As said in our introduction, a person experiencing mild traumatic brain injury (MTBI) may appear normal. Most people you have suffered MTBI can still walk, talk and function. However, some functions will remain compromised. Even in patients who do not lose consciousness, a diffuse injury can result in difficulty concentrating, focusing, multi-tasking, and those persons may be easily distracted. Here is why: in a normal human brain, we have the ability do more than one thing at a time. For example, most uninjured people can read something and also hear music at the same time, without major disruption.
For those with MTBI, this process may not be possible because a distraction tends to “short circuit” everything. They tend only to be able to focus on the task and can become easily disrupted by other stimulation. In computer terms, it’s like the person has less bandwidth and can’t process more than one function, causing the processing to shut down.
Because doctors often can’t or don’t recognize the signs of a brain injury, the injury becomes frustrating to those around the person with the injury. He or she may become slow or unable to participate in conversations.
When the brain is forced against the skull, the common term used by most is “concussion” which is a form of mild traumatic brain injury. Concussions can occur even if a person does not lose consciousness. In more severe trauma, injuries may also include loss of consciousness, diffuse axonal injuries, edema, swelling, and lacerations.
Concussions are graded as follows: 1. transient confusion; no loss of consciousness and symptoms clear within 15 minutes typically; 2. transient confusion, no loss of consciousness, altered mental status or symptoms typically last longer than 15 minutes; 3. Loss of consciousness, either short or long.
Medical professionals also rely on the “Glasgow Coma Scale (GCS)” in making a diagnosis of MTBI. The GCS is a numerical ranking system from 3-15. The scale measures three criteria including whether a person’s eyes are open, best verbal response, and best motor response. The lower the score, generally, the more severe the injury to the brain. In a very severe injury, a person may never open her eyes, may not respond verbally and may exhibit little or no motor response.
You may have seen trainers or doctors asking questions of football players after they suffered an on the field injury. Most likely they are measuring the player’s level of awareness to check for the possibility of concussion or brain injury.
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The classic rear-end collision(“rear-ender”) in car wrecks is a major cause of mild traumatic brain injuries (MTBI). Studies have shown that people can suffer mild traumatic brain injuries even at low or minimal speeds. Rear-end impacts are usually more violent than front or side impacts to occupants of the automobile, as described below.
To help understand why rear-impacts are more violent, we must look to how a person’s head moves during a rear-end crash. First, the seat back usually hits a person’s spine, causing it to flatten against the seat. After the spine and car seat are thrown forward, the person’s head will roll back and hit the headrest. After hitting the headrest, her head accelerates forward with great speed and momentum. In other words, a person’s head will accelerate with greater speed than the rest of her body and torso. As her torso moves forward, it is then caught and restrained by the seat-belt, causing the head then to decelerate abruptly. What happens to a person’s brain inside the skull is what can cause injury to it. In order to understand what happens to the brain, it may be useful to imagine the brain as an egg.
An egg has a protective covering (shell) and a clear liquid surrounding the inner yolk. The shell and the liquid protect the inner yolk. However, if the egg was thrown forward by an object traveling at 20 miles per hour and then suddenly decelerates from 20 miles per hour to zero miles per hour in a split second, the yolk continues to travel inside the shell and will strike the inside of the egg shell. It is this striking of the yolk against the hard shell that can cause damage to the yolk.
The human skull is no different than an egg for the purposes of this illustration. The human brain is protected by the skull and the fluid that surrounds the brain. The fluid provides a cushion to the brain when a person’s head is jarred. However, it was not designed to be able to absorb the great forces that can act on it in a rear-end collision. The brain can move forward inside the skull, striking the inside of the skull and the indentations on the skull wall. The illustration below shows how a human brain can move within the skull and strike the skull walls.
This force on the brain is called a shearing force and it can have profound effects on the the function of the brain, which we will explore in the next posts.
This blog is devoted to those who seek information about injuries, especially those affecting the brain and central nervous system. Brain injuries are often misunderstood by the public. Often, those who have suffered brain injuries may appear normal on the outside but can have their lives severely disrupted because the internal filing systems of the brain have been altered from trauma. These injuries can cause memory problems, anxiety, mood disorders, focus problems and a general inability to cope in modern day life. Those affected by brain injuries are often told they are lucky to have survived their accident and that they should just get on with their lives. What those people fail to understand is that sometimes that is not possible.
Through discussion and sharing, we hope to bring a greater level of understanding and empathy for all those affected by brain injury including those who love and care for the victims of brain injury.