"Mild TBI" is defined by lesser levels of brain damage,
as indicated by only brief or no loss of consciousness. Nevertheless,
mild injury is important to discuss for four reasons:
- Although the negative consequences of mild TBI tend
to disappear more or less quickly for most people who have mild
injuries, a significant minority — about 15% — continue to suffer
residuals that can be severely debilitating. This is especially
true for individuals with life styles requiring high-level cognitive
skills, such as learning and using complex information and complex
executive functions.
- Those who receive a blow to the head with brief
(or no) LOC are often sent home from the hospital with assurances
that they are "just fine". However, this may or may not be the case,
and when not the case, this misinformation about "no residuals"
may have devastating effects, as the person remains unaware of the
basis for his or her altered ability to function.
- Some individuals who have experienced a concussion
or whiplash, or a brain injury with brief LOC, do not enter the
health care system at all. In effect, they assure themselves that
they are "just fine" and don't require help. However, residuals
often emerge and often do not get attributed to the injury, leading
to the same negative effects referred to above.
- Mild injuries often occur through the physical
abuse of children/spouses or in the jarring of sporting events.
The negative effects of such injuries may not emerge immediately
in clinically detectable or functionally meaningful form, except
as the effects accumulate with repetition of the injury. The beaten
wife or the sacked quarterback may be "fine", although damage has
occurred at the neural level; negative sequelae in day-to-day life will appear unless repeated injuries are prevented.
Mild TBI can be a problem for two reasons. First, the
cognitive and other sequelae may not disappear and, in themselves,
create problems. These sequelae are often similar to those described
above with respect to moderate and severe injuries. Second, the psychological
disruption created by these consequences can add to (or occasionally
outlive) the original problems experienced after injury. One might
ask, Why is this not also a problem for people with moderate or severe
injuries?
The difference with mild brain injuries is that neither
the injured person nor his or her social network expect any
negative effects of the whiplash or concussion (or otherwise labeled
instances of a jarred or shaken head). Medical 'experts' have told
them to "go home, watch for problems, but really, you'll be just fine".
Or, the injured person has written off the blow to the head as not
even worth the effort of seeking medical help.
On the other hand, with more severe injuries, expectations
of negative sequelae are commonly held by health care providers and
by members of the injured person's social network; these expectations
are reinforced through an intense medical experience, validating that
"something bad" has happened.
What happens to the individual with mild TBI after the
injury? As Kay (1986) points out, individuals with mild injuries can
live out several possible scenarios; some are functional, others not.
Good outcomes occur whenever the dysfunctional consequences of TBI
totally and relatively quickly disappear or the individual finds ways
to easily accommodate any functional deficits that emerge and that
do not improve to pre-injury levels.
This type of recovery is predicated on the individual
with TBI being an educated consumer, i.e., having a clear understanding
that problems may occur, the type of problems to expect and that these
problems may or may not disappear, but can be accommodated.
Often the individual with a mild TBI returns to his
or her daily life after the injury with very little if any awareness
that the head injury will have ramifications -- short lived probably,
but perhaps long-term. To individuals in this situation, "out of the
blue" they notice that in big and little ways they are no longer able
to do what came easily before. "For no reason that I can see, what
I know about myself is not longer true". These inexplicable difficulties,
which are not associated with "the blow to my head", can lead the
person to feel that he or she is 'losing it'.
As was mentioned above, good outcomes for individuals
with minor TBI require their being told in very clear terms what can
be expected in the days, weeks, and months following injury. As problems
in functioning emerge, they also need to obtain assistance in learning
how to compensate for deficits, as is further discussed below.
