An estimated 85% of veterans have experienced a traumatic brain injury (TBI) during their time in service. A TBI is a physical injury caused by trauma such as a blow to the head, a fall, a motor vehicle accident, or a blast from an explosion. The trauma causes the head and brain to move quickly back and forth which, depending on the severity, can lead to bruising of the brain, damage to nerve tissue, or internal bleeding. TBIs are considered invisible wounds because while many of the symptoms may be physical, they are not all visible.
There are many misconceptions about TBI, its effects, and how these can be treated. By exploring a few myths about TBI, the Emory Healthcare Veterans Program team wants to emphasize that it is possible to heal invisible wounds through evidence-based treatment.
Myth: You can’t tell how severe a TBI is, so all head injuries should be considered equally serious.
Fact:
TBIs are classified into two types (closed or penetrating/open) and three severity levels: mild, moderate, or severe. Most TBIs (70-90%) are mild in severity and are commonly known as concussions. Penetrating TBIs or “open head injuries” are rare and occur when the skull is penetrated, such as with a fracture or via a projectile.
Severity of the injury is determined based on a number of criteria, including level of responsiveness after the injury and, among other factors, how long someone is unconscious or in an altered state of consciousness (e.g., feeling dazed and confused). In some mild cases, you may not lose consciousness at all but instead experience temporary confusion, headaches, nausea and dizziness.
Because TBIs vary in severity, it is essential to seek medical attention following any head injury to learn about your expected recovery and what, if any, treatments may help improve your functioning.
Myth: TBI symptoms are only physical.
Fact:
Not all symptoms of TBI are physical.
Physical symptoms may include:
- Headaches
- Dizziness
- Sensitivity to light or sounds
- Blurry vision
Mental (i.e., cognitive and emotional) symptoms may include:
- Difficulty remembering new information
- Irritability and moodiness
- Difficulty thinking clearly or concentrating
- Nervousness or anxiety
- Sleeping more or less than usual
Myth: If you don’t get treatment after a TBI, there will be permanent damage.
Fact:
Medical intervention is not necessary for most TBIs since most fall in the mild range of severity. The recommended treatment for a mild TBI/concussion is rest and a gradual return to typical activities, and symptoms resolve within a few weeks for the vast majority. However, some people have longer-lasting symptoms called “post-concussion syndrome” (PCS). PCS is not a result of permanent damage but rather an indicator that other underlying issues have interfered with an individual’s recovery. Consultation with a knowledgeable health care provider can help you identify any issues that could be impacting your recovery and learn about appropriate treatment recommendations.
Myth: TBI from blast exposure is worse than TBI from other events (e.g., fall, car accident).
Fact:
Blast exposures are the most common source of TBI trauma for military personnel. Although blast injuries are associated with greater hearing loss than other causes of TBI, they are not inherently more or less severe than other trauma sources.
Myth: TBI symptoms get gradually worse over time, and nothing can make the symptoms better.
Fact:
TBI symptoms are worst at the time of injury and they gradually improve over the six to 12 months thereafter. How well someone recovers from a TBI depends on how severe the injury is.
A full recovery is expected after a mild TBI, but getting enough rest and gradually returning to physically and cognitively demanding activities in the days to weeks after the injury can help maximize the recovery process. If symptoms persist for more than a year or gradually worsen over time, that usually indicates that there is another underlying problem that needs to be addressed.
Myth: TBI symptoms may appear several years after a head injury.
Fact:
Symptoms of a TBI onset within 24 hours after the traumatic event or following medical complications associated with moderate to severe injuries (e.g., seizures, brain bleed). Some people may not immediately recognize subtle changes to their mood or thinking skills until they resume their typical daily activities. However, symptoms do not spontaneously appear years after the injury. If you have experienced a new onset or worsening of symptoms more than a year after a TBI, you should consult with a healthcare provider for evaluation and treatment options.
Myth: TBI symptoms occur in “episodes,” and people can experience “good TBI days and bad TBI days.”
Fact:
Regardless of severity of the injury, TBI symptoms follow a predictable recovery pattern. They are worst initially after the injury and gradually improve over about one year’s time. A full recovery of cognitive and physical abilities is expected after a mild TBI/concussion, while people with moderate to severe TBI may or may not return to their pre-injury baseline. Unpredictable “episodes,” “flare-ups” or fluctuations in symptoms are typically due to other factors such as day-to-day stressors (e.g., family stress, poor night’s sleep) or are indicative of a change in medical status. Meeting with a health care provider can help you determine what could be causing these changes in symptoms and learn about appropriate treatments.
Myth: Once you’ve had a head injury, you can’t function normally again. You just have to accept your “new normal.”
Fact:
In the same way that you can’t “un-sprain” a sprained ankle, it’s true that you can’t “un-injure” your brain after a TBI. But, the effects of mild TBI don’t have to be permanent. Just like the rest of our bodies, our brains are incredibly resilient and inherently driven towards recovery. You can live a fulfilling and functional life again, and the Emory Healthcare Veterans Program (EHVP) can help!
EHVP offers assessment and Intensive Outpatient (IOP) treatment of TBI-related concerns for post-9/11 veterans. Interested veterans complete an initial intake assessment to determine eligibility and appropriateness for the program. Veterans deemed appropriate for the TBI track undergo a neuropsychological evaluation as a part of their IOP stay. They have a one-on-one feedback session with the neuropsychologist to discuss the results of the evaluation and are provided a written report documenting the findings, any pertinent diagnoses, and recommendations.
The providers at EHVP take a holistic approach to the treatment of invisible wounds. As such, in addition to the many available components of the standard IOP (e.g., individual and group psychotherapy sessions, wellness sessions, case management, yoga, medication review, etc.), veterans on the TBI track also participate in interventions aimed directly at addressing their TBI-related concerns. This includes an educational session with the neuropsychologist to learn the facts about TBI recovery as well as daily Cognitive Rehabilitation Therapy (CRT) sessions to learn and practice strategies aimed at improving your day-to-day functioning and helping you live the life you want to live.
