Recovery from Traumatic Brain Injury: 
Frequently Overlooked Issues

by Judith Bluestone 
Clinical and Educational Director, The HANDLE Institute

The issues addressed in this article relate to processing and memory, motor control, emotional responses, and other functional behaviors. While an individual's life-support is still at issue, of course that concern must first be addressed through appropriate medical intervention.

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Foreword: This article is presented to nourish the hope expressed by so many: that we can improve the functional outcomes for individuals with traumatic brain injury (TBI). It is written with a minimum of technical language, so those inflicted with TBI and their families can also enhance their understanding of the issues presented.

Function and organization (in the brain, the body, and all systems), are interactive and developmental in nature. Successful movement from dysfunction to function (healing), therefore requires a comprehensive (that is, holistic) perspective, rather than a focus on specific symptomatic deficits and splinter skills.

The first studies of brain injury--those related to discrete puncture wounds--helped physicians develop maps of specific areas of the brain which are deemed responsible for discrete activities. This view of isolated events in the nervous system, which led to the model of rehabilitation practiced for years, is now recognized as invalid. Yet many evaluation and treatment plans still subscribe to the concept that a specific area regulating a particular function is damaged and must first be directly addressed. Then two adjustment processes are emphasized: (1) compensating the individual for the loss by altering the environment and demands, and (2) helping the individual accept the limitations gracefully.

Many individuals who incur a TBI, and their families, feel invalidated, misunderstood, not helped enough, and even abused by some of the diagnostic and treatment procedures to which they are subjected according to this model. Despite these feelings, and an over-riding sense of hopelessness that frequently is imparted, TBI clients/families usually realize that there was no intentional or malicious action, rather a lack of knowledge about some of the issues discussed in this article. And it is in response to their call for understanding that this article came to be.

TBI has numerous origins. Some injuries are received prior to or at birth. Some may be a result of illness, such as encephalitis. Others may be by puncture wounds. Yet others may be due to substance abuse. Probably the most common injuries are caused by a blow to the head and/or severe jarring. In all of these instances the natural neurodevelopmental flow is affected. Even localized injury from a penetration wound will affect many functions. Some of the most frequent side aftereffects of TBI include sensory disturbances (most frequently visual and auditory in nature), changes in muscle tone and range of movement, memory problems, difficulty with organization, word finding and speech fluency problems, poor balance, and/or mood swings. Frequently the exhibited deficit is reflective of injury or loss to an underlying or integrative function, and is not what it appears to be at the surface.

One woman (for whom undergoing neuropsychological batteries, ENG procedures, etc., caused severe stress to injured systems) helps others understand her problems, knowing they do want to help. She spoke at a community college program for individuals with acquired brain injury.

"The teachers invited X and I to speak to them. It was just wonderful! They were so respectful, listening, validating to us. The next day all staff came in solid colors easy for us to see. They are going to get a solid blue smock in case any of their clothing sets us off. I just shut down totally in brain function with some patterns, esp. polka dots. So you can see, they really want to learn and be responsive."              Kate Vincent

Approaches that provide functional outcomes are evolving. They incorporate such concepts as:

• the integrity of the system
• neural plasticity that continues throughout the lifespan
• knowledge of the negative effects of stress on human functioning.

So, what are some of these frequently overlooked issues?

The University of Washington is currently enagaged with The HANDLE Institute in a scientific study analyzing the effects of HANDLE on brain functioning. Read the latest news regarding this exciting project!