The invisible injury
By Cheryl K. Miller
In October 2000, my sister Rhonda did something she's done a hundred times
before. She crossed the street in front of her office. That simple act on a
beautiful fall day changed her life forever. While crossing Washington Street
in Madison, Wis., she was hit by a Honda Accord going 35 miles per hour. Her
unprotected head bore the brunt of the trauma. Rhonda's head slammed into the
car's windshield, fracturing her skull, then she tumbled to the concrete, with
two broken legs. Curled into a fetal position on the pavement, Rhonda had no
way of knowing that she'd soon be counted among the two million Americans who've
suffered a Traumatic Brain Injury (T.B.I.).
The soft tissues of a brain are terribly vulnerable to injury from something
as simple as riding in a car, on a bicycle, motorcycle or horse, playing a sport,
crossing the street, or falling and hitting one's head. Despite the fact that
this injury is so common, with almost 5.3 million people living with a permanent
disability from T.B.I., most people have never heard of it.
This "invisible injury" is especially prevalent if you're a young
man between the ages of 15 to 24, someone over 75, or a child under the age
of 14. The Centers for Disease Control (CDC),
http://www.cdc.gov/, in Atlanta monitored emergency room visits in the year
2000 and discovered that 400,000 were for head trauma. Over 3,000 children under
the age of 14 died from a head trauma.
With two million people a year being affected by head injuries, this is eight
times more than the number of diagnoses for breast cancer and thirty-four times
more prevalent than the number of people diagnosed with HIV/AIDS, according
to the Centers for Disease Control. This epidemic of brain injuries cost an
estimated 56.3 billion dollars, in direct and indirect costs, according to a
research study conducted in 1999 by Dr. D.J. Thurman for the CDC.
With my sister's accident, my family entered the murky world of traumatic brain
injury. Since the accident, Rhonda was left with only ten percent of her vision
and will live the rest of her life with short-term memory problems, cognitive
processing problems and difficulties with her judgment and concentration. Her
greatest frustration comes from knowing she used to be able to do simple tasks
that now seem totally beyond her reach and ability.
After two years of hospitals and rehabilitation centers, my sister now lives
in a group home with other adults who have also experienced T.B.I. Every day
Rhonda wakes up to check her "Memory Book" checklist: "Take a
shower, get dressed, eat breakfast, brush teeth, check clothes in mirror before
you go to work." Checking her list is critical. One day Rhonda forgot to
change out of her pajama top and went to work in it. That's the embarrassment
of a brain injury. You don't remember that people don't wear pajamas to work.
Also recorded in Rhonda's Memory Book are each day's events. Because she's lost
the use of her short-term memory, all events, both happy and sad, mundane and
tragic, don't stay in her head. Rhonda says this loss has its uses. She can
watch a movie over and over, and it's new every time. Also, if someone hurts
her feelings, causing her to cry, the next day, she has no memory of the hurt.
My family is not the only one in America to have gone through the trauma of
having a family member experience the changes that occur after a T.B.I. Almost
two million other families have been where we've been with Rhonda. Alice Brown,
a teacher, suffered a brain injury after she was thrown from her horse. Despite
the fact that she even had experience working with disabled children, Brown
took a long time to recognize her own symptoms of brain malfunction after her
accident. Retelling her journey to acceptance of her disability, Brown wrote
a book called Amazing Lady, There is Life After Brain Injury. Often
victims of a T.B.I. can lose their sense of smell, their ability to hear, or
may have a complete change in their personality.
Depending upon the extent of injury, many T.B.I. patients end up living in a
group or residential treatment center for the rest of their lives.
There are several possible levels of injury to the brain, ranging from mild
to severe. Many people who have suffered a mild T.B.I. go back to living a normal
life, with adjustments for whatever losses they suffered from their injury.
Claudia Osborn, M.D., returned to medicine in a teaching role, rather than as
a physician, after being thrown headfirst over the handlebars of her bicycle.
She details her adjustments and her eventual acceptance of her limitations in
her book Over My Head.
Hundreds of concussions, a common brain trauma, occur on football and soccer
fields, on basketball courts and in hockey arenas across the country every year.
A recent research project was completed studying concussions in high school
athletes in Pennsylvania, Michigan, Illinois and Oregon. Almost 78 percent of
the athletes who had experienced a concussion played football. Eight percent
in the study were soccer players and five percent were basketball players. The
average age of athletes studied was 15.8 years old and 92 percent were male.
Researchers discovered that players who experienced a concussion were usually
prone to experience the symptoms of post-concussion syndrome: headaches, nausea,
and fatigue.
Research into sports-related concussions is a new discipline in athletics. The
National Football League, which only recently began reporting concussion
injuries, accounted for 600 last year. Citing an increase in head injuries,
the National Hockey League recently formed the Injury Analysis Panel to study
equipment, rules, environment, and the affect of concussions on hockey players.
The tragedy of a T.B.I. and its effects are that it's often a simple thing to
prevent. Take the simple act of wearing a safety helmet. In 2000, the National
Highway Traffic Safety Administration reported 2,862 motorcyclists died
and approximately 58,000 were injured in highway crashes in the United States.
When motorcyclists were injured while not wearing a helmet, they were 40 percent
more likely to suffer a fatal head injury. A University
of Michigan study found that unhelmeted motorcycle riders who were injured
paid 20 percent -- or $6,000 -- more in hospital costs than those who wore helmets.
