Traumatic Brain Injury & Cognitive Impairments

The recent shooting of Congresswoman Gabrielle Giffords has raised questions for many about the nature and prognosis of traumatic brain injury.  According to the National Institute of Neurological Disorders and Stroke (National Institute of Healths), a traumatic brain injury (TBI) is “a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain [that] can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue [with] [s]ymptoms [that] can be mild, moderate, or severe, depending on the extent of the damage to the brain.” A person with a mild form of TBI may briefly lose consciousness but also may be able to maintain consciousness throughout the experience, and could likely experience symptoms such as “headaches, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.” As the TBI increases to moderate or severe, the same symptoms may be seen, however, these individuals may additionally experience a persistent and/or worsening headache, chronic nausea or vomiting, seizures/convulsions, difficulty of inability to wake from sleep, pupil dilation in one or both eyes, speech slurring, extremity weakness or numbness, lack of coordination, increased confusion, restlessness, and agitation.

The above possible symptoms do well to highlight how varied the experience of individuals with TBI can be, and recovery can be the same way. According the NINDS(NIH) "[a]pproximately half of severely head-injured patients will need surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue).” The disability resulting from a TBI and the hope for recovery all depends on the severity, location of the injury, and the age and general health of the individual. Common resulting disabilities include: “problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).” However, the results can be as severe as placing the individual in a stupor, coma, vegetative state, or even a persistent vegetative state (PVS).

Though many aspects of life can be affected by TBI, one aspect that is particularly relevant to the academic setting is the effects on cognition, a difficulty that is highly common for people with TBI. Cognition (simply defined as “thinking skills”) includes “an awareness of one's surroundings, attention to tasks, memory, reasoning, problem solving, and executive functioning (e.g., goal setting, planning, initiating, self-awareness, self-monitoring and evaluation).” Issues with cognitive function vary greatly, similar to recovery, by severity and the location of the injury. Problems include:

  • Trouble focusing in an environment with distracting stimuli, such as holding a conversation while in a noisy, or multi-tasking.
  • Decrease in the processing time (“taking in”) of new information. This means that longer messages or amounts of information must usually be broken down or “chunked” into smaller pieces. Repetition and recitation of new information and messages is often necessary to ensure that crucial information is properly processed, and other may have to slow their speech down in conversation with the individual.
  • Short-term and recent memories may also suffer, causing learning new materials to be rather difficult. However, long-term memory for events and information that was stored prior to the injury is generally unaffected (such as the names and faces of friends and family).
  • Executive functioning problems. Individuals with TBI may have trouble starting tasks and setting completion goals. It takes a greater than usual effort to plan and organize tasks and events, and self-evaluation becomes increasingly difficult. These individuals may seem highly disorganized and will need the assistance of friends and family for many of these tasks. Problem solving can also become and issue, often with impulsive reactions to many situations.

There is, however, hope for many people to lead a fairly normal life and many individuals are able to go on to obtain degrees in higher education, have successful careers, and enjoy a fairly normal life as they are able to retrain their brain processes with the help of physical therapy and adapt to their specific injury.  The important thing to remember is that though individuals with TBI may have many cognitive difficulties in their lives, particularly in academics, they are still highly capable and intelligent, they simply have to work harder, which makes their achievements all the more enriching.

Jack Words Episode 1 from Jack Scanlan on Vimeo.

Sources:
NIH: NINDS

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