Life Changing Moments

In November 2017, a mother dropped off her children at school and proceeded to drive to a hair appointment. While traveling on a busy 2-lane highway, she suddenly saw a green truck heading straight toward her. Without a second to respond, the truck, which ran a red light, hit her vehicle head on. In those few moments, she saw the impact of the two vehicles, her children’s faces, and a large utility pole. Thinking she was dying, she prayed for God to protect her.

When she began to wake, she noticed smoke in her car and began to cry, repeating “The car is on fire.” The mother heard calming voices outside her vehicle explaining the car was not on fire, the airbags created the smoke, and to remain calm and still. After being extracted from the vehicle, the mother felt as though her body was not her own.

She was sore, confused, and thought the hill in front of her was a mountain. She could not differentiate between fire fighters, police officers, and others simply standing around. She was, however, able to recall her husband’s phone number but had no recollection on how to use a cellular phone. She was later told the impact caused her car to spin out of control prior to stopping an inch from that same pole.

A few days later, the confusion set in at a faster pace. She had difficulty with word finding, recalling information from one minute to the next, concentrating during conversations, multi-tasking in all aspects of her life, and keeping her emotions intact. As these symptoms persisted on a daily basis, others arose as situations emerged. She began having insomnia, migraines, a burning sensation on her scalp, and started snapping at her family.

In addition, she had increased confusion when driving and while being driven. Many times, she told her husband he was driving in the wrong direction. Other times, she would pull off to the side of the road because she could no longer recall how to get to her destination or what area of town she was located.

As time passed, her cognitive function began to improve but was never quite the same. That one moment in time changed her life. Not only was her cognitive function noticeably weaker than it once was, but she couldn’t help but wonder how her traumatic brain injury would affect the later years of her life.

As a speech-language pathologist, I’ve had the pleasure of working with countless patients who acquired traumatic brain injuries due to motor vehicle accidents, falling off ladders, pedestrians hit by moving vehicles, etc. While these patients’ stories may differ, they are also similar in nature. Each one woke up the morning of their accident, completed their morning routine, and began to conquer their daily agenda. Instead of the day ending as planned, the unknown occurs, ultimately changing their lives forever. BUT there is hope.

Understanding Traumatic Brain Injuries

According to Centers for Disease Control and Prevention, in 2019 there were approximately 223,135 individuals hospitalized due to traumatic brain injury (TBI). In 2021, it was estimated that 190 Americans died on a daily basis due to a traumatic brain injury diagnosis.

Keeping these statistics in mind, let’s take a look at the cause of TBIs, the cognitive symptoms of a TBI, the basics of the healing brain, and how a speech-language pathologist can help rehabilitate those diagnosed with it.

What is a TBI?

A TBI can occur when an individual’s head or another part of their body incurs a bump, jolt, or blow, thus, causing the brain to quickly shift, in one or more directions, while bouncing off the interior of the skull.

This sudden movement can cause swelling of the brain and damage to the brain’s tissues, blood vessels, and internal lining.

There are two types of brain injury: open-head and closed-head. Both can equally lead to debilitating effects on your daily functions.

An open-head injury occurs when the skull is penetrated or fractured by an object or hard surface.

Conversely, there is no breach of the skull with a closed-head injury. They are often a result of falls, motor vehicle accidents, sporting injuries, and shaken baby syndrome. Other common causes of head injuries stem from assaults, explosive blasts, injuries from combat, and self-inflicted trauma.

The severity of TBIs can range from mild to severe. Mild TBIs are commonly referred to as concussions and may cause temporary side effects. Whereas those who suffer from moderate-severe TBIs may exhibit lingering and more serious side effects, including the risk for aphasia (loss of language), seizures, coma and/or death.

In the above story, the mother suffered a closed-head injury. Her head forcefully hit the front airbag, which, then, caused the back of her head to hit the driver’s seat headrest, creating a coup-contrecoup (sudden back and forth movement) brain injury. In addition, it is suspected the left side of her head hit the curtain airbag covering the window of the driver’s door.  All of which resulted in the mother being diagnosed with a moderate traumatic brain injury.

What are the cognitive symptoms of a TBI?

Traumatic brain injury symptoms, level of impairment, and length of symptoms often differ from person to person. In addition, it’s common for the degree of impairment to fluctuate daily. For instance, one may have clearer thinking skills on the days when he or she had a full night’s rest and has fewer daily stressors.

