Sunday, August 26, 2012

Oh, that strange TBI planet

What if you could explore the direction your life would take before going there? Dip a toe in, figure out what you were in for...

After all, someone has to drive one of these...

Going into this, I wish it had been possible to orbit the mTBI planet for a few days before landing.
I would have assembled a team to explore the surface. Report on the landscape and its inhabitants. 

Today on the bridge at the kitchen table, lacking both a spacecraft and willing explorers, imagine my delight in finding that report on the Internet. A team from the NIH has already been down to the planet surface! They give an overview, rich with links to research articles. And I can buy the Starbase Fighter on Second Life for $4.13...

Hang onto something stationary, because the NIH report validates many of my observations and experiences. As revealed in the batter that will become Mary's birthday cake, something is a little haywire on the TBI planet...

What are those strange structures?
The Introduction talks about blunders and cognition traps that previous explorers fell into:
The deficits produced by mild TBI are frequently more subtle, less often recognized, and more contentiously debated than are those resulting from severe TBI ([ref]. Given the large number of persons that experience mild TBI each year, it is indeed fortunate that the majority of these individuals recover fully within the first year following TBI. However, a nontrivial minority of persons with mild TBI, with estimates ranging between 1% and 20% [ref], will develop persistent cognitive, emotional, behavioral, and physical impairments that extend well into the late (> 1 year) period following TBI.
....
Functional MRI (fMRI) studies demonstrate that mild TBI produces abnormal allocation of memory processing resources in the acute post-injury period even among persons whose objective neuropsychological performance appears relatively normal [ref]. Such abnormalities may underlie the subjective experience of difficulty with memory even where neuropsychological performance is within the normal range.
...
The findings from neuropathological, neuro-physiological, neuroimaging, and electrophysiologic studies of persons with mild TBI suggest that the traditional view of these injuries as neurobiologically trivial requires serious reconsideration.
In plain language, mild TBI is a big deal for some people. Symptoms can linger for longer than a year. Memory changes not detected by neuropsych tests can be significant.

How many of us are living with these cognitive changes? Mild TBI is underreported, so statistics are hard to come by. For a low estimate, try 1.7 million traumatic brain injuries in the US every year. Three-quarters of those are mild TBI, which leaves 1.275 million. Of those mild TBI cases if 90% resolve on their own, that still leaves 127, 500 people per year with lingering symptoms.

They go on to cite a study that shows malingering is "relatively uncommon, if not frankly rare". "Malingering" is the medical establishment's word for faking symptoms to get disability and insurance money. After a few doctor visits you would have the opposite impression. In not so many words the last neurologist I saw accused me of it. In fact, every professional I've seen for help with TBI or whiplash suggested malingering at one point or another. I was either making it up or my symptoms were not caused by the accident. This guy was the sole exception.

The NIH expedition was 7 years ago. Since then nearly one million Americans have been told we're not credible. So, when do you think the neurologists and neuropsych folks will catch up with their reading...?

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