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Mild is not mild

Mild TBI is as misunderstood today as the scourge of AIDS was in the 1980s. Missed diagnoses is a consistent theme because knowledge about mild TBI is generally limited to the nation’s top medical institutions, and often even doctors associated with these institutions are challenged to diagnose accurately. The delay in diagnosis can make it difficult or impossible for the person with TBI to obtain healthcare treatment, or collect disability benefits without going to court.  This can be a frightening situation.

One clinician specializing in neurology commented that:

“As technology improves and more advances in research are made, at some point we’ll be able to look at cellular responses and brain chemistry and be able to say with certainty “That’s TBI” – and confirm that it, too, is a real physiological problem.”

A brain injury specialist at Mount Sinai Hospital observed:

“Often the individual with a mild TBI returns to his or her daily life after the injury with very little, if any awareness, that the head injury will have ramifications – short-lived probably, but perhaps long-term. To individuals in this [latter] situation, they notice out of the blue that in big and little ways they are no longer able to do what came easily before. "For no reason that I can see, what I know about myself is no longer true." These inexplicable difficulties, which they do not associate with the "blow to my head," can lead these people to feel that they are losing it.” [i]

Researchers assert that “as many as 80 percent of mild TBI injuries go undiagnosed” and that mild TBI is a “silent epidemic.”[ii]  Clinicians offer statistics based on a timeline from when a first diagnoses of TBI is made; for example, that 85 percent of people with mild TBI return to work within one year. What they don’t say, maybe because the data is too new, is that of the 85 percent who return to work, a significant majority of them believed they returned too soon.  Those who don’t recover within one year are made to feel as though they are statistical outliers since they don’t represent the majority of cases.

There are a host of conventional diagnostic tests that people with TBI may go through as part of their diagnosis. Unfortunately, these tests are often not sensitive enough to detect the stretching, tearing and twisting of the neurons in the brain that leave lasting damage. Still, every member of the Recovery Model Team should have a basic understanding of what these tests are, and the results they yield.

Computed Tomography (CT) - scans that utilize computer-processed X-rays to produce images or 'slices' of specific areas of the body

Positron Emission Tomography (PET) scan - a nuclear medicine imaging technique which produces a three-dimensional image or picture

Magnetic Resonance Imaging (MRI) - a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body, and

Electroencephalogram (EEG) - a test that measures and records the electrical activity of your brain

People with mild TBI are likely to face a multitude of challenges. The injury is invisible to everyone but the injured. They look normal, so everybody thinks they are normal.  Dr. Elaine Woo, of Mass General Hospital, states:

Mild TBI is a distinct clinical entity with its own unique problems to the patient [and] a multifaceted syndrome. Despite apparently normal test results, many patients with mild head injury experience an array of symptoms spanning physical, cognitive and psychological functioning. [These include] a generalized impairment of all intellectual functions…but problems with memory, concentration and attention, judgment and abstract thinking are most prevalent. A residual unique to mild head injury is the problem of impaired quantitative intellectual functioning, which refers to the inability to process information successfully if speed or complexity is required. [The aftermath of mild TBI can] lead to life disruption and lost productivity inestimably costly to the individual, his family and his community.

[i] Mt Sinai Hospital Traumatic Brain Injury (TBI) Central

[ii] Dr. Joe Congeni, You Tube; "Concussions Can Have Delayed Consequences"; WLWT-TV Cincinnati