(TBI) is a common occurrence that both healthcare professionals and laypeople should be aware of. According to the Centers for Disease Control (CDC), there were 69,000 deaths related to TBI in 2021, which amounts to approximately 190 deaths per day.
Awareness is where it all begins with TBI. This includes but is not limited to the common causes of TBI, what the experience is like for patients and their loved ones, and what nurses need to know to intervene effectively in patients’ often arduous recovery process.
About TBI
Kelly Tuttle, FNP, is a neurology nurse practitioner who suffered a traumatic brain injury after a car accident in 2015. In her book, After the Crash: How to Keep Your Job, Stay in School, and Live Life After a Brain Injury, she chronicles her story and provides firsthand advice on how to recover and thrive after a TBI.
“People usually acquire TBIs from falls, motor vehicle crashes, or assaults,” says Tuttle. “Other causes of TBI are a blow to the head or body, sudden acceleration and deceleration of the head or body, penetration of the skull by an object, and exposure to a blast wave from an explosion.”
When it comes to age and TBI, Tuttle states, “Being older, female, or having had a previous traumatic brain injury can increase your risk of a prolonged recovery.”
Common TBI symptoms include:
Headaches
Dizziness
Confusion
Convulsions
Loss of coordination
Slurred speech
Poor concentration
Memory problems
Personality changes
The CDC reports that the following groups are more likely to experience a TBI:
Racial and ethnic minorities
Service members and veterans
People who experience homelessness
People who are in correctional and detention facilities
Survivors of intimate partner violence
People living in rural areas
TBI can impact employment, relationships, performance of ADLs and IADLs, brain development (in children), and almost every aspect of life. It is an all-pervasive experience that can wreak havoc on the lives of patients and their loved ones, and the road to recovery can be long.
What Nurses Need to Understand
When asked what nurses need to know about working with and supporting TBI patients, Tuttle has a great deal to share.
“TBI affects all aspects of a person’s life by changing their physical, emotional, and cognitive abilities, thereby potentially altering their career, personality, values, and role in the family,” she states.
“TBI survivor’s stories often tell of life before and then after their brain injury. Some will even say that on the day of their TBI, the person they were died.”
“Allowing a brain injury patient to monitor their recovery is a mistake,” Tuttle opines. “After a concussion, patients are not always self-aware of their behavior and limitations. Patients should not leave a clinic until they have scheduled follow-up appointments to monitor their healing.”
Tuttle continues, “If concussion symptoms persist over three weeks, the patient should be referred to a specialist, such as a physical medicine, rehabilitation doctor, and neurotherapist. Delaying care has been shown to prolong recovery.
“Another mistake providers make is diagnosing patients with anxiety or depression, not realizing that the patient is suffering from brain injury symptoms,” warns Tuttle. “Light and sound sensitivity or sensory overload are common symptoms after a concussion, which can cause brain injury patients to feel anxious or overwhelmed.
“Neurofatigue, another brain injury symptom, may lead to an incorrect diagnosis of depression because the patient is too tired to be social or motivated to engage in daily activities.”
Recovery is a process for TBI patients. In this regard, Tuttle shares, “To move forward in recovery, TBI survivors need to grieve what they’ve lost. Some survivors will need talk therapy with a psychologist or counselor. Support groups connect TBI survivors and their caregivers with people who will be understanding and knowledgeable about other community resources and local TBI care providers.”
The resources available for TBI survivors can vary widely. Tuttle states, “There’s support for TBI survivors who are hospitalized and discharged to a rehab facility. However, after being discharged from a rehab facility into outpatient care, the resources become scarce in comparison.
“TBI survivors who see their primary care doctor after their head injuries are often sent home with meager information and left to figure things out on their own, says Tuttle. “I know this from personal experience. Most people recover well from a concussion. However, some people’s symptoms can persist for months to years. Mild TBI survivors usually recover within two years.”
The Road to TBI Recovery
Journaling, mindfulness practices, and spending time outside helped me get out of my head and into the present moment,” says Tuttle when reflecting on her recovery process.
“TBI survivors must get away from negative ruminating thoughts to start their self-discovery. Through journaling and mindfulness, they can identify their brain injury symptoms and what factors in their environment aggravate their symptoms. They can also apply strategies to support their brain performance.”
She adds, “Journaling and mindfulness practices also support grieving and the discovery of a TBI survivor’s core values. Once they have learned to let go of the old and embrace their new brain, they can get to know their new self and move into the next chapter of their life.”
In terms of science, Tuttle states, “The discovery of neuroplasticity provides hope that healing can occur even after several years after a brain injury. Neuroscientists have learned that when an area of the brain is damaged, the brain can make new connections to replace lost connections.”
In addition to her book, Tuttle also recommends Norman Doidge’s The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.
There are many resources for TBI survivors, and science and medicine will continue to improve the potential for recovery in the future.
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