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A New Brain Injury

A New Brain Injury

There are several essential things you need to understand, including possible pitfalls following trauma.

If you live alone, please see the checklist.

No two brain injuries are the same, which means that the effects of brain injuries vary greatly from person to person. The signs can be subtle or misunderstood by anyone without experience. If you suspect a traumatic or acquired brain injury, it is essential to immediately contact the injured person’s doctor or go to the accident and emergency department at your nearest hospital.

As well as the severity and type of injury, the age and general health of a person can have an impact on how well they recover. Diet and lifestyle also influence healing.

Children’s brains are more ‘plastic’ and better able to rewire. However, this knowledge mustn’t set an expectation. A child can struggle into adulthood, and they need careful observation and support throughout their educational years. Watch out for hormonal changes or imbalance. Damage to the pituitary gland can be a contributing factor in depression. Children and young adults are also more susceptible to mental health problems when they are under pressure sitting tests and exams.

It is essential to listen to children and to help them describe their struggles. Sometimes children stop telling adults how they feel because they don’t think they are understood.

Possible pitfalls:

  • Staff levels in many emergency rooms are more skeletal during the weekend. These shortages can exacerbate problems with being given a diagnosis, assessment, advice or treatment. If you are in any doubt about a diagnosis, worsening symptoms or the information provided, either see your GP or return to the A&E department
  • Emergency medical personal and general practitioners don’t always have specialised knowledge of brain injury. If you are concerned, ask to see a neurological specialist or if one is not on duty ask for a referral appointment
  • A neurological specialist may not be available to see you (or a loved one), and this can result in people with head injuries not being referred for a CT or MRI scan. Concussions do not show up on a CT scan. Do not allow CT results to dictate diagnosis
  •  Some brain injuries are overlooked or not given priority when other injuries can take precedence. Voice your concerns if symptoms develop or persist.
  • Even when there is a diagnosis of the initial injury or insult, it is highly likely that no information or treatment will be given to halt the secondary effects – the biochemical cascade. If symptoms persist for more than a few weeks, speak to a neurological specialist, such as a neuropsychologist. It is best to address symptoms as early on as possible
  • You may not be given information to take home with you or a follow-up appointment and may worry about assessing what to do next. If symptoms worsen, you should seek urgent medical help. If symptoms persist but don’t get worse speak to your doctor
  • What to do if symptoms persist or become worse

The biochemical cascade

While the science about the disruption to the physiological processes in the brain following trauma is complex, what we need to be aware of and to understand, is reasonably straightforward.  This knowledge is critical to how well someone will recover following head trauma.

A diagnosis of concussion or mild traumatic brain injury can be confusing because of “a continuing lack of unity regarding mTBI definitions.” Not all concussions will result in a biochemical cascade. Where concussion symptoms clear up after a couple of weeks or a month at the most, it will be more likely that the body has dealt with the inflammatory response. When symptoms persist, you need to take action.

Following the ‘primary injury‘ to the brain, the force or blow causing concussion and brain injury, a cascade of biochemical events happen including damage to the blood-brain barrier leading to inflammation and cellular damage. Excitotoxicity leads to further axonal damage, mitochondrial dysfunction, oxidative stress as well as also adding to apoptosis and necrosis.

Studies have shown that this cascade can continue for 16 to 17 years post-injury and without doubt, add to the difficulties people have with overcoming symptoms and improving cognitive and executive functioning. Unaddressed this cascade works much like an on-switch, with each event causing a vicious circle of non-abating problems.

There are ways to get this ‘on switch‘ to turn back off and the information on this site is based around how to do this using nutrition and supplements amongst other important interventions.

Laboratory studies show that people who have high levels of micronutrient reserves recover more quickly from a brain injury. Further studies also show that brain injury depletes reserves and that a diet supplemented with micronutrients improves recovery.

There is also evidence from a “case series of three patients with severe TBIs who were aggressively treated with vitamin D3, progesterone, omega-3 fatty acids and enteral glutamine for up to six weeks, termed neutraceutical augmentation for traumatic brain injury (NATBI), with very favorable outcomes” to show this treatment reverses coma and improves clinical outcomes in patients with severe traumatic brain injuries.

There is a rapid growth in the science behind supplements as researchers work for a way to tackle the lack of treatments for brain injury. One of the reasons for this is because brain injury commonly causes sensitivity to prescription medications.

Historically, mainly due to a lack of specialised knowledge, doctors treat individual symptoms without relating these to the cause – i.e. brain injury and the biochemical response. While many people do find improvements, they can become reliant on medications designed for short-term use. Many others develop further symptoms and notice that prescription medications are not helping at all, leading to worries and fears about recovery. Added stressors feed the biochemical cascade making things worse rather than better.

We have created a series of video tutorials which describe the management of the biochemical cascade.

Repeat Concussion

While everyone should take extra care with their brain pre and post-injury the risk of a second injury or ‘repeat concussion’ is most common in sports where players are at higher risk of head injury and whiplash movements. 

