Traumatic Brain Injuries: Symptoms, Scope, & Severity
Aside from both being invisible injuries, occurring in the head, differentiating between physical symptoms after a traumatic brain injury (TBI) and the psychological impacts of service is not always clear. Generally, impacts on the structural and functional integrity of the brain after a TBI are characterized by persistent disorientation and difficulty concentrating. However, there is also a wide spectrum of cognitive, emotional, and behavioural disturbances not only associated with damage to these neural networks but what might have also been a traumatic event.
Despite the increased risk of exposure to service-related TBIs, many are not immediately identified, diagnosed, or treated. For example, damage to brain tissue can still occur even without the loss of consciousness or obvious injuries. Aside from short and long-term consequences a First Responder experiences and a Veteran takes from service, families may also not be fully aware of what has caused changes in their loved ones. This has the potential to reduce recovery rates, quality of life, and strain potentially protective social networks.
Damage to brain tissue can still occur even without the loss of consciousness or obvious injuries
Although not an exhaustive list, common indicators may include:
| Physical | Psychological | Social |
|---|
| Headaches | Difficulty with concentration | Withdrawal from others |
| Dizziness | Difficulty with decision-making | Breakdown of supportive
relationships |
| Nausea | Difficulty with memory | |
| Difficulty with verbal fluency | |
| Difficulty regulating mood | |
Neurotrauma
Symptoms from a TBI may exist without notable problems with intelligence, communication, and motor or sensory functioning. Nevertheless, disruptions in brain structure and functional integrity may not always be immediately noticed. It is important to know that the threshold for a brain injury is not the loss of consciousness. Sometimes, it can be as unsuspecting as mild disorientation or vomiting shortly after an incident.
Two common types of brain injury occur in service: mechanical injuries, such as blows or penetrating wounds to the head, and biomechanical injuries, such as from blasts. Both injuries may also occur separately or simultaneously. For example, exposure to a blast (biomechanical) could also include striking the head (mechanical) against a hard surface and/or penetrating wounds (mechanical) from shrapnel or debris.
The number, severity, and age at the time of the injury/injuries can all significantly impact recovery at a physical level. However, impacts on other aspects of personal and social well-being are also important factors we must consider.
Psychological Impacts of a TBI
The impacts of a TBI can be associated with poorer short and long-term psychological outcomes, such as difficulties with word finding, flexible thinking, and working memory, with a greater risk of early-onset cognitive decline later in life. Managing pain from frequent headaches and migraines while feeling more sensitive to sensory stimulation (i.e., loud noises, bright lights, etc.) often reduces patience and increases levels of irritability as well for First Responders and Veterans.
The distinction between neurocognitive symptoms after a TBI from those of PTSD, for example, are characterized by persistent disorientation and difficulty with concentration in the former and re-experiencing and avoidance in the latter.
Once again, neurocognitive symptoms and criteria for psychological injuries are not mutually exclusive. The distinction between neurocognitive symptoms after a TBI from those of PTSD, for example, are characterized by persistent disorientation and difficulty with concentration in the former and re-experiencing and avoidance in the latter. In this example, neurotrauma from a TBI can exacerbate signs of PTSD in First Responders. Likewise, symptoms of PTSD for First Responders can intensify those of a TBI.
TBI and Breakdowns in Social Connection
Families typically share the strains of service-related injuries, acting as potential sources of support or stress to the First Responder or Veteran. As stress on the family consumes emotional resources, their capability to offer the support necessary to foster resiliency begins to worsen and are likely to further exacerbate the symptoms a First Responder or Veteran are already experiencing.
As stress on the family consumes emotional resources, their capability to offer the support necessary to foster resiliency begins to worsen and are likely to further exacerbate the symptoms a First Responder or Veteran are already experiencing.
Recall that TBIs are frequently not identified and, therefore, not diagnosed or treated. This means that not only is the First Responder or Veteran unaware of the injury/injuries, but neither are their family. This can increase frustration at home, with the First Responder or Veteran experiencing chronic symptoms, and both them and their family not understanding why they have changed. Clear as mud? This often result in breakdowns of communication, physical withdrawal, and increased emotional isolation from social networks that could otherwise have provided needed support.
Brain Injury Treatment & Recovery
Interventions should address not only the limitations caused by these injuries but also identify strengths that can be further developed. For example, teaching compensatory strategies through cognitive rehabilitation and emotional regulation with possible modifications in the home may all comprise a rigorous treatment plan. However, it is important to reiterate that this does not necessarily reduce symptoms of other presenting difficulties, such as those from traumatic events. For example, although PTSD shares many similar symptoms to a TBI, both require collaborative yet independent treatment from a suitable therapist and neurologist.
