MILD BRAIN INJURY: IMPLICATIONS FOR INDEPENDENCE

This article from therapist Luann Jacobs is the most concise and comprehensive description of Mild Traumatic Brain Injury that I have read, as a MTBI survivor. MTBI can be caused by strokes, wounds to the brain, tumors, diseases, concussions (whether from explosions, contact sports such as hockey and football, auto accidents, or falls), and anything which compromises the circulatory or neurological functions of the brain. 

At the onset of my brain injury due to a stroke, now 14 years ago, I had to learn to walk again, read again, use the telephone again, and do almost all the daily and other tasks of life too.

It is impossible to imagine, no matter how intelligent and creative one might be, just how overwhelming this challenge is. It is impossible to know the constant fatigue, exhaustion, frustration, and pain which must be endured daily still. It is impossible to know of all the obstacles thrown into the path of recovery, the meanness, the isolation and marginalization which far too many impose.

This article by Luann Jacobs is one of the best descriptions of trying to live a life with brain injury that I have read. Its only short coming is not conveying the mean adversity faced by most survivors and the sheer trauma of having a life which no longer fits together or works as it once did.

“MILD BRAIN INJURY: IMPLICATIONS FOR INDEPENDENCE”

Luann Jacobs, MA-CCC/SLP RMT

Mild brain injury is a real misnomer, as it conveys the idea that nothing much is a problem when quite the opposite is more often true. It is called “mild” because, in fact, the mildly brain injured can walk, talk, eat and dress independently, often times drive a car, shop cook, go to school, or even work.

What the term fails to account for is the inherent limits of how often, for how long (endurance), and the all-important, how consistently (e.g., every day, once a week) these activities can be performed. Even more elusive is the concept of how many of these daily activities can be done sequentially in a given day as is normal in the lives of people who are not brain injured.

The mildly brain injured cannot put back-to-back the normal activities of everyday living (dressing, eating, shopping, cooking), work (engaging in gainful employment by meeting deadlines, delivering a product for money, being present a requisite number of hours) and social life (eating with family or friends, participating in parties or holidays, going to movies, etc.). They cannot do all of this on any one day or in any one week. Many mildly brain injured have poorer hygiene than they did prior to injury because if they bathe and wash their hair, that may be all they can accomplish in a given day. So they often must trade off activities. Bathe on alternate days. Cook two days a week. If they engage in work, then someone else must be performing many or all of the other activities.

The mildly brain injured who live alone, but attend family and social functions, are often seen either as lazy (they don’t help out much before in the planning or after in the clean up), or if they do pull it together when in the company of others, they pay for it with severe fatigue, crashing for hours or days afterward. They fatigue they feel defies description, going far beyond and far deeper than anything a non-brain-injured person would consider profound exhaustion.

It is extremely common for the mildly brain injured to become overwhelmed in the attempt to organize a normal or routine life. Normal life is filled with unanticipated changes to the schedule. A routine life is never just so; it is filled with the need to do simultaneous functions, to operate on automatic while engaging the conscious mind in decision-making, planning ahead, responding to changes, and improvising with more than one person’s schedule in mind. The mildly brain injured go into meltdown when faced with normal and routine living. In fact, even when they can engage in a seemingly normal pace, it is frequently because they have not judged carefully enough how much energy they have in store, and the mildly brain injured with overload, crash and burn.

I have worked with clients with mild brain injury for many years. One of the most valuable lessons I have learned is simply to say “it’s time to take a break now,” when a client has been doing well, but starts for no particular reason to express meltdown. Meltdown is frequently not recognized until too late, not only by others, but also by the person experiencing it. Meltdown can be recognized by a shift or change in the outward behavior of the person’s seemingly normal responses. One client’s speech rate increases as she starts not to process those who are speaking to her. Another client breaks into tears for no apparent reason and can’t recall how to do simple mental functions he may have been doing (or organizing) just a moment before. Meltdowns frequently trigger the very real feelings of isolation and loss that come with brain injury that can, in turn, trigger depression.

Mildly brain injured clients who are fortunate enough to live with family or friends can be helped a great deal by timely cueing to conserve their energy. If many of the daily independence functions. which are serious energy eaters for the mildly brain injured, can be handled by others, then they can use their energy to really expand their social and work worlds. When energy does not have to be used just to stay afloat, then it can be used for other creative and productive work. However, in the mildly brain injured, the supply of energy is extremely reduced from whatever the individual was capable of prior to the injury.

Mild brain injury often is accompanied by pain. Frequently the pain and fatigue go hand in hand. But often they do not, further confounding the understanding of what system is working here—what is cause and what is effect? The pain is often felt or expressed as flu-like. Muscle and joint aches. Frequently the pain wanders between two or three loci (head, neck and lower back, for instance). Weather and pressure systems also seem to interact and cause difficulty. Pain and fatigue are often the baseline of what is felt as normal to the mildly brain injured. This is where the day starts—awakening with flu-like symptoms, and having the day go down from there with the press of many activities to do and so little time and energy to do them.

Additionally, rehabilitation and cognitive work help the mildly brain injured to stay focused on what they can do and how to organize and apportion their time and efforts. Psychological therapy helps them deal with the emotional devastation of losing the self they were prior to brain injury. Neurological help in the form of good diagnostic work-ups and supportive treatments can help to control the multiple physical symptoms: blood pressure problems, fatigue, pain, and sleep deprivation, to name a few common sequelae of brain injury. Alternative therapies such a chiropractic, acupuncture, homeopathy, Reiki, meditation, and yoga can be very valuable in treating symptoms and providing self-help and self-healing tools.

……Luann Jacobs

Note that the author has given her permission to share this article attributed to her as a means to raising awareness and understanding of this invisible crippler of people who are the walking wounded.