Traumatic brain injury (TBI) is a consequence of head injury in which a blow to the head results in damage to the brain due to stretch forces. TBI is the leading cause of death in North America for people below 45 years. The UAE has a comparably young population which makes TBI a very common and serious disease.
Many survivors live with significant disabilities, resulting in major socioeconomic burden as well. In 2000, the economic impact of TBI in the US was estimated to be $9.2 billion in lifetime medical costs and $51.2 billion in productivity losses.
Symptoms are often mild and hard to detect. It needs a trained specialist to diagnose and most importantly treat the condition. If treated adequately TBI has very good prognosis.
• Motor vehicle accidents
• Sport Injuries
• Military combat
Brain injury is a frequently misunderstood injury. Numerous invisible residual complaints are labelled as ‘psychological’ and are not well understood. A major complaint of brain injury is fatigue and overstimulation.
We live in a society that is very fast, with lots of stimuli to be processed at a high speed. When someone experiences overstimulation it is harder for them to process stimuli, sounds are perceived as louder and light as brighter. Ambient noise is perceived as irritating, normal sunlight is harder to endure and one gets easily overwhelmed by crowds and lots of movements in their surrounding.
Due to the quick onset of fatigue it can be difficult to go to birthday parties, to go grocery shopping and to participate in social activities. The fatigue causes disturbances in thinking processes and limits the entire functioning. After reading a text, one can already be so tired that one must rest for a period to recover from the mental effort. In particular, the reading of displays (smartphone, computer, tablet) can be highly discomforting to patients who experience brain injury. In addition to the fatigue and overstimulation one notices to have more trouble remembering and concentrating. Memory and concentration becomes harder when fatigue increases.
When one experiences symptoms but keeps on functioning beyond their own capacity, people can develop secondary complaints. Overstimulation of the brain cannot be compared to overstimulation of the body. The body has, for example, pain signals as a warning signal. The brains gives totally different warning signals like overstimulation by light, noise or crowds, having difficulty processing stimuli, more problems with thinking (concentration and memory) and fatigue. Many people do not recognize these alarm signals, or are not adequately dealing with them and are likely to push through their complaints. The functioning outside their own capacity will further increase the complaints and ultimately exhaustion will occur. Not being able to function in the way as is desired by the patient, the patient can also develop emotional reactions which are often characterized by feelings of powerlessness and frustration. Misunderstood injury thus consists of fatigue, rapidly becoming overstimulated, experiencing a decline in performance and emotional responses.
Misdiagnosing Traumatic Brain Injuries
Brain injury patients are often misdiagnosed or not diagnosed at all. As most professionals are not specialized in diagnosing TBI, the patients hear often “there is nothing wrong”, even if they are suffering from symptoms. Or their symptoms are evaluated as “only psychological”. Not treating TBI adequately will worsen symptoms. This described process is resulting in a major socioeconomic burden (US: $9.2 billion in lifetime medical costs and $51.2 billion in productivity losses).
Neuropsychological assessment is needed to get a good impression of the ‘invisible’ residual symptoms and how to cope with them. The neuropsychological examination is used to assess the extent of (mental) energy loss, fatigue, cognitive – / emotional changes and the impact of pain sensations.
At the start of the counseling / therapy an extended interview (anamnesis) with the patient is performed. A broad range of issues are discussed, such as what happened, what are the symptoms, has it been a breaking point in the health perception, which conditions worsen symptoms or affect it. Furthermore, we look at (medical) history, education, type of work, hobbies, social life and how complaints are limiting it. A neuropsychological examination is carried out and on the basis of the results an appropriate treatment plan is suggested. If there is not enough information available, the expertise of many other disciplines can be consulted (neurologists, internists, psychiatrists, etc.).
With this information and understanding, it is possible to establish an adequate treatment involving persons with brain injuries to understand the actual limitations and how to adapt to it.
It is important to know that patients themselves often do not have a good understanding of the limitation of their symptoms and complaints, and the patient is driven to perform at pre-morbid level. Recovering from brain damage is a complex process that a patient has to go through with the help of a professional. It is necessary that one acquires knowledge in the presentation of symptoms and also get advice how to deal with it. A brain injury is essentially a neuropsychological phenomenon.
In the next phase, the affected cognitive functions are reactivated and a medical fitness program is used to improve the energy level and reduce pain levels.
Often, the treatment consists of guidance of a clinical neuropsychologist which will provide insight into the complaints and why these occur. Adjustments are taught and exercise / rest schedules are discussed. During the same period, patients will follow medical fitness programs and a cognitrain program. This followed by rest periods. If pain symptoms stay apparent, a neurologist or pain doctor (anaesthesist) is considered. Often the pain sensations consist of pain in the neck and shoulders which also develops into headaches. The progress of each patient is discussed daily and programs are adapted to this feedback. The goal is to become a well- balanced individual again.
To achieve this, the main focus is on personal attention. Our view is that every person is like a fingerprint, completely unique. There is no standard protocol used to provide treatment, as each person has their own way of reacting to all aspects relating to brain injury.
The program usually has a duration of three months and the maximum group size is 12 people. The main goal of a small group is to build a personal relationship with each participant in the program.
Often there is a misconception that the complaints of (mild) brain injury will resolve after some time. This natural recovery can only occur when conditions are optimal. One needs to perform the right activities during the recovery period in order to optimize the recovery. It should be noted that even with an optimal recovery period there may be residual complaints!