Traumatic Brain Injury (TBI) The Silent Disability

The acronym TBI stands for traumatic brain injury, brunt force trauma that leaves a person mentally crippled for life. It invades your soul and removes the person you knew leaving sometimes a mere shell, or even remnants of this previous human being. It ages you far beyond your years incorporating short-term memory loss, the inability to find words during conversation, inability to sequence or do something as simple as basic math and possibly much more. TBI is a stress related disorder.

TBI recipients are daunted with a disability that will not heal with time like a broken bone, or a cut to the skin instead they have been stricken with something more devastating, something that depending on the severity of the brain injury is the severity of the TBI. This can range from mild to severe TBI (see below Glascow Coma Scale for more information)

Brain injuries do not heal like other injuries. Recovery is a functional recovery, based on mechanisms that remain uncertain. No two brain injuries are alike and the consequence of two similar injuries may be very different. Symptoms may appear right away or may not be present for days or weeks after the injury. * These symptoms from a neuropsychological standpoint fall under a similar umbrella.

With a TBI injury, the brain fluid becomes displaced and the brain, the one bodily organ that has no feeling, will impact the certain part of the skull whereby, in the case of frontal lobe, brunt force trauma, the brain cells will either become severed or destroyed. It is this point of impact that will determine the TBI symptoms. While there is, a TBI umbrella to determine similar symptoms there is no clear determination from person to person what aspect of TBI they will be affected by.

Since our brain defines who we are, the consequences of a brain injury can affect all aspects of our lives, including our personality. *

One personality change triggered by something as slight as normal stress can evoke a heightened sense of emotion I have describe as Dr. Jekyll, Mr. Hyde outbursts or temper tantrums from the very slight to the monstrous. It is a horrible thing, pushed to the edge of toleration to bring forth these moments, these petcocks of sorts to alleviate the moment. It could be something as simple as not being able to find a parking spot close enough to the store, or the barking dog that keeps you awake at night. Sometimes these moments, if not properly diagnosed the public are deemed hazardous and can scare the living daylights out of someone. They can be seen in a fist pound on the counter top or tossing a rider mower by its undercarriage across the lawn. Most of us are not nueropsychologists and cannot see through the actual act to determine the stress level this person is under. These triggers are so slight, compile themselves, like a firecracker turned volatile explodes in a momentary explosion rendering TBI victim’s attitude much calmer and able to deal with the situation better.

Another would be short-term memory as mentioned before.

The normal mind has memory consolidation that is the consolidation of STM >>>> LTM. The first part of it involves encoding the memories in neural circuits in the hippocampus, and takes minutes to a few hours. The second part of it involves transferring the memory from the hippocampus into the architecture of the actual brain cortex, and that can take ears/decades.**

Is there something we can do after a traumatic event to prevent the memory from forming?**

There’s also something that goes against the theory of short and long term memory called depth of processing theory by Craik and Lockhart in the 70’s. Basically it says the importance and significance of something determines how deep in your memory it goes. Think of it as pushing an inflated ball underwater. If u get it right below the surface, when u let go it will shoot up and out almost instantly, the deeper u push it, the longer it will take to rise back up.**

An experiment that backed it up involved putting people through work association tasks where people were asked things like what rhymes with nurse, and what word that rhymes with nurse fits this sentence “the nurse left her____at work”. After that portion, they were asked to recall all the words they had been asked to generate, and those who had to come up with one that fits the sentence were significantly more likely to remember their words.**

The TBI person can conform to societal expectations. While some may have the ability to get and retain employment others are subject to their lives with caretakers to guide them though the day. It is necessary for the TBI patient to have a good support network to provide them immediate input required for growth. Some may revert to that of a child and constant verbal rewards may be required to build the person’s self-esteem.

The Glasgow Coma Scale is a good determination of how severe a person’s traumatic brain injury is. Below is information taken from

Glasgow Coma Scale*

There are a few different systems that medical practioners use to diagnose the symptoms of Traumatic Brain Injury. This section discusses the Glasgow Coma Scale. Click on the link to find out more information about the Ranchos Los Amigos Scale.

The Glasgow Coma Scale is based on a 15-point scale for estimating and categorizing the outcomes of brain injury on the basis of overall social capability or dependence on others.

The test measures the motor response, verbal response and eye opening response with these values:

I. Motor Response6 – Obeys commands fully
5 – Localizes to noxious stimuli
4 – Withdraws from noxious stimuli
3 – Abnormal flexion, i.e. decorticate posturing
2 – Extensor response, i.e. decerebrate posturing
1 – No response

II. Verbal Response5 – Alert and Oriented
4 – Confused, yet coherent, speech
3 – Inappropriate words and jumbled phrases consisting of words
2 – Incomprehensible sounds
1 – No sounds
III. Eye Opening4 – Spontaneous eye opening
3 – Eyes open to speech
2 – Eyes open to pain
1 – No eye opening
The final score is determined by adding the values of I+II+III. This number helps medical practioners categorize the four possible levels for survival, with a lower number indicating a more severe injury and a poorer prognosis: Mild (13-15): § More in-depth discussion on the Mild TBI Symptoms page. Moderate Disability (9-12): § Loss of consciousness greater than 30 minutes § Physical or cognitive impairments which may or may resolve § Benefit from Rehabilitation Severe Disability (3-8): § Coma: unconscious state. No meaningful response, no voluntary activities Vegetative State (Less Than 3): § Sleep wake cycles § Aruosal, but no interaction with environment § No localized response to pain Persistent Vegetative State: § Vegetative state lasting longer than one month Brain Death: § No brain function § Specific criteria needed for making this diagnosis The first thing necessary is to stabilize the TBI patient. Any head injury should not be taken lightly and the TBI recipient should be rushed immediately to the hospital to better ascertain what specifically needs to be done. Here a team of doctors lead by a trauma surgeon will determine the treatment necessary. 911 and their ability to respond could be a lifesaver. Rehabilitative Care Center treatment would be next to assimilate the patient back to a normal lifestyle. This could include eating, walking, disassociation from the problem/accident to make them realize what happened. Every step in the rehabilitative process is a step to regaining individual freedom and becoming a person again. If the brain is swollen there made be the need for surgical intervention.

(* text has been taken from

(** text has been taken from

Side note:

On August 2, 1969 (at 9 y/o) I was bodily struck, while crossing the street, by a late model Peugeot where at 90 feet away, the driver was doing 90 miles per hour before he decided to apply the brakes and have been a TBI recipient ever since. The injuries I sustained were a shattered pelvic bone and a fractured skull which in turn caused my TBI. While these may be mild by comparision, mind are still attributable to be a certified member of the TBI family.

My struggle to assimilate into normal society has been an uphill battle because in 1969 Rehabilitative Care Centers were non-existent. My recovery consisted of basically only the neurologist. I give credit and kudos to all TBI patients, caretakers and family members. The TBI recipients struggles with their lives, their modified realities, to “make it”, to struggle, to assimilate themselves into normal society. For this struggle awards should be given and recognition. This is not to say others who have encountered modified realities should not also be given awards for kicking cancer’s butt (my 20 y/o son kicked Ewing Sarcoma Cancer’s BUTT) or some other intolerable disease that brings us to death’s precipice. Stay well one and all and blessing, prayers and hope are given to all those who are today struggling.