How many times have you hit your head, brushed it off, and went about your day? You may think nothing of it, and gratefully, that is where it ended…but what if it didn’t end there and you had sustained a serious injury that you couldn’t see or feel right away?

According to the Center for Disease Control, the CDC, 2.9 million people suffer from brain injury every year, resulting in 56,000 deaths, 288,000 hospitalizations, and 2.5 million trips to the emergency room.

Medical experts call it the “silent epidemic” because traumatic brain injuries are still not often top of mind even though they can happen at any time to anyone.

We expect TBIs to arise from car accidents, mishaps on construction sites, or major accidents, but slips and falls around the house can also pose a threat if left untreated and can have dire consequences.

The spotlight was thrown on TBI when in early 2022, Full House star Bob Saget died when he “accidentally hit the back of his head on something, thought nothing of it, and went to sleep," the actor's family said in a statement, per CNN.

What is a TBI?

A traumatic brain injury (TBI) is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. Traumatic impact injuries can be defined as closed (or non-penetrating) or open (penetrating). Examples of a TBI include:

• falls
• assaults
• motor vehicle accidents
• sports injuries

An Acquired brain injury (ABI), a non-traumatic brain injury causes damage to the brain by internal factors, such as a lack of oxygen, exposure to toxins, pressure from a tumor, etc. Examples of ABI include:

• stroke
• near-drowning
• aneurysm
• tumor
• infectious disease that affects the brain (i.e., meningitis)
• lack of oxygen supply to the brain (i.e., heart attack)

Calculating the risk

While a TBI can happen to anyone, young males have been noted to have higher incidences. Men are three times more likely to have a traumatic brain injury with those between the ages of 15 to 25 at the highest risk. Most of the risk comes from road traffic accidents, sports related injuries, and falls

Sixty-four percent of severe TBI is caused on the road and affects drivers, passengers, pedestrians, motorbikes, and cyclists and 36% relate to all other causes including assaults, falls, sports/recreation, and gunshot.

It’s general knowledge that the brain is a very delicate and sensitive organ protected by the skull. The brain comprises nerve cells and fibers that are the consistency of ‘al dente’ spaghetti and has two hemispheres that control the opposite sides of the body. The brain is also divided into four areas, or lobes, namely the frontal, temporal, parietal, and occipital lobes. Everything we do depends on these areas working together and the nervous system that controls the functions and activities of our bodies.

A TBI can arise from the brain being impacted and bruised by the bony surface of the skull or the nerves twisting or stretching. This happens in acceleration/deceleration injuries in which the head is in motion, then abruptly comes to a halt.

For example, if a car crashes and suddenly stops and the driver’s head hits the steering wheel. The brain within the skull still has forward momentum and can hit the inner surface of the skull with some force, resulting in bruising, lacerations, and bleeding. This kind of TBI is called a closed head injury because the injury occurs within the skull.

Another TBI, the penetrating head injury occurs when an external object pierces the skull and comes in direct contact with the brain. A penetrating injury can be caused by high-velocity projectiles like gunshots or objects of lower velocity like knives or bone fragments from a skull fracture that is driven into the brain. Penetrating head injuries have a mortality rate of over 90%.

Debunking the Myths

TBI has been sorely misinterpreted and misrepresented in the media. We have all watched shows where a character awakens in a hospital bed, groggy but lucid asking for chocolate milk.

In reality at the point of injury, a person will exhibit an altered state of consciousness which may include a coma. The length of unconsciousness can be measured on the Glasgow Coma Scale. As people emerge from a coma they go through a period of post-traumatic amnesia (PTA) during which the person is not oriented to time, place, or person and may display disinhibition, irritable or agitated behavior.

Not all TBIs result in a coma or loss of consciousness, mild TBIs can result in confusion and a few minutes of disorientation. But even a concussion while playing football with friends ought to be checked out by a physician.

The Recovery Curve

TBI recovery has many highs and lows. Recovery can be fast-paced during the first six to nine months post-injury with the TBI survivor recovering physical, language, and other functional abilities. But after two years the recovery plateaus and slows down significantly. After the plateau, improvement can still happen but this will be through a process of adjustment and developing strategies to compensate for remaining disabilities.

There are three stages to TBI rehabilitation. Rehabilitation is not recovery but an active learning process that creates the best environment for the TBI survivor to make the most of recovery which happens spontaneously.

The first stage is Acute Rehabilitation which involves ensuring that the person is medically stable in the Intensive Care Unit and high dependency wards. This usually occurs in a hospital with a strong focus on physical recovery and regaining basic independent living skills.

This is where Andrea’s Angels Independent Living Skills Trainers (ILST) come in. Everyday in Northglenn and Greeley Colorado, ILSTs from Andrea’s Angels assist TBI survivors with their recovery, helping them make strides towards regaining their independence and finding new ways of working around permanent limitations.

TBIs are for the most part unpredictable and we always hope that anyone affected by this condition pulls through, even though life will change dramatically. Recovery is possible and chances of returning to a semblance of normal increase with the help of trained professionals, a supportive family, and a fighting spirit.