Divide and Conquer – 5 Reasons changing the #concussion term makes sense

Yesterday, I got a bit of flack for suggesting that the term “concussion” should be used for the impact which causes the brain disruption, while “brain injury” should be used for the result of that impact. People just didn’t like that idea very much, and they particularly objected to my “awful cartoon” saying “Concussion is the event, Brain Injury is the result”.

I tried to engage in a discussion about exactly why that image is so terrible, but I never got a response. Then someone else chimed in that “concussion isn’t an event, it’s a process” and others agreed. Yep, it’s true. Concussion, as we currently understand and discuss it, is absolutely a process. The thing is, I think we’re mistaken in lumping everything together.

So, I got on with my day and decided to let it go. It’s a process. I know that as well as the next person. It’s not worth fighting over.

As I was driving around last evening, picking up meds and other supplies from the pharmacy, it occurred to me that I shouldn’t just give up on my idea. There are in fact a number of benefits to using the term “Concussive Brain Injury” or “CBI”, rather than “concussion” alone. It’s even more useful than “mild traumatic brain injury”, which is technically what a concussion is.

Here’s my short list of benefits from the switch to talking about CBI – and the problems that could solve.

1. “Concussive Brain Injury” or “CBI” calls the injury what it is — a brain injury produced by a concussive impact. It combines elements from both concussion and brain injury concepts. It describes a consciousness-altering impact which may or may not involve loss of consciousness, and may or may not have lasting consequences, but needs to be watched. And it includes the brain in the mix. It causes you to sit up and take notice – and not take it lightly, because it is, after all, a brain injury. Most importantly to me, CBI literally is what it says it is.
2. CBI gets the word “mild” out of the discussion. Yes, what we call a “concussion” is in fact a mild traumatic brain injury (mTBI), but very few everyday people understand what “mild” means. They don’t care about the Glasgow Coma Scale or Rancho or the other criteria used. The problem is, “mild” gets translated wrong — and it works against healthcare providers and survivors alike.Those who have experienced mild TBI know there is nothing mild about it. And yet, “mild” is right smack dab in the description of our injury… for all the world to latch onto as proof that we’re faking it or taking advantage of the situation, to slack off. “Mild” makes it tempting to take your injury lightly and not fully rest and recover. And that’s never a good thing. As an added bonus, removing “mild” from the definition can eliminate that sports reporting blight: references to “mild” concussion. That misuse is so wrong, and yet so common. Wouldn’t it be fantastic, to have a term for a concussive brain injury that doesn’t include the misleading designation “mild”?
3. CBI gives us a separate designation from TBI. Yes, yes, yes, I know it is a TBI, but that term has been used so widely in connection with the military (and they’ve more than earned the right to do just that), and it so often goes in hand with references to PTSD, that there’s a certain charged association that goes along with it. TBI is one of the invisible wounds of war in our collective consciousness, with all the connotations that accompany it. And that can be a pretty heavy thing to lay on someone who fell down some stairs. Concussive brain injuries within the civilian population — from sports, accidents, assaults, falls, etc. — have a different nature than blast injuries and wounds of war. And having a separate term that’s specific to post-concussive situations gives people something more tailored to their conceptions, which they can use as a point of reference. For that matter, call it “Civilian Brain Injury” for good measure. And to the point in #2 above, CBI removes mild TBI from the status of a “mini-me”, less serious version of real TBI.
4. CBI is an acronym, and that’s a plus. People like acronyms. Especially when they’re specialized. CBI is short, it’s sweet, and it’s a term people can use, when they want to look good to others — which is often. No, I’m not being cynical or flippant. I once drove widespread adoption of a new technology solution at a global enterprise, overcoming widespread push-back from a lot of very temperamental colleagues simply by renaming it with an acronym. CBI could work, too.
5. The name “CBI” might just eliminate “concussion-like symptoms” from our conversations about concussive brain injury. That expression makes me almost as crazy as “mild concussion”. And it gets talked about as much. What are people going to say? CBI-like symptoms? It doesn’t work as well as “concussion-like”, so people just might stop saying that type of nonsense.

Those are my top 5 reasons why I favor the term CBI over  mild TBI.

To me, it just makes sense.