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Traumatic Brain Injury - Miserable Minority

Robert Karns

The term "mild" in a mild traumatic brain injury (mTBI) is misleading. Mild refers to the severity of the initial trauma not the severity of the result of the injury. Survivors of Mild traumatic brain injuries that suffer continuing symptoms that don't resolve - persistent post-concussive syndrome are known as the "miserable minority".

Recovery from a mild traumatic brain injury is a slow process.

Some suggestions to aid in recovery are as follows:

  • Create the best possible environment for recovery - caffeine, alcohol and nicotine can affect the person with a brain injury much more than it did before the injury.
  • Allow more time to complete things - fatigue, attention and memory issues can cause delays in completing tasks that were easily done before the injury.
  • Professional help is important - getting the proper medical attention is important including working with a cognitive rehabilitation therapist.
  • Support groups - it is important to identify traumatic brain injury support groups in your area and attend them for help.
  • Rest - It is very important after suffering a traumatic brain injury to get as much rest as possible.

Recovery may be slower among older adults, young children and teens. In addition, those who have had a prior mild traumatic brain injury are also at risk of taking longer to recover if they have a second injury.

There are scientific reasons why a mild traumatic brain injury victim does not recover fully. A person in an automobile accident that is struck from behind will have their head and neck snap back and forth causing the brain to move forcefully back and forth inside the skull. This would be classified as a mild traumatic brain injury based upon the severity of the force. However, what can occur scientifically is that the brain cells (neurons) connected by axons can be severed causing brain injury. This injury is known as diffuse axonal injury (DAI) and causes white matter damage to the brain. This type of injury is microscopic and difficult to diagnose and can sometimes be seen on an MRI using diffusion tensor imaging techniques. Brain injury survivors with this type of injury can in fact suffer persistent post-concussive syndrome and not make a full recovery.

Estimates of traumatic brain injury survivors with persistent post-concussive symptoms know as the "miserable minority" have been anywhere from 15% up to 25%.

Young children suffering a traumatic brain injury present a very difficult situation. Cognitive problems a young child will have multiply as they are unable to learn as they did before the injury causing them to become further behind not only in their recovery but their ability to learn.

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