Recognize brain trauma to stop its progression:
How to help your patients and their families

ADHD



By James F. Zender, PhD




After 15 years as a clinical and forensic psychologist specializing in the treatment of auto accident trauma cases, I have come to appreciate the complexities posed by the often-missed diagnosis of mild traumatic brain injury. The recent movie, Concussion highlighting NFL football players’ brain injuries, is a game-changer for the general public. Even many health care professionals, however, don’t fully grasp how vulnerable the human brain is to injury, sometimes with devastating consequences.

It’s telling that health care providers treating auto-accident survivors still ask if the patient suffers from a traumatic brain injury (TBI). In fact many noted neurologists believe that every person who has been in an auto accident has a TBI: it is just a matter of severity. The g-force imposed on brain tissue and neuronal connections is a disruptive force of varying degrees, resulting in direct structural changes like axonal shearing and neurometabolic impairments. The resulting impairments can manifest in these ways:

But what is often overlooked is that these injuries may manifest slowly as trauma to the brain unfolds after the accident.

Patient presents with broken jaw from a high-speed, rear-end impact
To fully understand how my patient would only have a broken jaw, an engineer described how kinetic energy from the g-force of the impact traveled through the vehicle’s material structure and then the patient’s body to focalize at a particular point in the jaw. While forensic engineers from MIT develop computer models to predict physical injuries from such forces, myriad uncontrolled variables make this extremely difficult. Such engineering experts were used by the defense against the patient’s claims of injury, but the patient prevailed.

Patient presents with severe spinal injuries, while spouse sitting next to him is uninjured
Another patient was reading a book in the front passenger seat when the car was rammed from behind at high-speed. The passenger suffered severe spinal injuries, requiring surgery. But the driver was unscathed. It was difficult for the husband and wife to understand the dramatic difference in severity of injury while they were seated next to each other. Having his head down reading a book may have been the deciding factor given body physics and positioning as the energy passed through the body.

Forensic neuropsychologist in minor rear-end accident presents with disorganized cognition for several months
It appeared to be a minor rear-end accident, but the forensic neuropsychologist whose car was struck was perplexed to discover difficulty organizing himself for the next six months. He just didn’t feel like himself: Even a neuropsychologist had difficulty understanding why everything seemed difficult for him until accepting his brain had been injured. He could then stop fighting and allow himself to heal.

Teen in a severe roll-over suffers from brain fog for several years
A teenage patient was deemed lucky to be alive after his new car flipped over several times after an intoxicated driver crossed the road divider and crashed into him. In addition to some broken bones, he described experiencing a constant brain fog for the next three years. For more than a year, he refused to accept that more than his bones were broken. He slowly came to appreciate his brain injury, which continued to manifest in signs of severe cognitive compromise: being unable to do many of the higher-level functions he routinely performed before the accident.

Referring patients to psychologists familiar with auto accident/occupational trauma and mild traumatic brain injury can help with the correct diagnosis of mild TBI. Unrecognized TBI may seriously complicate recovery.

Proper diagnoses provide clinical context of behavioral and personality changes, enabling more accurate interventions. Decades of treating brain injuries from auto and other occupational injuries shows: The more serious the traumatic brain injury, the more patient denial exists. Often family members will fall into denial, too, which further complicates professional awareness of the problem. Recognition and proper education and clinical support can be the key to greater success for everyone involved in the long road to recovery for patients with mild traumatic brain injury.

James F. Zender, Ph.D., is a Detroit-area clinical and forensic psychologist specializing in auto accident trauma psychological services for half of his 30-year career treating psychological trauma. Helping patients with traumatic brain injuries become aware of their areas of compromise and finding adaptive solutions to impairment, restoring confidence and self-worth, is especially rewarding.

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