Mild to moderate traumatic brain injury
A lot of people get traumatic brain injury — estimates are 600,000 per year in the United States. Often this happens from car accidents, including relatively "minor" accidents. The most common result is that you have "brain fog": lower concentration, trouble reading, mental slowness, often sleep disruption. Often vision is "not right," with sudden loss of reading speed, comprehension or comfort; depth perception may be dramatically worsened.
Getting poor sleep because of sore muscles from whiplash injuries makes the effects of any mild brain injury much worse. The hard part is that you look normal to friends, family, and your doctor. If you keep complaining, people will often think you're depressed or just a complainer. Not so.
We have treated several hundred people over the years using a variety of cognitive and emotional rehabilitation methods, including neurofeedback, cognitive behavior therapy, and binocular vision training.
Assessment
We discuss your history, your level of accomplishment before your injury, any intellectual testing you might have had before the injury. If you haven't had intellectual testing since the injury, we may refer to a neuropsychologist for memory and cognitive testing, depending on what appears necessary. Neuropsychological testing may be helpful, although it may show a person as "normal" who in fact had a higher IQ and/or memory capacity before injury.
When treatment is desired, we will use a quantitative EEG to assess the levels of abnormal electrical activity that is present. The QEEG is very sensitive to signs of mild brain injury (95%) and fairly specific (90%), although we do not attempt to use it as "proof" of an injury in litigation.
What is actually happening in TBI?
Traumatic brain injury typically occurs when the head is suddenly accelerated and/or decelerated during an accident. There may or may not be unconsciousness, or even a blow to the head. A severe whiplash situation can cause the same kinds of twisting and shearing forces on the brain's axons — the nerve fibers connecting one part of brain to another — as does a blow to the head. It is thought that these forces damage the connections between nerve cells and possibly the conducting fibers themselves, resulting in impairment of function.
TBI patients can have emotional instability, impaired concentration and memory, and reductions in the ability to multi-task. Patients with brain injury often show a dramatic drop in coordination of the two eyes — measured as a relative failure of the eyes to converge and/or diverge rapidly and accurately. This results in decreased reading speed and comprehension and decreased depth perception. Patients often feel "clumsy," disoriented in space. This is obviously dangerous and predisposes to further injuries.
Traumatic brain injury is one of the most underestimated clinical challenges in modern medicine and psychology. It is underestimated in its prevalence — millions of people are living with its effects who have never been formally diagnosed or treated. It is underestimated in its subtlety — the microscopic damage, termed "diffuse axonal injury" is usually not visible on standard MRI imaging and undetectable on routine neurological examination. And it is underestimated in its meaning: it takes not just function but identity, not just capacity but the felt sense of being a coherent, continuous self.
Treatment
It is terrible, but true that even today healthcare providers appear to be unaware of neuroplasticity , which refers to the fact that the demand of new learning provokes brain to create new connections and strengthen old ones. Tragically, we continue to see patients who have been told by licensed healthcare professionals that when a year or two has passed after an injury that they will "just have to adapt, get used to the impairment that is left after the so-called "spontaneous recovery period". We've known about neuroplasticity for several decades now. The brain responds to new learning. We use neurofeedback to restore more normal communication between affected parts of brain. Frequently there is poor connectivity — low coherence, slowed phase, and unsteady synchronization. Neurofeedback improves these signs of connectivity and with them the subjective sense of alertness, attention, and normal thinking. Neurofeedback is coupled with binocular visual training and cognitive behavior therapy.
The most profound thing a patient has ever said to me — and I've happily heard this from TBI patients many times over four decades of clinical practice — is this: "I'm starting to feel like myself again." Not "I feel better." Not "the symptoms have improved." Not "I'm functioning more normally." Those things may all be true as well. But what the patients say, consistently and often with tears, is that they have recovered something they thought was gone. Not symptom relief, not just healing. A self.