Overview

Doctors say that traumatic brain injury (TBI) is a catastrophic condition, like burns, amputations, and spinal cord injuries. But TBI is different. It upsets life on multiple levels: physical, psychological, social, and even spiritual. TBI affects the roots of who we are — our ability to think, to communicate, and to connect with other people. For approximately 85 percent of people with TBI, those problems eventually resolve, but the remaining 15 percent have lasting difficulties. If you’re dealing with lingering symptoms of a TBI, or if you’re caring for a loved one, it can help to understand more about the wide range of challenges that TBI can pose.

A tap on the head, and anything can go wrong. Anything usually does go wrong. Light taps — mild TBI — can result in daily headaches, agitated moods, or periods of sleeplessness. Stronger jolts may cause you to forget your name, or make you think you’re someone different. When you tell someone you’re sad, you may unintentionally yell. A TBI can introduce a frustrating amount of confusion and uncertainty into your life

TBI by the Numbers

TBI has a way of affecting everything and everyone in your life. It can make family life tough, and it can seriously impede your ability to work. It can affect the relationships you have and make it harder to make new friends. In the United States, TBI is a quiet crisis. As many as 3.2 million Americans are living with a permanent disability resulting from a brain injury. The Centers for Disease Control and Prevention report that 1.7 million Americans sustain a traumatic brain injury each year. Fifty-two thousand people die from it. Almost a quarter-million people are hospitalized. Some of them go home only to discover they no longer have a sense of smell or taste, or that their sleeping habits have changed, or that they can’t seem to do their job anymore. 

If you look at the numbers a little differently, they’re even more upsetting.  . . . Fortunately, the majority of people who experience TBI will be able to return to a productive life once they receive appropriate treatment

A Closer Look at the Brain

Even though the numbers are large, it’s important to remember that TBI is a human injury. It has a way of showing us that life is fragile and precious. Because the brain is a complicated network of cells, each injury is as distinctive as the person it affects. Our skulls are only a quarter inch thick, although male skulls are a little thicker, which is lucky considering the fact that men tend to get TBI more often than women. The skull is both protective and restricting; it is the brain’s best defense but also its greatest risk in times of trauma.

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Types of TBI

Every brain injury is different, but there are two basic types: open head injuries and closed head injuries. Open head TBIs are a frightening mess. Whether the injury comes from a bullet, a baseball bat, or a high-speed collision, the result is always chaotic and distressing. The scalp bleeds a lot when it is cut, and when the skull is cracked or penetrated, pieces of it can get lodged in the brain. Because the brain is such a complicated tangle of tissue, it’s extremely tricky to remove objects lodged inside a brain. That’s why we put brain surgery right up there with rocket science in our everyday language.

In a closed head injury, nothing penetrates your skull, but a closed head injury can be just as complicated and vicious as an open head injury, sometimes more so. During a closed head injury, the brain may slam against one portion of the skull, then bounce against the opposite side of the wall. Doctors call that a “coup-contracoup” injury, where two injuries occur from a single blow. One of the most common types of closed head injury is a concussion — a strong blow from an external force. . . .

Treating and Living With TBI

  . . .  the survivor has to manage life with the effects of the TBI. Everyone reacts differently, depending in part on the severity of the injury, the quality of their care, and the strength of the social network around them. Many survivors feel pulled in different directions, feeling at times that the injury has made them less than what they were, and at other times that they can integrate TBI into their lives in a positive way. People with TBI are forced to confront a whole series of personal questions: How does my injury really affect me? Can I regain the things I’ve lost? What am I other than my brain? How can I make the most of my life?

Looking Ahead

Our understanding of TBI is changing in front of our eyes. As organizations such as the Brain Trauma Foundation continue to define the best practices in treating brain injury, medical care is slowly improving — at least for those patients able to gain access to early trauma care. The war in Iraq has already changed the way we treat TBI in America. Military surgeons who learned life-saving techniques like early cranioplasty are able to employ similar protocols in American trauma centers 

In the years to come, we may increasingly see brain trauma as a chronic but manageable condition similar to diabetes or cardio-pulmonary disease. That perspective might also help in reducing the negative stereotypes of TBI. For now, though, TBI survivors and those who care for them continue to face serious challenges in finding help and finding acceptance.

TBI is a much more manageable injury today than it has been in the past, but it remains a major health problem. As people with TBI continue to live longer and face the challenges of aging with TBI, it will be our duty to provide better education and long-term programs and services. We all have brains; let’s continue to use them — injured or not — to support TBI prevention, research, and treatment.