Traumatic Brain Injury and PTSD
Traumatic brain injury (TBI)
occurs from a sudden blow or jolt to the head. Brain injury
often occurs during some type of trauma, such as an accident,
blast, or a fall. Often when people refer to TBI, they are
mistakenly talking about the symptoms that occur following
a TBI. Actually, a TBI is the injury, not the symptoms.
How serious is my injury?
A
TBI is basically the same thing as a concussion. A TBI can
be mild, moderate, or severe. These terms tell you the nature
of the injury itself. They do not tell you what symptoms you
may have or how severe the symptoms will be.
A TBI can occur even when there is
no direct contact to the head. For example, when a person
suffers whiplash, the brain may be shaken within the skull.
This damage can cause bleeding between the brain and skull.
Bruises can form where the brain hits the skull. Like bruises
on other parts of the body, for mild injuries these will heal
with time.
About 80% of all TBI's in civilians
are mild (mTBI). Most people who have a mTBI will be back
to normal by 3 months without any special treatment. Even
patients with moderate or severe TBI can make remarkable recoveries.
The
length of time that a person is unconscious (knocked out)
is one way to measure how severe the injury was. If you weren't
knocked out at all or if you were out for less than 30 minutes,
your TBI was most likely minor or mild. If you were knocked
out for more than 30 minutes but less than 6 hours, your TBI
was most likely moderate.
What are the common symptoms following a TBI?
Symptoms
that result from TBI are known as post-concussion syndrome
(PCS). Few people will have all of the symptoms, but even
one or two of the symptoms can be unpleasant. PCS makes it
hard to work, get along at home, or relax. In the days, weeks,
and months following a TBI the most common symptoms are:
Physical
headache
feeling dizzy
being tired
trouble sleeping
vision problems
feeling bothered by noise and light
Cognitive
(Mental)
memory
problems
trouble staying focused
poor judgment and acting without thinking
being slowed down
trouble putting thoughts into words
Emotional
(Feelings)
depression
anger outbursts and quick to anger
anxiety (fear, worry, or feeling nervous)
personality changes
These
symptoms are part of the normal process of getting better.
They are not signs of lasting brain damage. These symptoms
are to be expected and are not a cause for concern or worry.
More serious symptoms include severe forms of those listed
above, decreased response to standard treatments, and seizures.
Do I have the symptoms that follow a TBI or PTSD -
or both?
You
may notice that many of the symptoms that follow a TBI overlap
with the common reactions to trauma. Because TBI is caused
by trauma and there is symptom overlap, it can be hard to
tell what the underlying problem is. In addition, many people
who get a TBI also develop PTSD.
It
is important to be assessed because:
people
with TBI should not use some medications
no matter how mild or severe the injury itself was, the effects
could be serious
Although TBI screens are used, a screen
is not used to diagnose TBI. Even if your TBI screen is positive,
that does not mean that you have a TBI. It means that you
should be assessed further.
Diagnosing
a TBI is hard because there may not be any physical signs
of injury. Details of the trauma may be hard to pin down.
Sometimes right after the injury the effects are so brief
that they are not noticed. You may go to the doctor some time
later when details of the injury are not as clear. TBI can
occur in confused times of crisis, such as combat. In the
heat of events the injury may be ignored. Many of the symptoms
that can result from a TBI are the same as the symptoms of
PTSD. For these reasons, the best way to diagnose a TBI is
an interview by a skilled clinician.
Are there effective treatments?
Many
people recover from TBI without any formal treatment. Problems
that linger may clear up in a few weeks. You may notice some
problems more as you return to your normal routine. For example,
you may not realize that you get tired more quickly until
you return to your regular chores, work, or school. Even so,
people usually get better after a head injury, not worse.
Professional treatment for the symptoms that follow TBI usually
involves rehabilitation to improve functioning.
To
treat TBI and PTSD, the good news is that effective treatments
for PTSD also work well for those who have suffered mTBI.
This includes two forms of therapy: Cognitive Processing Therapy
(CPT) and Prolonged Exposure (PE). Learn more about treatment
for PTSD.
What can I do to cope?