The biochemical cascade described above can be delayed by days or weeks following a minor concussion, so a person may not be immediately aware of how seriously they are hurt. Repeat concussions are likely to increase the severity of each injury. The advice to ‘sit it out’ is crucial to avoid a more severe brain injury. Disability and loss of life are genuine dangers for people returning to play before a concussion has had the time to heal completely.

Studies have shown that muscle mass in the neck can reduce the severity of a concussion, which is why girls are more prone to a sports-related injury. As above, studies have also shown that athletes with highly nutritious diets, and therefore reasonable reserves of micronutrients, are more likely to recover in a shorter period. It is important not to think that you are at less risk if you have focused on building muscle mass and have included supplements as part of your daily routine. Although these interventions have been shown to help – they don’t prevent a concussion from occurring.

Information you may miss

Whether in an emergency room or practice doctors are always very busy. They may not have the information you need for you to take away or have time to discuss all your concerns. So, what do you need to know?

Everyone needs to be aware of the signs of worsening symptoms as these may indicate a slow brain bleed or that further assessment is necessary. Symptoms may be subtle and may not appear until days or weeks after an injury.

For those people who live alone, please refer to the checklist for help.

  •  Who to call for advice:

Start with your doctor. Print this to take with you – Brain Injury A Guide for General Practitioners – Click To Print / Download

Many countries have brain injury organisations you can call. The easiest way to find a group near you is to search on your browser. Type in ‘brain injury support group near me.’ If you have any problems, please contact us. We will be more than happy to assist.

  • Finding other people to talk to:

There are many online support groups and forums. We recommend Traumatic Brain Injury Healing and Recovery Support Group.

No two brain injuries are the same, so if you do chat with other people to share experience, be mindful of comparing symptoms and outcomes. You will find that you share similarities with many people and talking about these can be useful as long as you bear in mind that your journey is particular to you. Read The Comparison Trap by Wendy Lustbader M.S.W.

Many factors influence recovery including age, health, diet and lifestyle. For example, two people of a similar age may find differences in their symptoms and outcomes because one may be sedentary and another a sports and health enthusiast. Many people find strength and feel supported, knowing they are not alone.

Every single brain injury is unique.

  • Understanding prognosis

Because every brain injury is unique, it can be difficult for doctors to predict outcomes. People want to know what to expect and can feel at a loss when answers are not readily available. Also, diagnosis may not always be clear to the patient or family, for example, a ‘mild’ traumatic brain injury does not indicate that the damage is not acute; the definition means that there was no loss of consciousness or that if apparent it was minimal in length.

Recovery outcomes are dependent on many factors adding to the difficulties doctors have in giving a prognosis. Over the first months, a doctor will be able to provide a better indication of what to expect. Treatment and how immediately this starts will also make a difference. There is a six month ‘golden window’ of opportunity in which the injured brain is most able to recover spontaneously. Services are available; when symptoms and outcomes persist, you need to ask for an urgent referral to a neuropsychologist who will devise and guide a treatment plan.

There is a lot you can do to help yourself; the sooner you start, the better although steps can be taken to improve symptoms at any stage.

  • Recovery is always on-going

The provision of inadequate information can persist. Sometimes people are still told that healing does not continue after two years. However, this opinion is very much outdated. The brain is capable of rewiring indefinitely after injury. It helps people to understand this at the onset because false expectations can have a psychological impact which can interfere with rehabilitation.

You may also hear that a brain injury is ‘for life’ and this can frighten some people and cause them to believe that how things are will never change. It is vital to get a perspective on this in the early stages. While the person may never regain the same level of skill they had previously, the brain is always rewiring and with patience, gentle feedback, support from a neuropsychologist, plus repetition of learning, people can and do overcome impairments.

Some functions are replaced by learning coping strategies taught by a neurological specialist. Doing things differently to the way they have been taught can be challenging for some people; however, as time passes, they will feel safer and become more flexible. In many cases, skills will become ‘automatic’ and habitual again. The time it takes will depend on the severity of the injury and the level and quality of professional support and involvement of family and friends in the recovery process.

The other common misconception is that brain injury permanently changes the personality. The core personality remains, and so intentions and motivations remain true to the character of a person. As these sponsoring reactions make their way through the damaged neurological circuits, they become broken and twisted, resulting in evident changes in behaviour. The same person is still inside.

Unfortunately, ignorance can also still persist. Some people are abandoned by their families because there is a belief that brain injury has caused them to become ‘retarded.’ Brain injury does not affect intelligence; it changes the way people can accomplish tasks with neurological damage.

Brain injury is not a psychiatric illness either. There can be many changes in emotional response and control. However, these tend to balance back out, and in time, people regain their ability to manage their thoughts and feelings.

Brain injury can exacerbate previous personality tendencies and traits but will not cause a new personality to evolve. People rebalance themselves through learning about their brain injury and how it has affected them.

  • Alternative approaches

There are alternative approaches to recovery, and it is worth spending time doing some research. Find a specialist who has experience in brain injury and will support you in the best way. Because a brain injury can affect the way the whole body functions, there are benefits to working with a functional practitioner.

