For some – especially those of us who have sustained a traumatic brain injury (TBI) – football is synonymous with concussion. And since football season is upon us once again, I thought this would be the perfect time to re-visit the topic of concussions. To get more to the point, as the Brain Injury Association of Nova Scotia asks of us – both the brain-injured and non-brain-injured – “Please keep this in mind …”

A concussion is an invisible disability.

Everyone’s brain and brain injury are different. It is a many layered issue. If you’ve had a concussion and recovered, what worked for you may not be best for me.

A concussion is not just a headache. It affects everything I do.

It’s not that I don’t want to do things, it’s that I can’t.

I’m doing my best, but my best may not be your best.

My symptoms may change day-to-day. Because I’m doing better one day, does not mean I’m better overall. If I have a bad day after a good one, I am not making it up.

I am not attention-seeking. My pain is real. I need validation.

Due to my unpredictable symptoms, I have trouble meeting timeline expectations (i.e. in work settings).

If I over-exert myself physically or mentally, I may feel the effects of that for many days.

My emotions may be heightened. I may be more reactive to situations that didn’t bother me before.

I may have stress and anxiety from my injury and the recovery process.

I may have issues with my mental health afterward.

My self-worth may be impacted, especially if is tied to my ability and productivity.

I may need some scheduled down-time and alone time. It doesn’t mean I don’t enjoy your company; I just need to take care of myself first.

The fact that it’s hard for me to articulate my symptoms and feelings is part of the injury.

Thank you, everyone, for reading this!

And thank you, Brain Injury Association of Nova Scotia.

Did you know that at least sixty areas of the brain are involved with the processing of visual information, and that seventy percent of all sensory information is visual? I didn’t know this. I learned that fiber of trivia from Amy Pruszenski, a doctor of optometry, during her talk about post-traumatic vision syndrome (PTVS) at the Brain Injury Association of Vermont annual conference this past October. Simply put, PTVS is a disruption in flow within the complex network of nerves, tracts, and subsystems of the brain. Such disruption prevents the processing of visual data. This is not an uncommon occurrence in people who have sustained a traumatic brain injury (TBI). So, if you’ve sustained a TBI, including a concussion, and you’ve been wondering whether or not you have PTVS, keep reading.

Some common problems associated with PTVS include blurred vision, sensitivity to light, reading difficulties (words may appear to move on the page), poor comprehension, difficulty concentrating, poor memory, double vision, headaches when straining eyes, eye pain, squinting, closing one eye, poor depth and spatial judgment, and strabismus, or misalignment of the eyes. The list is endless.

But there’s no reason to walk around fearful that you’re about to fall over because you’re visual processing system is out of wack – you swear that every time you go out for a walk, the sidewalk curb shifts just as you are about to step off it to cross the street. Fortunately, there are treatments and behavioral changes that can help improve the flow and processing of information between the eyes and brain. Corrective lenses can help with blurry vision and magnification of objects, and can improve both close-up and distance vision. Prism glasses have a ground prism in or on the lens, which changes how the light enters the eye. These might help alleviate double vision and improve peripheral vision. Some optometrists recommend patching one eye to help with double vision. Doing so prevents information that causes double vision from entering the brain. After testing a patch during Amy’s talk, and having had to wear one as a kid to strengthen my “lazy eye,” I can tell you that this is not the most appealing option, especially if you are prone to claustrophobia.

Some behavioral changes Amy suggested, which apply to people without a TBI too, sounded tempting. Of course, they require discipline and training. Every twenty minutes, step twenty feet away from your computer, and focus on something else for at least twenty seconds. (I must do as Amy urged and set a timer to remind myself to turn away from the screen – I’ve been staring at it for more than an hour now.) Also, try what Amy calls a “Palm Break.” Block your eyes with your palms to block out all visual stimulation. But it’s not only the length of time engaged in an activity that affects visual processing; the type of activity affects it too. For instance, computer work is more strenuous on the eyes and brain than, say, washing the dishes.

Here are a few more tips to help avoid visual overload: remove clutter in your home and at work. (You don’t want to be around me when my home is a mess.) Prioritize activities, and don’t set yourself up to do too much in a day. (I still think I’m the super-woman I was before my TBI and list five or six brain-heavy tasks in my date book each day.) And shut down your computer, ipad, iphone, iwhatever, even the television, two to three hours before bedtime. (I know, this is a tough one, especially if you’re like me and must watch just one more episode of Call the Midwife before you click the off button on the remote.) The short wavelengths emitted from these kinds of devices suppress melatonin, a hormone that controls wake and sleep cycles. The suppression of melatonin not only interferes with sleep, it has also been linked to all kinds of bodily dysfunctions: cancer, diabetes, heart disease, obesity.

Rather than leaving you bloated with worry about how to fit in yet another self-care activity into your busy day, I’ll end with a shout of encouragement from Amy: “Celebrate accomplishments!”

Traumatic brain injuries are a subset of acquired brain injures, which are not the result of trauma, but occur after birth: hypoxic brain injuries (lack of oxygen to the brain), and anoxic brain injuries (no oxygen to the brain).

In a diffuse axonal brain injury (a type of closed traumatic brain injury) the skull is not broken, but the brain is violently jarred and collides with the skull, causing tissue swelling. Since there is no opening to relieve the swelling, there is increased pressure in the brain, damaging neurons, the core cells of the nervous system. As a result, the communication network between neurons is impaired (think of a downed cable or telephone wire), and basic functions like speech, and  breathing might be affected.

A concussion is caused from direct impact to the head by an object, or sudden movement or momentum from shaking, like in whiplash. Neurons stretch and blood vessels tear, which can cause contusions – bruises on the brain. The individual may or may not lose consciousness. Shaken Baby Syndrome, also known as Abusive Head Trauma and Shaken Impact Syndrome – is a form of whiplash where the aggressor vigorously shakes the baby. Most of these cases occur when babies are between 6 and 8 weeks old, since that is when they cry the most. The trauma may cause them to experience vomiting, seizures, irritability, and poor feeding.

In an open brain injury, the skull is fractured. If it’s pierced, say, from a gunshot or knife, the skull splinters, and fragments can hit brain tissue, causing further tissue damage (a penetrating injury). Even though cell damage can occur in an open injury, there is less chance of brain swelling and therefore increased pressure. That’s why doctors consider them less dangerous than closed head injuries. But, because there is an opening in the skull, bleeding into the brain can occur. And the individual is at high risk for infection, most commonly meningitis – an infection of the membranes surrounding the brain and spinal column.

Frontal lobe injuries affect the front part of the brain. The frontal lobe controls motor skills, thoughts, emotions,and personality. The left side of the lobe controls verbal communication, and the right side controls non-verbal communication – the arty side of our brains. The right lobe also plays a role in negative emotions, while the left lobe involves positive emotions. The area of the frontal lobe that is damaged will dictate how your emotions and personality are affected. Once a cautious person, you may now find yourself to be more impulsive.

So I suppose it shouldn’t come as a surprise that the brain is susceptible to injury. Weighing a slight 3.4 pounds, and encompassing more than 1 billion neurons with an infinite number of connections, the brain is a delicate mass of tissue floating in a fluid environment, much like a fetus in a uterus.

http://www.msktc.org/tbi/factsheets/Understanding-TBI/What-Happens-During-Injury-And-In-Early-Stages-Of-Recovery

http://www.braininjuryinstitute.org/Brain-Injury-Types/Open-Head-Injury.html

http://kidshealth.org/parent/medical/brain/shaken.html