The Golden Hour (Scene 1)August 2012
Lesson 1: What is traumatic brain injury
Rebuilding a Life
Injuries do not always appear traumatic in the moment that they occur. For example, most of us have probably slipped or fallen on ice at least once during winter, and since it is such a common incident, it was likely brushed off and not given much thought. However, these seemingly minor events can have significant long-term impacts much like those expected of more striking accidents. So while falling or slipping on ice may not seem as daunting as a car accident, both can have very real implications for an individual’s quality of life.
Maria Gomez* awoke one February morning and left for work. The precipitation from the night before had created invisible patches of ice hidden beneath a wet sheen of rain.Maria slipped on a patch of ice and fell in front of her house. “I stepped on the curb and slipped in this very strange twist, and my head hit the curb” she said about the incident. No one saw the incident, so it is unclear if she lost consciousness, but soon after the fall Maria was back on her feet, seemingly unharmed as she continued on to work. Maria works as the executive director of the Palette, a community art studio and habilitation center she founded in 2007. During her normal routine that morning, Maria became disoriented and was unable to continue teaching her class. “I was going to do a marimba class with the staff and we started playing and the sound just brought me to my knees. I just doubled over. Something was really wrong.” Maria went home to rest soon after. She was out cold for several hours despite the repeated attempts of her coworkers to reach her. Maria soon lost her concept of time. Weeks passed by in a confused haze and she found it difficult to return to work. The MRI Maria received two weeks after the accident was surprisingly normal, and Maria convinced herself that she was fine and just needed to rest. But winter soon turned to spring, and Maria’s condition was as apparent to those around her as it had been to her; something more serious must have happened to her that morning.
One of the early signs that Maria had sustained a traumatic brain injury was her hyper sensitivity to light and sound. Levels of noise that she once considered normal, were now intolerable. She kept the shades drawn and often wore earplugs to interact with her children. Maria described it as a broken filter. She was unable to drown out background noise and had trouble concentrating on everyday conversations. Maria also experienced changes in her proprioception, or awareness of her body in space. While her balance was relatively unaffected, her awareness of her limbs in relation to her surroundings was severely altered. “I’m not dizzy. I can’t explain it. I don’t feel like I’m going to fall over. But I don’t feel the difference between my hand and the couch. It’s just one thing. There’s no difference….If I didn’t move, I wouldn’t exist.” Maria also had trouble following ordered sequences of events, such as a recipe, and found it difficult to be aware of things not in her immediate attention. Still, despite these changes to her life, Maria remained confident that she was getting better under the care of her primary physician and that she would soon return to work. It was not until months later that she was referred to a neurologist and began to understand what had happened to her that morning.
The neurologist performed several diagnostic tests, including the Glasgow Coma Scale (GCS). Her hypersensitivity to light and sound, short periods of loss of consciousness, and her reduced perception of herself in relation to space was assessed as a score of 10 on the GCS. Maria learned that she had suffered a coup-contrecoup injury. The force of the impact had caused her brain to strike the skull at the site of impact and on the other side. Essentially her brain had collided with her head due to the momentum of hitting the curb. Much of the damage from Maria’s injury occurred in the frontal lobe, a brain region near the forehead involved with executive functioning and decision making. “It was not surprising that her MRI did not show the extent of the damage” Maria’s neurologist said. “Many people sustain blows to the head but do not suffer a traumatic brain injury.” Most get better, but Maria did not realize the extent of the damage until months later. Maria’s injury can also involve diffuse injuries not specifically linked to a physical area of the brain.Every brain injury is different, and can only be treated on a case-by-case basis. Patients like Maria benefit greatly from a triple team approach of a speech therapist, occupational therapist, and physical therapist to assist in recovery. This therapy can create both physical and financial burdens for the patient.The area of impact influences both the areas of the brain affected and the most effective treatment of the injury. It is not always obvious what the problem is and the onset of symptoms can be delayed or sporadic. Regardless, the potential complications that can arise from a traumatic brain injury range largely in severity and can potentially have long-lasting impacts on a person’s life.
*Names have been changed for privacy.
Article adapted from
Fletcher, Amy. (2011, February 14). Rebuilding a life. Juneau Empire. Retrieved from
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