Symptoms of brain injury (and helpful tips to cope)
Welcome to the last week of Brain Injury Awareness Month (UK calendar). Today I would like to talk about the symptoms of brain injury and how to manage them. First, there are two categories of brain injuries: traumatic and acquired. Traumatic brain injury is sudden trauma to the head that is caused by an external force. This can be anything from car accidents, to physical assault, to falling on slippery or uneven surfaces. Acquired brain injury is injury sustained as a result of a neurological illness. This includes brain tumors, heart attacks, strokes, and other illnesses. Despite the varying categories, the symptoms are usually the same. The common ones that are familiar to most people are headaches and physical fatigue. But there are other lesser-known symptoms. You may know about them, but you may be unaware that they are related to brain injury. These include anger, irritability, lack of a filter, and sensitivity to light and sound.
There is also neuro fatigue. This is the mental fatigue that comes from thinking, and absorbing information from your surroundings. When you have a brain injury, your healthy brain cells bypass the injured cells, in order to communicate with each other. This means it takes longer for you to react to things. It also requires more energy, meaning you get tired faster. If you are in a crowded area (supermarket, bus stop or social gathering), it becomes more challenging. You may find yourself trying to process everything from what people are wearing, to picking up on their conversations, all while trying to keep track of your shopping list. While this may be simply distracting to a healthy person, for a brain injury patient, this can easily lead to overstimulation and neuro fatigue. This is why advance planning is important.
When you have neuro fatigue, everything takes energy, including tasks that traditionally refreshed you. So instead of feeling energized after a shower, you may find that you need to rest in between getting dressed and having breakfast. These breaks need to be taken as needed throughout the day. When you know how much time you take for certain activities, it gets easier to plan how much rest you need. The key to managing neuro fatigue is to rest before you get too tired. Otherwise, if you push yourself beyond your regular limit, you could find yourself exhausted for days at a time.
As a patient, the mental fatigue gets worse when you are in a crowd. Since social gatherings are impossible to avoid altogether, they require an exit plan. Before you attend an event, especially if it is longer than an hour or two, kindly notify your host that you need to leave early. If it is an event with flexible timing, you can arrange to go at a later time, when some guests have left. This arrangement can lead to assumptions that you are snobbish, but this is not true. The longer you stay in a crowd the more information you absorb, so if you plan on making it home safely, you need to protect yourself.
So, what can you, as a friend or family member, do to help? As mentioned in an earlier post, the first year of recovery from a brain injury is when progress happens quickly. This requires lots of rest and minimal stimulation. Social activities such as talking on the phone, or lengthy face-to-face chats may be taxing, especially if memory and concentration are still a problem. So, in the beginning, you can start by texting. This reduces the amount of information that the patient needs to remember. If they lose their train of thought mid-sentence, they can look at the text and try to remember. Creating simple to-do lists also helps with staying on track. The more familiar the routine, the easier it will be to stick to. The goal here is to reduce the number of things the patient needs to remember.
Managing mental fatigue is also a priority, because patients cannot always be around their loved ones. To the general public, who are casual observers, these symptoms can be mistaken for disorderly conduct. Signs of neuro fatigue include irritability, loss of balance and coordination, aggressiveness, forgetfulness and feeling disoriented. At its worst, a patient can forget where they are, how to get home, or even their names.
To help with this, some charities have created a brain injury ID. This wallet-size card contains the patient’s name, an emergency contact’s name, and their phone number. In case a patient is unable to communicate, this card enables the next of kin to be notified. It is helpful in reducing misunderstandings with police, and in case a medical emergency happens away from home, medical services can notify the patient’s family. In the US, they are issued by the Brain Injury Association of America. They have branches in more than 30 states. In the UK, they are issued by Headway. Unlike the US one, the Headway version has the patient’s photo, and explains the nature of their injury.
Also, although it may seem obvious, please be emotionally supportive of your brain injury patient. Many times, brain injury creates a communication barrier between patients and their family and friends. It can create personality changes, and patients may withdraw from social activities while they learn to adapt to the new symptoms. When friends and family don’t know how to react to the patient, the first instinct is to withdraw from them. When there are several of you dealing with a single patient, you can create a schedule. This may involve making a rotating visiting schedule, such as stopping by on specific days. This takes some pressure off the primary caregiver, while also dealing with the emotional effects of the brain injury together.
Brain injury is called a silent epidemic. This is because unless you or someone you know has one, it is rarely talked about in public. In fact, many people will be surprised that it has its own ribbon. Just like we have the pink ribbon for breast cancer, and the red one for AIDS, the ribbon for brain injury is dark green. It has two months for awareness: for the US calendar, it is in March (to coincide with St. Patrick’s Day), while in the UK, it is in May.
Conversations about brain injury are usually between patients, their doctors, and their close family. But it doesn’t have to be this way. The more awareness we create, the less stigma there will be. Brain injury can happen to anyone. The more we talk about it, the easier it will be to seek help. Thank you for your support in spreading awareness this month. Let us keep the conversation going year round.
