Traumatic Brain Injuries Complications
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Vision loss on the battlefield is increasingly associated with traumatic brain injuries (TBI), particularly in the wars in Iraq and Afghanistan.
Today as many as 15 percent of veterans are blinded or visually impaired in Iraq while only 10 percent of veterans received eye injuries in Vietnam. Traumatic brain injury can occur as the result of an explosion, car bomb, blast injury or direct hit of the brain from warfare or fragments. During these explosions, the eyes are particularly vulnerable to injuries that lead to structural damage within the eye. Over time, the structural damage can result in glaucoma, double vision, optic nerve injury, changes in the vision field, and other serious vision problems.
At the 2009 American Academy of Ophthalmology (AAO) - Pan-American Association of Ophthalmology (PAAO) Joint Meeting in San Francisco, researchers presented a new VA study and reported that Iraq and Afghanistan veterans who suffered vision loss as a result of a traumatic brain injury have significantly poorer quality of life than civilian patients.
The study determined that about 20 percent of those with neuro-ophthalmic vision loss also suffer with recurrent hallucinations. Many veterans do not mention the hallucinations for fear they are linked to mental illness. The visually impaired veterans with traumatic brain injury may “think” they see wild animals in their closet or people sitting on a couch facing them. This problem, called Charles Bonnet Syndrome (CBS), is common in people with age-related macular degeneration.
Once veterans with vision loss from traumatic brain injury begin to understand the hallucinations, they can start to distinguish the imaginary shapes and learn to ignore them. Sometimes medication is prescribed to help visually impaired veterans deal with the hallucinations.
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Because traumatic brain injury (TBI) causes changes in the brain, it makes it a challenge to stand, stay balanced, and walk without feeling clumsy or uncoordinated. Not only do you have noticeable physical changes, but your muscle movement and muscle coordination have been altered, making it hard to balance and even causing you to have fears of falling.
In addition, sleep problems associated with TMI can cause you to feel drowsy during the daytime, making it more difficult to be active and do the necessary exercises to improve your strength and balance. Sensory changes that affect your vision can make you feel unsure of how to stay on a straight path when walking or moving.
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Fatigue is a common symptom of traumatic brain injury, both in the acute stages of recovery up to 10 years after the trauma. While there few studies on fatigue and traumatic brain injury, people who experience this symptom know how it affects their mood, productivity, relationships, and other physical symptoms. Along with TBI causing fatigue, some of the medications you might take for brain injury can cause fatigue, including anti-depressants, pain medications and anti-seizure medications.
Talk openly with your doctor about the fatigue with TBI. Ask if changes in medications may help your situation. Also, try to get more rest throughout the day. Even a short morning and afternoon rest may help you get through your day without feeling exhausted. Make sure you go to bed and wake up at the same time each day and avoid alcohol and caffeine before bedtime if you have sleep problems. Try not to take on the world but slowly build up your strength and endurance after traumatic brain injury. It will take time for your body to heal, so make sure you avoid over-commitment that can increase the feelings of fatigue with TBI.
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Cognition is a scientific term that refers to the processes of thinking, reasoning, problem solving, information processing, and memory. Even with mild to moderate TBI, people may suffer loss of cognitive function or cognition. Cognitive disabilities include losing executive functions such as the ability to plan, organize, problem solve, and make proper judgments.
Some people with a severe TBI suffer post-traumatic amnesia (PTA). They may have poor memory of what happened prior to the TBI (retrograde) or forget events that happened after the TBI (anterograde). Experts claim that the greatest recovery from cognitive disabilities is during the first six months after the TBI. After that time, the recovery may be far more gradual.
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Some aspects of your personality did change with traumatic brain injury (TBI). When parts of the brain are injured, it can affect social emotional behaviors that may result in feelings of irritability, aggression, depression, lack of motivation, fluctuating emotions and even feelings of dependency. You may feel stressed out for no reason at all. You may laugh or cry inappropriately and have no control over your emotions. You may now feel introverted and depressed when you used to be extroverted and optimistic. Perhaps you used to be a calm and controlled person, yet now you are agitated and angry after TBI.
Nothing you did caused these personality changes. Rather, they are the result of brain damage caused by TBI. Talk openly with your doctor about any emotional changes with TBI. Your doctor can work with you to find the best medication and/or psychotherapy to help you regain control.
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The left hemisphere of your brain deals with speaking, language, and analyzing all the day-to-day information that’s given to your brain. If the traumatic brain injury affected the left hemisphere of your brain, you may have difficulty sequencing and problems speaking (called aphasia) and in understanding language. Left hemisphere brain damage may result in serious emotional reactions such as anxiety or depression and impaired logic. In addition, with left side of the brain injuries, you will notice decreased control over the right side of the body. This means if something touches your right hand, you may be oblivious to it, because the left side of your brain has lost awareness of the right side of the body.
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Remember, the brain is the core of your central nervous system (CNS) and controls every bodily function and process. When a traumatic brain injury (TBI) damages parts of your brain, this affects how the brain regulates the body. TBI alters intricate functions that may affect the regulation of blood pressure, body temperature, and bladder and bowel control.
Along with physical changes, there may be changes in cognitive function such as memory loss, difficulty concentrating, an inability to process information correctly, and judgment lapses that can lead to making bad decisions. Also, a TBI can lead to emotional changes that lead to anxiety, anger, depression, mood swings, and impulsivity. These cognitive and emotional function changes can be short- or long-term (chronic). Even a mild TBI (concussion) can result in temporary or permanent brain damage that dramatically affects a person’s life, work, and relationships.
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Because traumatic brain injury damages parts of the brain, TBI can impair the functions the brain regulates. Some people with TBI have problems with vision, which affects balance and walking. Others have difficulty identifying or recognizing items, which can lead to falls or bumping into objects. Many people with TBI have problems with movement, causing them to be unsteady in walking, sitting or even standing. After suffering traumatic brain injury, some people can no longer play sports or recreational activities such as baseball, soccer, golf or tennis because of lack of coordination.
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The long-term physical effects of a traumatic brain injury can vary greatly from one person to another, depending on the severity of TBI. Pain is a major symptom with traumatic brain injury. Severe headaches are also common and may be difficult to manage. Other physical changes include sleep disorders, fatigue, loss of stamina, weakness, physical paralysis or spasticity, and loss of bowel and bladder control and more. Some people suffer with seizures after traumatic brain injury. It’s important to talk with your doctor about any physical effects you have with TBI. Your doctor can run specialized tests to determine more about the physical effects with TBI. Prescription medications, physical therapy, and psychotherapy may help you manage these problems while your brain heals.
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If TBI damages the right side of the brain, you will have right hemisphere brain damage. The brain has two hemispheres, the left and right hemispheres. Each hemisphere controls specific bodily functions. The left hemisphere of the brain controls your language and speech centers. The right hemisphere controls all thinking skills or cognitive functioning. Damage to the right side of the brain may present problems such as impaired memory, attention deficit, altered creativity and music perception, and poor reasoning. Someone with right hemisphere damage will have difficulty with organization and problems understanding abstract concepts. In addition, an injury to the right side of the brain will result in decreased control over left-sided body movements and "left neglect," which means inattention to the left side of the body.