Helmets are so critical to the protection of the brain, especially for skiers
and snowboarders, that Dr. A. Stewart Levy, a brain injury researcher in Colorado,
started a program that distributes thousands of free helmets on ski slopes.
A research study by Dr. Levy discovered that helmets reduce the risk of brain
injury as much as 75 percent. The need for helmets was highlighted by the recent
death of Congressman and former entertainer Sonny Bono, who died of a head injury
after hitting a tree while skiing.
Unfortunately, the long-term disabilities associated with a T.B.I. are often
devastating, both to the victim and to their family members. In 1995, Rhett
White was a star pitcher on a championship baseball team in Alabama. Finishing
out his senior year in high school, Rhett had committed to play baseball in
college on scholarship.
As Rhett and three of his teammates were returning from attending a college
baseball game, the driver lost control of his vehicle and flipped the SUV into
a ditch. Rhett was thrown from the vehicle and suffered severe internal and
head injuries. Afterwards, he was airlifted to University Hospital in Birmingham,
Ala. Given less than a ten percent chance of survival, the trauma surgeon went
to work to save Rhett's life. During a two-week coma, doctors were pessimistic
about Rhett's recovery. Despite the pessimism, after a month in the hospital,
Rhett was able to return home.
"When we first got home, it was like he was starting all over again from
about age three," said Rhett's mom, Peggy Holland White. "Rhett's
recovery continues even today, seven years later. He struggles with short-term
memory problems, with difficulty getting his thoughts into words, with an inability
to see the 'big picture,' has experienced some personality changes, and now
has hair-trigger emotions and seizures." Rhett has repeatedly tried to
make a comeback in baseball, but has failed because of several other baseball-related
injuries. He has a hard time keeping a job and suffers from depression. "As
his parent, it breaks my heart to see him struggle," said White. "It
is hard to imagine what it must be like to actually live with the effects of
this every day."
Brain injury is "the invisible injury" because it's often not apparent
when you first meet a person who's experienced a T.B.I. My sister looks exactly
the same, yet the differences in her are very apparent when she repeats the
same story for the third time in fifteen minutes or she repeatedly says, "I
can't remember."
Researchers continue to look for ways to help my sister remember and to help
her brain recover from injury. A recent University of Pennsylvania School of
Medicine study published in the October 2002, issue of Neurosurgery
found some encouraging results towards a solution after injecting embryonic
stem cells into brain-injured mice. The mice didn't perform better on cognitive
tests, but on physical tests the mice showed marked improvement.
Study author, Tracy McIntosh, reported "The study may ultimately have implications
for the millions of human beings who have had traumatic brain injuries."
But, he adds, he is encouraged because mouse and human brains behave similarly
when injured. "Treatment for humans is many years away and there currently
is no known treatment to restore damaged areas of the brain," said McIntosh,
who directs Penn's Head Injury Center.
In a related effort to help prevent head injuries from car, bike and motorcycle
accidents, Australian researchers are working on a headband that will protect
the skull and brain from damage during accidents. Professor Jack McLean, from
Adelaide University's Road Accident Research Unit, developed and tested the
headband, which looks similar to those worn by tennis players. Recent tests
showed that it offered significant protection from injury in accidents.
Not every brain injury has a tragic ending, however, in October 2002, a Post-Standard
writer, Jennifer Jacobs, reported on the case of Syracuse University student
Lisa Ellis. About a year ago, Ellis was in a hospital with a brain injury after
being knocked fifty feet in the air by a hit-and-run driver. This year Lisa
will finish a bioengineering degree on time, despite being sidetracked into
the world of "rehab," where she learned to walk, talk and think again.
Despite her dramatic recovery and reentry into school, Lisa has nevertheless
discovered that she doesn't have the same stamina and carries medication to
curb the constant headaches she's experienced since the accident. Relying more
on written reminders and taking twice as long to study, Lisa remains determined
to overcome the losses she's experienced.
As difficult as it often may be, Traumatic Brain Injury doesn't mean the end
of life. My sister Rhonda has a message she'd like to give the rest of the world.
"I wish people would treat me as a person, instead of always focusing on
my disability."
I agree. My sister is one of the most optimistic, incredible people I know,
one who has successfully overcome the tremendous challenges she's faced these
past several years. In a manner that has inspired others, Rhonda worked very
hard, got out of her wheelchair, then her walker, then dropped her canes behind
to walk unaided. In being an eyewitness, I, for one, know miracles are still
possible. A Traumatic Brain Injury doesn't mean the end of the world. It's just
a different world for people like Rhonda and Rhett.
###
For Further Information on T.B.I.:
Over My Head, by Claudia L. Osborn, M.D. which details a medical doctor's
personal experiences after a bike injury.
Where is the Mango Princess? by C. E. Crimmins, a wife's story after
her husband was injured in a boating accident.
Confronting Traumatic Brain Injury: Devastation, Hope and Healing by
William J. Winslade and James S. Brady. (Brady was injured in the Reagan assassination
attempt.)
Please contact the Brain Injury Association in Washington, D.C. (1-800-444-6443)
for a catalog of resources.
###
An experienced writer, Cheryl K. Miller lives on a lake in Georgia
with her writer-husband, Steve, and seven sons.
Copyright © 2002 by Cheryl K. Miller. All rights reserved.
The Magazine’s writers welcome your feedback. Please be sure to reference the specific article in your response.
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