The following are common cognitive symptoms related to traumatic brain injuries:

• Difficulty recalling long and short-term memories
• Feeling “lost” in conversations and/or “foggy” due to decreased memory
• Inability to complete simple to complex problem solving or reasoning tasks, such as money and medication management
• Difficulty with simple mathematics
• Poor visual spatial skills, such as the ability to draw a clock face with numbers/hands, plot time, or read maps
• Decreased response time
• Inability to multi-task, such as being able to do more than one thing at a time without confusion or mistakes
• Inability to complete tasks with environmental distractions
• Impulsive and/or unsafe behaviors
• Poor insight or the inability for one to self-recognize their cognitive difficulties, such as everyone noticing your memory loss except you
• Poor organization of one’s daily routine or activities
• Decreased orientation to self, date, time, or situation, such as not recalling your own name, where you live, etc.
• Word retrieval issues during conversational speech (cognitive-communicative deficit)
• Inability to follow one-step to multi-step directives (cognitive-communicative deficit)
• Decreased processing of verbal and written information

Other common symptoms resulting from a TBI may include but are not limited to:

• Swallowing disorders
• Speech disorders
• Voice disorders
• Fatigue
• Headaches
• Sensitivity to light and smell
• Anxiety and depression
• Vision issues
• Tinnitus (constant ringing noise in one or both ears)

*It is important to note that speech-language pathologists diagnose and treat swallowing, speech, and voice disorders.

Know the basics of how the brain heals!

The human brain has neuroplasticity which allows it to change, adapt, and reorganize in response to intrinsic and extrinsic stimuli. The amount of neuroplasticity one’s brain has is dependent upon one’s age. Although there are limits to neuroplasticity, a child’s brain has more than an adult brain due to maturation taking place by the mid-20s.

When the human brain is damaged, there are two proposed mechanisms that may contribute to one’s functional improvement, neuronal spouting and reorganization.

Neuronal sprouting allows the building and strengthening of new neuronal connections from existing neurons to other neurons. When this occurs, the brain has the ability to reorganize itself by rerouting neuronal pathways from the damaged areas of the brain to the undamaged areas.

Subsequently, the brain’s functions can have the potential to recover as the neuronal pathways and undamaged areas of the brain strengthen and/or take on new roles.

This concept of neuronal sprouting and reorganization might account for one’s ability to learn novel information, create new memories, improve focus, and adapt to new situations and experiences.

Dr. Britt Stroud, pediatric neurologist, provided this simplified explanation of neuronal sprouting and reorganization:

“I think traditionally the thought is that the brain strengthens alternative connections and some pathways, and parts of the brain take on new functions. They start to carry the load, so to speak.

For example, let’s say you are right-handed, but your right arm gets injured. You now have to use your left arm to perform tasks it wouldn’t normally have to do, such as writing. Although your left arm and hand were fully capable of these movements prior to the injury, it wasn’t necessary to use them.

Over time, you will be able to write almost as good with your left hand. If by chance your left arm gets injured and is nonfunctional, you might need to use your teeth to hold the pen. Over time, your neck muscles will be good at doing what it never needed to do before.”

How can a speech-language pathologist help your brain recover from a TBI?

Speech-language pathologists, who specialize in traumatic brain injuries, are often called cognitive therapists. As a cognitive therapist, our role is to evaluate the patient’s current status, develop a patient-centered plan of care, and utilize this plan to rehabilitate the patient.  The goal is for he or she to either reach their maximum functional potential or recover to their prior level of function.

At E-Integrated SLP Services, our speech-language pathologists combine years of experience with treating TBIs, across all age groups, with our cognitive expertise. As a result, our company created a unique Traumatic Brain Injury Program, which assists and promotes brain healing and “re-training”.

In addition to improving our patients’ brain function, we provide them the knowledge for continued brain strengthening.  We instill the confidence needed to perform daily living activities, so they “get their lives back.”

Our speech-language pathologists possess decades of combined experience when working with all age groups, who are diagnosed with mild to severe traumatic brain injuries. This includes a multitude of settings, such as acute and subacute care in hospitals, rehabilitation hospitals, trauma centers, TBI clinics, outpatient clinics, pediatric and adult home health care, skilled nursing facilities, and telehealth.

Personal Communication

Dr. Britt Stroud, personal communication, June 24, 2023

Sources

Centers of Disease Control and Prevention. TBI Data. Accessed June 2023, https://www.cdc.gov/traumaticbraininjury/data/index.html.
John Hopkins Medicine. Traumatic Brain Injury. Accessed June 2020, https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury

Puderbaugh M, Emmady PD. Neuroplasticity. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557811/?fbclid=IwAR2I33DqJX8zzfNu6fHb3L4RSHtm8nWJjjMu-jMls8xJwA6abgeA5cnb6-g

Stampanoni Bassi M, Iezzi E, Gilio L, Centonze D, Buttari F. Synaptic Plasticity Shapes Brain Connectivity: Implications for Network Topology. Int J Mol Sci. 2019 Dec 8;20(24):6193. doi: 10.3390/ijms20246193. PMID: 31817968; PMCID: PMC6940892.