While many people find relief with medications, many others have strong reactions following brain injury or may develop sensitivity over time. Symptoms may worsen, or there may be strong side effects as a result of using prescription drugs to relieve physical outcomes. It is essential to work closely with a prescribing physician and to discuss long-term approaches to your health.

An excellent alternative to prescription medication, often given for isolated symptoms, is black seed oil. The thymoquinone and other natural compounds work at a source level. In other words, it exerts actions on the causes of symptoms following brain injury or brain surgery such as oxidative stress, excitotoxicity, dysfunction of mitochondria, disruption to the blood-brain barrier and inflammation.

Backed by over 800 research papers, many of which are specific brain injury studies, black cumin seed oil tackles pain as it is it a natural analgesic, headaches and migraine, is beneficial for seizures, is anti-inflammatory, balances the immune system, is anti-spasmodic, and supports mental health such as depression, anxiety and mood swings.

Oils for culinary use are very mild and do not have the same powerful effects. The oil we recommend has been found to contain anti-oxidant, anti-inflammatory, anti-microbial, anti-fungal, anti-tumour, and immune-enhancing activity and is available in strengths and carefully tested for its medicinal qualities.

Black cumin seed oil is also packed with antioxidants which have been shown to help with issues such as the loss of taste and smell, hearing and balance problems.

Research also indicates the positive effects of omega-3 fatty acids due to their nutritional potential to support the brain’s biochemical environment.

  • Finding the balance

Advice about rest and activity following a brain injury can vary depending on the source. While doctors used to advise that people take complete rest, the consensus is to find a balance between light activities and rest.

Depending on the severity of the injury, reactions and needs can vary.  Overstimulation can increase feelings of being overwhelmed and can also exacerbate emotional responses such as anger, irritability and frustration. For many people, making this connection is difficult, and the automatic response systems may cause people to feel they should try to get back to their everyday routine.

It is essential to listen to the guidance of your neuropsychologist or doctor.

If you have problems with maintaining attention, you may need to find activities that are outside of your usual comfort zone. All forms of art and craft are known to be therapeutic.  If physical injuries allow taking gentle walks in the fresh air, listening to guided meditations, or yoga/tai chi are all beneficial.

  •  Unexpected changes

The effects of a brain injury ripple out and touch everyone. The changes can vary on a spectrum from minor to extremely severe across all aspects of health and life.  There is now more understanding about the emotional and psychological repercussions on everyone, and it is essential that wherever possible, the family are included in the therapeutic process.

The experience of living life after brain injury can vary enormously and very often will depend on the quality of care the injured person receives. The more a family are included, the less likely they are to become frustrated or to walk away.

A brain injury can have a significant impact on family income, career, relationship dynamics and intimacy, and also on established roles, responsibilities and hierarchy within the unit. Adapting to these changes can be difficult and may cause anguish and fear. Sometimes these worries need to be put on the back burner because there are more immediate needs to attend. It is vital to give these matters your practical attention as soon as you can.

When we are educated about something, we feel more able to manage it. Do all the research you can do so that you know what to expect. Encourage the wider family and friends to read any pertinent information you find. Many people drift away because they don’t know how to help or be supportive. Allow people to learn, and they are much more likely to maintain relationships. Let them know what you need and talk about what you understand. By sharing knowledge and information from the many sources available, including neuro specialists and support organisations and groups, you can better manage expectations and outcomes.

Change can be catastrophic and tragic, affecting every part of daily living. Ambiguous grief is commonplace, and feelings of emotional loss can be prevalent seeping into everything you try and do. Grief can affect everyone and can be overwhelming. Acknowledging what has happened and getting to the point of acceptance early on can make a big difference to the way anyone manages the outcomes of brain injury.

Many brain injuries are ‘invisible’ because there are no visual clues of disability. Very often, people do look physically well and yet will be struggling with a myriad of complications and change without having the cognitive functionality they need to deal with it. Despite appearances, there will be functional loss and cognitive impairment. The degree to which someone is affected will depend on the severity of their injury. All brain injuries are acute, and everyone needs support and understanding.

Resources:

For the families and friends who are looking for help and information following a recent trauma involving a loved one, there is useful information on Headway about what to expect and answers many worries and questions.

You will also find the information about what happens to the injured brain useful as this describes the secondary injury – biochemical cascade – in more detail.

It is vital to read ‘A New Brain Injury‘ – especially if you are the one who has been directly affected and aren’t getting any medical help or other support.

There is also more information on the Research & News page.

References:

National Neuro Trauma Society – Primary and Secondary Brain Injury

Choosing Wisely Canada – CT scans for adults with head injuries

NCBI – The Neurometabolic Cascade of Concussion

NCBI – Stuck at the bench: Potential natural neuroprotective compounds for concussion

Original research paper Assessment of dietary adequacy for important brain micronutrients in patients presenting to a traumatic brain injury clinic for evaluation
Terry Wahls1, Linda Rubenstein2, Michael Hall3, Linda Snetselaar4

PMR Archives – Methodological issues and research recommendations for prognosis after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.

NCBI – Concussion is confusing us all

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