Coping with Concussion and Mild Traumatic Brain Injury: A Guide to Living with the Challenges Associated with Post Concussion Syndrome a nd Brain Trauma - Softcover

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Diane Roberts Stoler, Ed.D., is a neuropsychologist and a practicing board-certified health and sports psychologist. She is a sought-after international speaker and lives in Massachusetts. Barbara Albers Hill is the author or coauthor of six previous books.

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PART 1
CONCUSSION/MILD TRAUMATIC BRAIN INJURY: AN OVERVIEW

INTRODUCTION

Lynn, a 26-year-old dental hygienist, was driving to work one morning when her car was rear-ended at a red light. The fifteen-mile-per-hour impact caused no damage to either vehicle, and the seat belt kept Lynn’s body in place. Only her head moved, quickly snapping forward and back. Lynn felt momentarily disoriented, but the feeling passed, and she went on her way without giving the matter much thought.

By lunchtime, Lynn had a severe headache. By evening, she also felt nauseated and extremely tired. At first, Lynn suspected a virus. But as the days passed, her headaches escalated and her fatigue increased. She also began to have problems sleeping, concentrating, expressing herself, and making decisions. To others, Lynn seemed uncharacteristically short-tempered and forgetful, and this led the puzzled young woman to see her physician. The eventual diagnosis? A concussion, also referred to as a mild traumatic brain injury(mTBI), a result of the now months-ago incident at the traffic light.

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LYNN’S STORY is not at all unusual. In fact, each year millions of people worldwide are seen in hospitals, suffering from concussions. Many more visit doctors’ offices and walk-in clinics, or may not even report the event, which is why concussion has come to be called “the Silent Epidemic.” The principal causes of TBI are falls, motor vehicle accidents, blows, assaults, sports injuries, blast injuries, and violent movements such as whiplash. Like Lynn, a significant number of those who incur a concussion suffer debilitating aftereffects—post concussion syndrome (PCS)—for months or years afterward despite what is usually a perfectly normal outward appearance. Part 1 of this book will help you better understand this phenomenon by providing a detailed look at the brain and brain function as well as the causes, significance, and evaluation of concussion.

CHAPTER 1
WHAT IS A CONCUSSION/MILD TRAUMATIC BRAIN INJURY?
 

In the course of everyday life, you have little reason to think about the workings of your brain, even with television ads and magazine articles presenting the relationships between eating, sleeping, and brain health. However, if you have suffered a concussion, also calledmild traumatic brain injury (mTBI), or know someone who has, the subject takes on sudden importance. As with almost any injury, knowledge about the affected organ—the brain, in this case—will help you and your family to better understand your symptoms and maintain a sense of control over the recovery process.

It is likely that you’ve attempted an Internet search for answers to your questions about your injury, symptoms, and treatment, only to feel overwhelmed by the quantity of information available. If so, you have probably wondered where you can find information that is accurate and leads to the answers you need. This book is intended to provide just that: the most recent research, verified by experts and presented in a concise, easy-to-use format.

A LOOK AT THE BRAIN

The human brain weighs about three pounds and is the most complex of organs—an intricate network of some 200 billion nerve cells and a trillion supporting cells. It is nourished by a vast network of blood vessels that supply the oxygen and glucose needed to fuel the brain. Your diet, quality of sleep, degree of stress, hormonal factors, and general quality of life directly affect your brain function, impacting all bodily activity from heart rate and movement to emotion and learning. The brain’s complex components include veins, arteries, capillaries, threadlike nerve fibers, connective networks, neurotransmitters, neuromodulators, and hormones, which are involuntarily reactive to both internal and external events. Only a small portion of the brain operates in a voluntary, responsive manner; thus, brain function determines a person’s abilities, personality, and state of health, all the while creating a capacity for thinking, feeling, imagining, and planning.

While the human skull is hard and bony, the brain within has been likened to custard in a bowl—soft, pliable, and slippery (Figure 1.1). Directly beneath the skull are three thin membranes called meninges that hold pockets of air and about a coffee-cupful of cerebrospinal fluid (CSF), which cushion the brain and its circulatory network.

Figure 1.1. A cross-section of the brain.

This network, composed of arteries and veins (Figure 1.2), nourishes the brain, with each heartbeat providing oxygen and important nutrients as fuel. The countless small branches off the arteries and veins are called capillaries (Figure 1.3).

Figure 1.2. The brain and its arteries.

Figure 1.3. The brain and its veins and capillaries.

Directly beneath the meninges is the brain’s wrinkled gray and white matter, made up of four distinct areas of brain functioning. These include the brain stem, midbrain, limbic system, and cerebral cortex. Of the four areas, the frontal area of the cerebral cortex is the most voluntary (responsive) to internal and external events.

The cerebral cortex, sometimes called the cerebrum, is the top layer of the brain and is its largest and most advanced part. It controls problem-solving, planning, and judgment, as well as movement and sensory activity. This area is divided into two halves, or hemispheres—the left and the right. One curious fact about brain function is that the right hemisphere, or the right side of the brain, controls the left side of the body, while the left hemisphere controls the right side of the body. In addition, the right hemisphere governs aspects of creativity, intuition, and nonverbal communication—gestures, facial expressions, and the like—and is referred to as the nonlinear mind. The left hemisphere, called the linear mind, is responsible for logical thinking, mathematics, and verbal and written expression.

Both of the hemispheres are subdivided into parts called lobes, each of which controls specific body functions (Figure 1.4). The frontal lobe, located closest to the forehead, controls emotions and behaviors, social and motor skills, abstract thinking, reasoning, planning, judgment, and memory. Broca’s area, situated at the base of the frontal lobe, helps to govern speech. This area of the brain, especially the prefrontal area, is the area that governs voluntary responsiveness. It is similar to a symphony conductor, instructing areas of the brain that are voluntary and reactive.

Figure 1.4. A look at the cerebrum.

The parietal lobe is located halfway between the front and back of the skull. This area is responsible for sensory and spatial awareness, giving feedback from and understanding of eye, hand, and arm movements during complex operations such as reading, writing, and numerical calculations. At the center of the parietal lobe is the angular gyrus, a fold in the surface of the brain where visual messages, such as words that are read, are matched with the sounds of spoken words. At the back of the head, behind the parietal lobe, is the occipital lobe, which controls vision and recognition.

The temporal lobe is located beneath the frontal and parietal lobes and has an influence on emotions. The temporal lobe plays a part in smelling, tasting, remembering information, noticing things, comprehending music, and categorizing objects. It also plays a role in aggressiveness and sexual behavior. At the back of the left temporal lobe is Wernicke’s area, which is responsible for hearing and interpreting language.

Beneath the cerebrum are a number of internal brain structures (Figure 1.5). The thalamus acts as a nerve-impulse relay station for information...