Types of Traumatic Brain Injury
Traumatic brain injuries come in different types:
Open – where the skull is punctured in some way. Think bullet wounds or other accidents that pierce the bony protection of the brain. Because the brain itself has no pain receptors, people sometimes don’t even realize they’ve had an open head injury.
Closed – where the skull is intact. Even though the skull has not been punctured, there can still be damage. The brain can strike against the rough inside of the skull when it’s jolted or shaken – such as in a car accident or a fall. This can cause bruising or bleeding, and sometimes a bleed can result in pressure that has deadly consequences, such as Natasha Richardson’s death following a fall while skiing. The brain can also experience “diffuse axonal injury” (DAI), which is when the axons (connectors in the brain that transmit signals) are twisted or sheared by strong shaking or rotation of the head. Extreme cases of DAI can occur in car accidents, and there are numerous accounts of race car drivers experiencing precisely this kind of injury in an accident on the track.
(Note: For a comprehensive discussion of types of brain injury, visit the Brain Injury Association of America’s page About Brain Injury – http://www.biausa.org/about-brain-injury.htm)
Brain Injury Severity
Brain injuries are ranked in severity by different means. The Glasgow Coma Scale (GCS) is generally used to determine the severity – mild, moderate, or severe. The GCS measures eye, verbal, and motor responses after injury, and grades injuries on a scale of 1 to 6.
In all cases, the “severity” ranking relates to the original injury, not the outcome on down the line. And that’s where a lot of disconnects happen. People assume that a mild TBI is going to resolve quickly and not have much of an impact. As it turns out, the initial severity of the injury isn’t always a reliable indicator of long-term results.
A TBI qualifies as Severe if the GCS is 8 or less. Closed head injuries can produce a severe TBI as well as crushing blows to the head, and heroic measures are often necessary to treat these injuries.
A Moderate TBI has a GCS of 9-12. This can involve a loss of consciousness from several minutes to hours, lasting confusion, and a variety of physical, behavioral, and cognitive impairments. These impairments can last for months, or become permanent.
A TBI is considered Mild if GCS is 13 or above. Experts used to believe that to qualify as a TBI, there had to be loss of consciousness, but now we know that’s not true. A person can be dazed or confused — “dinged” — and still have a mild TBI. But there needs to be some alteration of consciousness, in order to qualify as a traumatic brain injury.
Where Does Concussion Fit In?
A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.
Health care professionals may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, their effects can be serious.
Concussion can cause the following types of issues (from Concussion Signs and Symptoms from the CDC):
Difficulty thinking clearly
Feeling slowed down
Difficulty remembering new information
Fuzzy or blurry vision
Nausea or vomiting (early on)
Sensitivity to noise or light
Feeling tired, having no energy
Nervousness or anxiety
Sleeping more than usual
Sleep less than usual
Trouble falling asleep
Most people with a concussion recover quickly and fully. But for some people, symptoms can last for days, weeks, or longer. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one and may find that it takes longer to recover if they have another concussion.1
For the purposes of this book, I’ll discuss mild TBI / mTBI / concussion. I’ll be using the terms interchangeably, because concussion is a mild traumatic brain injury. Also, people are often more comfortable with the term “concussion” versus “brain injury” and I want to get the points across as smoothly as possible.
Stats collection around long-term mTBI / concussion outcomes is still in its infancy. Actually considering concussion a “thing” that’s worth noting and treating is an oddly recent development. After all, it’s just a bump on the head, right? What could possibly go wrong?
Turns out, a lot. What experts now know, is that concussion symptoms don’t always resolve on their own. About 85% of folks who get clunked on the head or find themselves shake enough to be dizzy, confused, and disoriented, see their symptoms resolve with rest and time.
But around 15% of folks who have an mTBI don’t. Post-concussion syndrome – PCS – is all too common, disrupting the lives of folks who may have been cleared by their doctors to return to work, play, or school. For some of us (myself included) the after-effects of a mild TBI linger long past the time when they “should” be problematic. And if you’ve had more than one … or two or three… or nine… concussions (again, myself included), the cumulative effects can dramatically increase the time needed to recover from later injuries.
Why some people get better quickly and others don’t, is still under investigation. It’s probably a combination of many factors – physical, psychological, emotional, cognitive, spiritual, and so forth. And the combination of factors varies from person to person. How can it not? Each individual is different, each brain is different, each brain injury is different. Bottom line is, studies of long-term outcomes of mild traumatic brain injury often reveal ongoing challenges with the symptoms listed above (and many others), lasting frustration, and significantly lower quality of life, than is found in the non-TBI-injured population.
I can’t speak to anyone else’s experience, but my own has been one of frustration, confusion, and varying degrees of challenge and struggle, for most of my life. I started getting clunked in the head when I was a young kid, and over the course of 40+ years, I’ve had at least 9 consciousness-altering blows to the head. And those are just the ones I remember. The net result has been ten years of working my way back from the brink of personal disaster, after my last mild TBI in 2004. After falling down a flight of stairs and “just bumping my head a few times,” my recovery has been long and labor-intensive, with many fits and starts, plateaus and highs and lows along the way. It’s taken much longer than I ever expected it to, and I’m not done yet.