Column: How aware are you of your brain?

The brain is an amazing organ with growth and reparative capacity. It controls our cognitive, motor, sensory, emotional, and autonomic (like breathing) functions.

The average child is born with what may look like little brain functioning, but on the contrary, it’s a hotbed of potential to think and feel. Touch, eye contact, sound, emotion, and body sensations lay the groundwork for the brain to develop. And how exciting it is to watch a child learn language, come to understand their world, and ultimately to think with abstract ideas!

Unfortunately, at any point in one’s life, this beautiful growth can be stymied by internal or external factors. Internal factors can refer to a stroke, aneurysm, or brain tumor, whereas external factors suggest an injury such as a car accident, combat injury, sports injury, a gunshot wound, or physical abuse.

March is Brain Injury Awareness Month, dedicated to educating the public of the various types of brain injuries, the challenges faced by survivors, and the importance of prevention and treatment. Shelter Island is no different from the rest of the country with people in our community facing these challenges.

The Shelter Island Health and Wellness Committee will be sponsoring a library program in July with professionals and average people sharing their stories. But for now, in honor of Brain Injury Awareness Month, I’d like to share some basic knowledge and invite everyone to join us to learn more during the program this summer.

Let’s say you slip on the ice and hit your head in the fall. Should you seek medical attention? The answer is yes. Any headache or dizziness will probably go away within a day or two, but it could develop into a brain bleed or blood clot that can be life threatening. Or it can lead to other types of injuries.

Diagnosis of head injuries can be complicated and based on several factors. According to Brainline.org, any of the following symptoms require attention: loss of consciousness (even if brief), amnesia, feeling dazed or confused, headache, vomiting, or seizure.

To diagnose you correctly, you will be given a neurological exam where you will be asked questions to assess your cognitive functioning or possibly a CT scan or MRI. All these tests could turn out negative and you may still have a concussion or Traumatic Brain Injury (TBI). A concussion is considered a mild TBI and through rest, pain medication, and possibly cognitive rehabilitation, it will resolve within a few weeks.

But mild TBI’s can become more complicated if the patient is elderly or on blood thinners, aspirin, or lots of non-steroid inflammatory drugs (such as Advil).

So, to back up a bit — any injury to the head can cause a TBI. Because the brain controls so much of our functioning, a wide range of medical, psychological, cognitive, and behavioral problems may result. Here is some information from the Mayo Clinic: In a mild TBI, common symptoms are headaches, fatigue, balance issues, sensitivity to light and sound, and possibly blurred vision, ringing in the ears and changes in the ability to smell.

Often there are memory and concentration problems, mood swings, and anxiety.

Depending on the severity, moderate TBIs can share similar symptoms with mild, but on the other end of the spectrum can be more pronounced. This may be complicated by the fact that symptoms can come and go and vary from patient to patient.

A person can appear “normal” one day and complain of headaches, memory, loss, or concentration problems the next day. Family members can feel at a loss of how to help, because there is not a single trajectory for improvement.

Severe TBIs begin with a state of unconsciousness. When consciousness is regained, there may be repeated vomiting, convulsions, or seizures, loss of coordination, profound confusion, agitation, slurred speech and in the most severe cases, one can be in a coma or other disorders of consciousness.

It is particularly difficult to watch a child with a brain injury because they often can’t verbalize how they’re feeling. But common symptoms are irritability, persistent crying, inability to pay attention, and loss of interest in activities or favorite toys.

Recovery from a TBI is generally correlated with the severity of the injury. However, each brain injury and rate of recovery is unique. For a mild TBI, rest is essential and returning too quickly to regular activities can slow the recovery. According to the National Institutes of Health, even prolonged computer usage can slow the recovery as can alcohol or drug use.

According to a study from the University of Alabama (Birmingham), most people with a moderate TBI recover most or all of their brain functioning, although occupational, speech, physical therapy, psychological services and sometimes neurosurgery may be needed and it takes time.

Those affected may “recover,” but completely returning to pre-TBI functioning is rare. To quote a car accident survivor, “My doctors’ support, rehab, my family’s acceptance of my limitations all made a difference. But the biggest hurdle for me was self-acceptance, that I could no longer lead the same life I led before.” (The speaker is a psychotherapist who could no longer continue her practice after her accident).

With severe TBIs, recovery depends on many factors. According to the Model Systems Knowledge Translation Center (an online research and resource center), the priority is to address life threatening injuries. Next, they address medical injuries that may arise to ensure that the patient is stable. Numerous health care specialists are involved in the care.

Here are examples of the team: surgeons, critical care doctors and nurses, neurologists, pulmonologists, dieticians, pharmacists, rehab therapists, physiatrists (doctors who treat muscle, joint, and nerve problems), and social workers. Recovery can take a long time or may not occur. But a dedicated team will do everything they can to improve the patient’s status, which is why proper care is essential.

Non-traumatic brain injuries are also referred to as “acquired brain injury.”  The damage results from internal factors such as a lack of oxygen, exposure to toxins, or pressure from a tumor. Examples include: stroke, aneurysm, near drowning, and tumor.

While most people know of someone who has had a stroke, exactly what causes it may not be common knowledge. A stroke is caused when a blood clot or broken vessel prevents blood from getting to the brain.

Or they can be caused by a brain bleed (also called a hemorrhagic stroke or cerebral hemorrhage) which is even more serious. Outcomes vary:  A person can die, have permanent brain damage, or recover completely depending on several factors, but the most predictive factor for recovery is to identify that a stroke has happened and to get help immediately. 

The reason that time is so important is that the longer the portion of the brain is deprived of blood flow, the more likely there will be permanent damage. Once the patient is seen they can get “clot-buster” medications or even get the clot mechanically removed.

Strokes cause different symptoms depending on where in the brain the trauma occurred.  The most common symptoms are speech impairment, vision impairment, confusion, dizziness, headaches, loss of muscle control, and memory loss.

The acronym “BE FAST” is now commonly used to alert people (and those they are with) that a stroke may be occurring. Here is the information incorporated into BE FAST: B — changes in balance; E — changes in eyes; F — droopy face; A —inability to lift both arms; S —slurred speech; T —time is of the essence. Whereas aspirin used to be recommended when a stroke was suspected, this is no longer the case. Instead — call 911 immediately.

Surgery and rehabilitation with a team of professionals is the general course of treatment. Recovery varies. A friend of mine who survived a stroke in her 50’s recovered completely. She told me she had suffered seven brain bleeds. Her doctor was amazed. Others are not so lucky. Age, stroke severity, pre-stroke health and lifestyle, support, and good medical and rehabilitative care all contribute to the outcome.

Finally, an aneurysm is a ballooning of a blood vessel in the brain. It can be monitored and treated. But if it bursts, the results can be like those of a stroke and life threatening.

These are a lot of facts to absorb, and to be honest I’ve learned a lot while researching this column. I look forward to learning more in July when experts and survivors share their knowledge. In the meantime, let’s keep in mind the following facts:

1. Anyone can suffer a brain injury.

2. While it may be life-altering, it is not necessarily life-ending.

3. All brain injury patients deserve compassion and understanding.

Here are the words of “Alison,” who described her TBI: “It’s like an earthquake in my brain that knocked down bridges and damaged highways and knocked down some — but not all — lines of communication. Some of these things get rebuilt more quickly than others, and some are easily re-damaged.”

Nancy Green is a social worker and member of the Shelter Island Health and Wellness Committee.