When you woke up today, you thought this was like any other Tuesday. You packed the kid’s lunches and off to school they went. You’re on your way to work and everything is on schedule- it’s a good day! You are stopped at a red light when out of nowhere, someone crashes into the back end of your car and you feel your head snap back over the headrest and then bounce forwards, almost hitting the steering with your forehead. Everything goes blank for a second or two. "What just happened?" Initially, you’re in "shock," and after checking to make sure you’re not bleeding, you notice that your neck and head are hurting in a way that’s new to you. When the police arrive and start asking you questions about what had happened, you try to piece together the sequence of events of the collision but you’re not quite sure how it all fits together. Your memory just isn’t real clear. Within the first few days, significant neck pain and headache overshadow everything else but you begin to notice that you’re ability to "think clearly" is just not quite right. Your memory seems fuzzy, you lose your train of thought easily, sometimes in the middle of a discussion, and you are tired – really tired! Taking a nap several times a day is needed. The other day, you were discussing a project with a group of co-workers and you had to ask "…now where was I?" several times during the discussion as you lost your place in the middle of a thought.
Mild traumatic brain injury (MTBI) is exactly what is described above. Many patients do not even mention these things to their chiropractor when they present after a car crash as it’s hard to describe these symptoms and many feel it’s just because they are tired or upset about the accident. When directly asked if any of these symptoms exist, the patient is often surprised and say, "…how did you know?" They are even more surprised when they learn there is an actual reason and explanation for feeling this way. Most of the time, the patient has to be asked if these symptoms exist! This is actually "normal" behavior for those suffering from MTBI.
To better understand how this occurs, think of the more catastrophic situation where the person hits their head to the point of creating an internal bleed and is unconscious. In this case, it’s easier to appreciate the presence of a "brain injury." With severe head trauma, the person usually has significant memory loss, having no memory of the accident and maybe worse, not being able to recognize family or friends. Losing the memory of days, weeks, months, or years of time is common with these severe head injuries. However, in MTBI, there is less bruising to the brain and consequently, there are less severe symptoms. Though the symptoms are similar, MTBI is in a way, a mild form of the above. With MTBI, the person does NOT have to hit their head on anything to bruise the brain. This is because the speed at which the head is propelled forward and back literally slams the brain against the inside of the skull, creating the bruising. Because the brain is suspended inside our skull, damage to some of the nerve cells occurs, most commonly the brain stem, the frontal lobe, and/or the temporal lobe. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating ("cognitive deficits"), processing information, memory, and altered psychological functions. Recognizing these symptoms and managing MTBI in a coordinated approach with a neuropsychologist is sometimes needed.
