Traumatic Brain Injury: Causes, Effects & How To Manage Symptoms
When thinking about some of the leading causes of death in this country, cancer and heart disease may cross your mind, but a traumatic brain injury (TBI) likely doesn't—or at least not right away. But TBI is a substantial threat to public health in the United States, contributing to 30% of all injury deaths1. In 2010 alone, 2.5 million emergency room (ER) visits, hospitalizations, or deaths were associated with TBI in the United States.
Indeed, the issue is more widespread than we think.
What is a traumatic brain injury?
A TBI is caused by external force (e.g., a blast or fall) to the head, leading to disruptions in brain structure and function. It is also known as close head injury (CHI) and concussion syndrome (CS).
It has complex and pervasive long-term effects on a scale of 1 to 10, with 1 being a minor bump and 10 being something more severe like a car accident. No matter how minor the accident may appear, though, head injuries should never be ignored.
It is projected to become the third-largest cause of disease burden worldwide by 2020, which is why many people call it a silent epidemic. It is commonly accepted that the majority of TBIs are mild in severity and make up between 70% and 90% of all cases. This number is likely an underestimation, given that many TBIs are thought to go untreated and, therefore, unreported.
The CDC adds that nearly 47% of traumatic brain injuries are caused by falls, with young children and adults over 65 years of age being the most common patients. They can also be caused by sports injuries (21%), blunt force trauma (15%), car accidents (14%), and violent physical assaults (9%).
What are the effects?
TBI, a common injury in sport, military, and domestic environments, alters the fundamental aspects of gene regulation, which could explain mechanisms by which the TBI pathology can divert into other brain disorders2. The brain is not anchored to anything in the skull, so any bump will make the brain move, which can then cause it to hit the skull in multiple places, sending shock waves through the brain. This leads to diaschisis, which are mini lesions across the brain that can result in inflammation and mini hemorrhages.
Extended periods of inflammation are key factors in TBI. This happens when microglial cells (aka immune cells in the brain) increase in response to the injury. This inflammatory response is initially good, but if the injury is extensive, it will lead to an overabundance of microglia, and brain tissue can become damaged. This results in reduced activity in different parts of the brain—even mild brain injuries can cause sustained cognitive and psychiatric problems.
"Concussive brain injury reprograms genes, which could lead to predisposition to neurological and psychiatric disorders, and that genomic information from peripheral leukocytes has the potential to predict TBI pathogenesis in the brain3," write the authors of a 2017 study published in EBioMedicine. But there is research also showing these disruptions caused by a head injury seem to affect a master gene. This master gene "tells" other genes what to do. When affected by the head injury, the master gene can create confusion with other genes in the brain and may even change them long term.
TBIs also change the way energy flows through the brain: The genetic changes associated with TBI appear to disrupt brain activity over the damaged areas, which can be picked up by quantitative electroencephalogram (QEEG) technology, aka "brain mapping."
There are many symptoms of TBIs, including Alzheimer's disease, Parkinson's disease, post-traumatic stress disorder, stroke, attention deficit hyperactivity disorder, autism, depression, schizophrenia, and more.
One peculiarity of any TBI is that talents you had prior to the injury might be lost, and completely new talents could emerge in their place. There have even been cases in which someone becomes a savant following a head injury, such as a person affected with a developmental disorder (like autism or intellectual disability) who exhibits exceptional skill or brilliance in some limited field (i.e., mathematics or music).
There are also massive emotional changes associated with TBIs, including an extreme struggle to control or manage emotions. Many people experience frustration because they often remember how they used to function. They also experience language change, such as tangential speech and/or word-finding—needing more words to explain themselves, overexplaining, oversharing, becoming frustrated when people don't understand them, feeling easily triggered in emotional situations, and/or feeling like they cannot control voice tone or body language well—especially when triggered.
All these symptoms can be so mild that they can go unnoticed. However, if left unmanaged, the symptoms can progress. (The keyword here being if—because there is hope!)
How to manage TBI symptoms.
Through my research over the past 30-plus years in the field of neuroscience, and my experience doing directed mind work and brain-building, I have observed significant improvements in cognitive, psychosocial, emotional, and intellectual functioning when individuals with TBIs are taught to manage their symptoms. Recent research from the University of Texas at Dallas suggests that training-induced neuroplasticity (aka the ability to change the brain) continues through chronic phases of TBI and that brain connectivity and cortical thickness may serve as markers of plasticity4.
Brain-building is basically when we use the mind to remodel the neurological coding in the brain (specifically in our dendrites), and this happens through intentional and deliberate mind-directed thinking. This kind of thinking can be described as an energy surge that causes electromagnetic, genetic, and chemical changes in the brain. It stimulates neurogenesis, i.e., the birth of new brain cells, which help prevent and heal cognitive decline and combat the negative effects of diaschisis.
Brain-building includes intense, systematic, and deliberate small steps that are intellectually challenging and fun, which exercise both the mind and brain. By doing these types of exercises, we are tapping into something called regulatory genes.
Brain-building has many benefits, including:
- Increasing feelings of control and autonomy.
- Strengthening the brain: We need strong, optimized brains and clearly functioning minds to do the work of healing trauma, breaking unhealthy habits, and keeping our thinking on track during the day.
- Increasing resilience, intelligence, and mental toughness.
- Coping with challenging stressors. It helps us refocus and calm down when we feel worried, anxious, and panicky.
- Preventing and healing cognitive decline.
- Keeping the brain tidy and clean.
- Helping us sleep better by preventing toxic buildup from unused neurons.
- Helping our thinking get "unstuck."
- Combating feelings of imposter syndrome.
Additionally, during my studies and clinical practice, I developed a five-step process called Neurocycle, which I discuss in my books Cleaning Up the Mental Mess and Think, Learn, Succeed. This program is designed to help train the brain toward better self-regulation, brain stability, energy utilization, and neuroplasticity.
Traumatic brain injuries affect more people each year than we probably realize. The injury and its symptoms should never be taken lightly, as they can have long-term and even deadly consequences. When the injuries are managed, however, research shows that there is hope for patients of TBIs.
Caroline Leaf, Ph.D, BSc, is a communication pathologist and cognitive neuroscientist, specializing in cognitive and metacognitive neuropsychology. She received her masters and Ph.D. in communication pathology, as well as a BSc in logopaedics from the University of Cape Town and the University of Pretoria in South Africa.
During her years in clinical practice and her work with thousands of underprivileged teachers and students in her home country of South Africa and in the USA, she developed a theory about how we think, build memory, and learn (called the Geodesic Information Processing theory). The learning process has been turned into a tool for individuals with Traumatic Brain Injury (TBI), Chronic Traumatic Encephalopathy (CTE), learning disabilities (ADD, ADHD), autism, dementias and mental ill-health issues like anxiety and depression.
Leaf is author of Switch on Your Brain, Think Learn Succeed, Think and Eat Yourself Smart, and Cleaning Up Your Mental Mess. She teaches at academic, medical and neuroscience conferences, churches, and to various audiences around the world. Dr. Leaf is also involved in the global ECHO movement, which trains physicians worldwide on the mind-brain-body connection, mental health and how to avoid physician burnout.