The
best way to deal with symptoms following TBI is to go back
slowly to your normal routine, a little at a time. How much
time you spend at work, with family, with others, or exercising
depends on what feels comfortable. Pace yourself, and be sure
to get all the rest you need. Avoiding alcohol and not taking
any unnecessary medications is a good idea, to help allow
the brain to heal.
If your symptoms get worse, or if you
notice new PCS symptoms, this is a sign that you are pushing
yourself too hard. Ignoring your symptoms and trying to "tough
it out" often make the symptoms worse. Symptoms are your
body's way of giving you information. A broken bone or a torn
muscle hurts so that you won't use it and it has time to heal.
PCS symptoms are your brain's way of telling you that you
need to rest it.
Research
suggests that 1 week of relaxing at home and then a week of
slowly doing more after leaving the hospital is best for most
patients. Most patients who took this advice were back to
normal at work or school in 3-4 weeks. Most patients who weren't
told what to do took 5-12 weeks to get back to their normal
routine. They also had more PCS symptoms than patients who
returned slowly to their routines.
Accept and deal with the stress of the injury
Be
aware that having a head injury adds more stress to your life,
not just bumps and bruises to your head. The trauma itself,
being in the hospital, and going back to work or school and
normal routines are all things that add stress to most patients'
lives. You may have some trouble with work or school at first,
and even though it is normal, this may be stressful and frustrating.
Another
main cause of stress after a TBI is worry about the symptoms
you have. Thinking and worrying about your symptoms can make
them seem worse. Doctors who treat TBI agree that the single
most important factor in recovery is that you know what to
expect and what to do about the symptoms. You should remember
that the symptoms are a normal part of getting better. They
will likely go away on their own.
Involve Family
Any
level of TBI can disrupt families. Roles and responsibilities
change when a family member is hurt. From the start, families
needs to be involved and informed about TBI. By supporting
the family, patient outcomes can be improved and burnout prevented.
Return to school or work slowly
Returning
to school or work is often the biggest challenge after TBI.
This is because PCS symptoms can get in the way of meeting
your work and school demands. For example, trouble focusing
and memory problems may make it harder to learn new things
in school. Or fatigue may limit your being able to handle
work demands. Keep in mind when trying to return to work or
school that the process will be slow. Don't expect yourself
to perform right away as you did before your TBI. Instead,
you should slowly resume responsibilities as you are able.
Slowly increase your workload and hours. Only increase them
when you feel fully ready.
TBI and Veterans
The
conflicts in Afghanistan and Iraq (OEF/OIF) have resulted
in increased numbers of Veterans who have TBI. The main causes
of TBI in OEF/OIF Veterans are blasts, motor vehicle accidents,
and gunshot wounds. The Department of Defense and the Defense
and Veteran's Brain Injury Center estimate that 22% of all
OEF/OIF combat wounds are brain injuries. This is compared
to TBI in 12% of combat wounds that occurred in Vietnam.
Veterans seem to have symptoms for
longer than civilians. Some studies show most will still have
symptoms 18-24 months after the TBI. Also, many Veterans have
more than one medical problem, including: PTSD, chronic pain,
or substance abuse. From 60-80% of service members who are
hurt in other ways by a blast may have a TBI. These other
problems make it harder to get better from any single problem.
Veterans should remember, though, that their TBI symptoms
are likely to last only a limited time. With proper treatment
and healthy behaviors, they are likely to improve.
VA
is working to make sure that TBI care is easy to access. VA
is using a TBI screening tool to begin the assessment process.
VA has put in place the Polytrauma System of Care to treat
Veterans with TBI who also have other injuries. Veterans with
the most severe wounds are being treated at one of the 4 Polytrauma
Rehabilitation Centers or one of the 21 Polytrauma Network
Sites. Patients with less severe wounds may get treatment
at local VA Medical Centers. No matter where a Veteran goes
first, there is no "wrong door" for treatment.
Back
to the Top
Sources
Traumatic
brain injury: A guide for patients. (n.d.). CogSMART, VA San
Diego Healthcare System. Accessed at: http://www.mentalhealth.va.gov/docs/tbi.pdf.
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