TRAU­MATIC BRAIN IN­JURY

A se­ri­ous in­jury with se­ri­ous ram­i­fi­ca­tions

Mountain Bike for Her - - Front Page - Words by Joh Rath­bun

Trau­matic Brain In­jury (TBI) is from a sud­den jolt or blow to the head. The sever­ity of the in­jury can range from mild (mTBI) to se­vere, and are de­fined by dif­fer­ent lev­els. There are two dif­fer­ent scales used to de­fine sever­ity of in­jury: the Glas­gow Coma Scale and the Ran­chos Los Ami­gos Scale of Cog­ni­tive Func­tion­ing.

Per Med­scape’s web­site, TBI de­fined by the Head In­jury In­ter­dis­ci­pli­nary Spe­cial In­ter­est Group of the Amer­i­can Congress of Re­ha­bil­i­ta­tion Medicine:

“The Head In­jury In­ter­dis­ci­pli­nary Spe­cial In­ter­est Group of the Amer­i­can Congress of Re­ha­bil­i­ta­tion Medicine de­fines mild head in­jury as “a trau­mat­i­cally in­duced phys­i­o­logic dis­rup­tion of brain func­tion, as man­i­fested by one of the fol­low­ing: • Any pe­riod of loss of con­scious­ness (LOC), • Any loss of mem­ory for events im­me­di­ately be­fore or

af­ter the ac­ci­dent, • Any al­ter­ation in men­tal state at the time of the ac­ci­dent, • Fo­cal neu­ro­logic deficits, which may or may not be tran­sient.”

TBI is not a death sen­tence, but it, and its sis­ter syn­drome, post-con­cus­sive syn­drome (PCS) can com­pro­mise the qual­ity of life. PCS is a com­plex dis­or­der which is not com­pletely un­der­stood. What science does know is that mul­ti­ple con­cus­sions have a cu­mu­la­tive ef­fect on the brain, which can lead to per­ma­nent PCS.

As moun­tain bik­ing be­comes main­stream, TBI and PCS is be­com­ing preva­lent in our sport. One can sus­tain a con­cus­sion, not ex­pe­ri­ence any symptoms, but may still be in­jured. While MRI’s and CAT scans are used to as­cer­tain trauma, symptoms of TBI can fall un­der the radar. Symptoms in­clude be­hav­ioral changes, like de­pres­sion, per­son­al­ity changes and mood swings. Other symptoms may in­clude headaches, sen­si­tiv­ity to light and sound, mem­ory loss, in­abil­ity to sleep, seizures and nau­sea. mTBI is de­fined as the loss of con­scious­ness, for un­der 30 min­utes, and dis­ori­en­ta­tion and loss of mem­ory. Se­vere TBI, and PCS, in­cludes all of th­ese symptoms, and more, such as the in­abil­ity to speak, or un­der­stand when spo­ken to, slurred speech, and in­abil­ity to read and/or write. There may also be a par­tial or com­plete loss of sight, in­tol­er­ance to light, tin­ni­tus, chronic pain and paral­y­sis.

From TBI, PCS may arise. Sci­en­tific lit­er­a­ture shows shades of grey be­tween the two terms. West­ern medicine hasn’t un­rav­eled the cause and ef­fect of the in­jury and its symptoms, or have been able to dif­fer­en­ti­ate defini­tively be­tween the two. For this ar­ti­cle, TBI is the acute in­jury, with PCS be­ing the re­sult­ing symptoms. Th­ese symptoms can man­i­fest at any time af­ter sus­tain­ing a blow to the head, and last for months. If one ex­pe­ri­ences three or more of the above symptoms, one may be di­ag­nosed with PCS. PCS is con­tro­ver­sial, as it seems that West­ern Medicine has yet to ac­cu­rately ex­plain the causal ef­fect of TBI, with the re­sult­ing symptoms. Science does not deal in shades of grey, hence dif­fer­ent def­i­ni­tions for the same prob­lem. One thing is cer­tain, though, that a hit to the head is se­ri­ous, and even if one does not lose con­scious­ness, one should def­i­nitely see a doc­tor.

Wear­ing a hel­met may not be con­sid­ered

cool by some peo­ple, but it can be the dif­fer­ence be­tween life and death. Or com­pro­mise the qual­ity of one’s life per­ma­nently. Part of the fun in moun­tain bik­ing is the risk as­so­ci­ated with the sport. But do not risk your life be­cause of your hel­met. So, how do you know if your hel­met is bro­ken? Scott Sharples, the Mar­ket­ing Manager of Bell Bike said:

“While there is no sim­ple an­swer, gen­er­ally any­time a hel­met sus­tains a hard im­pact from a crash it should be re­placed. Some­times in a crash it is hard to tell if the hel­met has been hit – the trauma from the im­pact makes it dif­fi­cult to re­call if the hel­meted head hit a sur­face. Look for any im­pact sig­na­ture show­ing crush or crack­ing, in­spect­ing both the in­side and the out­side of the hel­met. Im­pact ev­i­dence can be hid­den be­hind the mi­croshell, so check the outer shell for ev­i­dence such as deep scuff­ing. Some­times you can feel crush by care­fully press­ing on the mi­croshell and feel­ing if the liner ma­te­rial un­der­neath has been com­pressed. If there is any dent deeper than about an eighth of an inch, or any crack­ing of the liner or shell, re­place the hel­met.

