuron. When a person is concussed due to trauma, such as from a car accident or a blow to the head, brain movement inside the skull causes stretching and tearing of axons and dendrites, disrupting the flow of chemicals to other neurons. When this happens, the brain is in crisis. For survival, it must immediately begin to heal itself.

Fortunately, our brains are very good at healing. Scientists call this “neuroplasticity” – our brains’ capacity to build new pathways for chemical communication by growing new neurons and axons. This building process takes energy. Even in its normal state, the human brain consumes 20% of the body’s energy output. Now add to that the energy needed for the brain to grow new cells and teach itself new communication pathways. Is it any wonder, then, that so many people living with TBI experience fatigue, exhaustion, inability to concentrate, and more?

Rest Following Brain Injury

Giving the brain the best opportunity to heal itself requires brain rest. Confusingly, not all brain rest is created equal. Not long ago, doctors advised people with brain injury to remain in dark rooms without stimulus for days on end. Today, experts have revised this recommendation, instead, dictating a limit on activity that would be “metabolically demanding.” Common sense dictates avoiding activities such as large social gatherings, lots of noise or visual stimuli, and focused concentration. When your brain is already facing an “energy crisis,” the last thing you want to do is subject it to complex activities other than the critical work of healing itself.

Does this mean that early brain rest following concussion always prevents a prolonged – or incomplete – brain injury recovery? Unfortunately, it’s not that simple. But brain scientists agree that to give one’s brain the best chance to heal itself, it needs rest – which is often very hard, if not impossible, for many living with brain injury to accommodate. Rarely do those with brain injury live lives that allow them to readily step back and allow their brain the necessary time to heal. Job pressures, financial responsibilities, and family needs are real-life barriers to “taking time off” for optimal brain injury recovery. Emotional factors are at play, too, as people living with brain injury often describe feelings such as guilt, shame, weakness, and humiliation at their inability to “get back to normal” quickly. The fact that many look and even sound perfectly normal to others increases these emotions and may lead to isolation and despair.

Supporting Others With Brain Injury

It is very important that those around the person who has experienced brain injury be educated in the seriousness of the injury and what recovery entails so they can provide support. This requires broadening public knowledge about brain injury and what others can do to help – supporting (if not insisting!) that the person with the brain injury take the time and care needed to maximize their recovery. The public should understand and recognize common conditions resulting from traumatic brain injury, such as frequent headaches, fatigue, inability to focus, irritability, and cognitive delay reflecting the brain’s difficulty processing information. Understanding that these symptoms reflect the effects of brain injury can empower those around the person to intervene, to insist that the person stop what they are doing, take a rest or seek further medical intervention. They should understand, too, that even as someone’s recovery is underway, the recovery is often neither linear nor seamless. Many recoveries come in fits and starts. A brain-injured person may be “fine” for a few hours and then suddenly crash, exhibiting an onset of confusion, irritability, and inability to focus or find the right words in conversation. And too often, people with brain injury can be their own worst enemy in recovery, seeking to do too much too fast and holding themselves in disregard or contempt when they have a setback. This is where support from others can be especially beneficial.

Rose, the obstetrician, and Evelyn, the newscaster, had quite different courses following very similar brain injuries. While the course of any particular brain injury is always unpredictable – hence the phrase, “If you’ve seen one brain injury, you’ve seen one brain injury” – Rose and Evelyn’s stories illuminate the important truth of brain injury recovery: it requires rest. If you’ve experienced a brain injury, give your brain the time it needs to heal. And if a friend or family member has sustained a brain injury, help them – make them if need be – take that time. It can make all the difference.

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