Monday, March 14, 2011

Traumatic Brain Injury: Giving TBI the Attention It Deserves

Ten years ago I met someone who had experienced traumatic brain injury as a result of whiplash occurring when someone drove into the back of her car car. She looked and acted normally.

But what the external observer couldn't see was that this once successful health care professional had, as a result of brain injury caused by the crash, developed many of the symptoms of attention deficit disorder.

She called it an invisible injury because people expected her to act normally, to be as organized as they always knew her to be, to be punctual, to be able to concentrate -- in other words to be the same vibrant, productive person she was before the injuries occurred.

When I met her, she had been reduced to poverty. Manitoba's Autopac insurance refused to validate her very real disabilities, which had developed post-injury, and she was denied monetary benefits. In fact, Autopac used the  opinion of a well known Winnipeg psychologist to deny these benefits.

All of this comes to mind as I reflect on the growing emphasis placed on concussions, especially in sports. I recall a time when concussion was considered by many as a minor injury, one from which a person usually recovered quickly. As knowledge about the brain grew, and more and more athletes were experiencing their third, fourth, or fifth concussion, it became obvious concussions create lasting injury to the brain, and that second and subsequent concussions are likely to create more harm than the first one.

Thus last Saturday The Globe and Mail  devoted its front page to stories about the National Hockey League and growing concern around concussions resulting from the rough and tumble of the game. The coverage was prompted by head and neck injuries sustained last week by Montreal Max Pacioretty as a result of a hit from Boston Bruin Zdeno Chara.

And in today's paper, Roy MacGregor, in a column entitled At This Moment of Crisis, NHL General Managers Must Act, notes that a year ago NHL managers thought they had resolved the issue through the creation of rule 48 which banned blind head-shots. Then he goes on to document what has happened in the last year:

"A year ago there was not the irrefutable scientific proof that concussions cause permanent and potentially debilitating brain damage; a year ago Sidney Crosby, the game’s best player, was still on skates; a year ago Max Pacioretty didn’t have a fractured neck after being slammed into a stanchion by Zdeno Chara; a year ago Montreal police weren’t investigating such a hit; a year ago major sponsors such as Air Canada and VIA Rail weren’t telling the NHL to clean up its act; a year ago the Prime Minister of Canada and the Premier of Quebec weren’t calling on the league to bring an end to on-ice violence; a year ago legendary goaltender and Canadian politician Ken Dryden wasn’t telling the hockey world that, 'It’s time to stop being stupid.'"

With all due respect to MacGregor, while more is certainly known about concussion today, there has long been good reason to be wary of repeated concussions, and the threat they pose to physical and mental well being.

So I come back to the woman with whiplash 10 years ago.

She provided me with documentation from reputable medical sources, which made it abundantly clear what the potential risks and personal costs of traumatic brain injury - including concussion - are. As a result of professional documentation on traumatic brain injury she gave me, and further reading I did on my own, it was clear the risks from sports-related head injuries are serious, and that a concussion, no matter how benign it may seem, is a serious insult to the brain.

Ten years ago, so taken by what I had learned about traumatic brain injury and the mental health risks associated with it, I began including questions about TBI of all my psychotherapy clients. In a few cases, this line of questioning yielded valuable information, and made for better therapy.

To this day I continue this practice. Just as it makes sense for amateur and professional sports officials to take traumatic brain injury more seriously, so should therapists and other health care professionals.

Next: What are the mental health risks of traumatic brain injury?

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