Al­ways, when in doubt have the hel­met in­spected by a qual­i­fied ex­pert at the man­u­fac­turer. Most US based man­u­fac­tur­ers of­fer a free in­spec­tion of hel­mets which may have been dam­aged. If an in­spec­tion is not avail­able, or if the hel­met has had more than three years of use, re­place the hel­met.”

It is im­per­a­tive to wear a hel­met while par­tic­i­pat­ing in any risky sports. Head in­juries can oc­cur any­where, even on the play­ground, much like pro down­hiller Amanda Batty. She sus­tained her first TBI when she was 2, when fall­ing off of a slide at the play­ground. An ac­tive life­style in­cludes in­her­ent risk, and Batty is no stranger to TBI’s, and their re­sult­ing symptoms.

WIth “a to­tal of 28 con­cus­sions over 28 years,” Batty has sus­tained them from “Horse­back rid­ing, tree­house build­ing, snow­board­ing, moun­tain bik­ing, and I think I fell down the stairs once (se­ri­ously). I didn’t think hel­mets were im­por­tant un­til about six years ago af­ter a level III closed­head trauma af­ter which I was life-flighted and [I was] in the ICU for six weeks and un­able to speak ac­cu­rately for nearly two months af­ter a snow­board­ing ac­ci­dent. Three life flights, all from snow­board­ing with­out a hel­met.” Batty says about her symptoms:

“PCS and brain tis­sue de­gen­er­a­tion have af­fected my daily life in ir­re­versible ways; my ir­re­spon­si­bil­ity as a young adult led to an un­cer­tain fu­ture and a del­i­cate brain.

From mood swings, af­fected vo­cab­u­lary and read­ing skills, mem­o­riza­tion, self-con­trol, depth per­cep­tion, sleep pat­terns, at­ten­tion span, and per­son­al­ity, TBIs have af­fected ev­ery sin­gle part of my life. I’m sen­si­tive to light, ex­pe­ri­ence crip­pling mi­graines and my work, so­cial and fam­ily lives all suf­fer. I also am flighty, for­get­ful and of­ten have to leave ex­plicit in­struc­tions for my­self.”

As the Mayo clinic states on their web­site, “re­searchers haven’t determined why some peo­ple who’ve had con­cus­sions de­velop per­sis­tent post-

con­cus­sion symptoms while oth­ers do not. No proven cor­re­la­tion be­tween the sever­ity of the in­jury and the like­li­hood of de­vel­op­ing per­sis­tent post-con­cus­sion symptoms ex­ists.” 2

So, whereas Batty has had se­vere TBI, no one in­jury can be at­trib­uted to her spe­cific symptoms. Much like Michelle O’Con­nell, out of Den­ver, Colorado, who grew up in the cir­cus. O’Con­nell has sus­tained mul­ti­ple TBI’s, who’s symptoms run the gamut, as she said:

When I started snow­board­ing and down­hill moun­tain bike rac­ing eight years ago, I started a fresh pat­tern of monthly mild to se­vere con­cus­sions. On three sep­a­rate oc­ca­sions I had se­vere crashes re­sult­ing in se­ri­ous head trauma that I had trou­ble hear­ing and think­ing co­her­ently for some hours af­ter­wards. One day in 2010, I lost my vi­sion for about 30 sec­onds...That was when I de­cided to ease up, to give my brain a chance to ‘heal’. I was aware that I didn’t feel like my­self, I wasn’t sad but I also wasn’t happy and would de­scribe it best as ‘be­ing stuck in a soft grey fog’. When I would feel ex­cited about some­thing, I wouldn’t re­mem­ber what it was and would have to care­fully back­track on what had hap­pened in the past hour or so to try and re­mem­ber. I for­got best friends’ names and had words stuck in my mouth that my brain couldn’t help me re­mem­ber how to say. To this day when I drink I have ‘black-out’ pe­ri­ods, even if I haven’t drunk much. I would say longterm ef­fect on my per­son­al­ity is I feel ‘sen­si­tive’ in life now, and am quicker to re­act badly in a sit­u­a­tion. Whereas the old me was a lot more laid-back and re­laxed about per­ceived slights.

This is how TBI can af­fect one’s life - on ev­ery level. Lisa Ma­son, the founder of the Women’s Freeride Move­ment, said, “Take your time af­ter a con­cus­sion. If you go back too soon, you risk a re­lapse. I passed out in front of my campers two weeks af­ter my largest con­cus­sion. And it not only spooked me, [but] it made me re­assess what I value in life. When the doc­tor says the next you might not wake up, you kind of take stock! Play with friends, you may never need to save their ba­con but I’m sure they’ll be happy with you and vice versa. En­joy life and wear your hel­met!” 1

http://emedicine.med­scape.com/ar­ti­cle/326510-over­view 2

http://www.may­oclinic.org/dis­easescon­di­tions/ post­con­cus­sion­syn­drome/ba­sics/causes/con-20032705

Rider: Lisa Ma­son Photo: Carolyn Ka­vanagh

Rider: Lisa Ma­son Photo: Carolyn Ka­vanagh

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