TBI: From One of the Walking Wounded
Since March is Brain Injury Awareness Month, we tapped one of our resident RehabVisions experts for information. Jean Herauf is a speech-language pathologist and our area manager in Dickinson, North Dakota. She is also a certified brain specialist.
We call brain injuries an “invisible injury.” People get hurt and are treated for their physical injuries. They are often told their headaches will go away in time but often they don’t, and there are other effects people don’t see but need to understand. At our outpatient clinic in Dickinson, we have a valuable member of our team who sustained a brain injury. Candy Johnson is one of our front office staff. She experienced a brain injury in a car accident in 1994 and dealt with this “invisible injury” for months before getting diagnosed with TBI. Here are her words:
In 1994, after a warmer-than-normal February day (for North Dakota), we were headed to a town about 20 miles away for a Valentine’s Day supper. The sun had gone down and the wind was picking up, blowing tendrils of snow across the interstate. That’s when we hit the black ice and rolled. I was seated in the back seat of the Bronco II and parted company with the Bronco along with part of the fiberglass roof, which covered the back portion of this vehicle. The remaining fiberglass roof embedded itself into the seat about where my neck had been. This was my welcome to the ranks of those with traumatic brain injuries (TBI).
At the hospital, they were concerned with sewing up all the open wounds and took X-rays. They kept me for a couple of days and then I was sent home. At no point did they discuss a TBI, even though my skull was cracked and the skin split open down to the skull. (You might think that was a clue).
Some of the first symptoms were good. I lost my glasses in the accident and when I went to see the optometrist, he found my astigmatism was gone, and my vision was better. I also found myself able to do things with my left arm and hand that before I could only do with my right hand and arm before the accident.
On the downside was vertigo, along with nausea. The doctors I saw just gave me medication for it, which didn’t resolve it, only made me sleepy and nauseous. Most concerning was my “autopilot” function was no longer working. For example, driving a car now required me to pay attention to every step of operating the vehicle vs. jumping in and going without mentally working through the processes. Also, I worked in a very busy business with phones ringing, tracking staff locations while typing numerous documents. In the past I thrived on all that activity, now I found it exhausting. One scary event for me was I answered the phone while a staff member was waving at me to tell me where they were going. The voice on the phone sounded like the person was speaking a foreign language. OMG, was I no longer capable of doing my job?
I went to see Kari Lyon at North Dakota Vocational Rehabilitation (VR) and poured out my heart. Kari recognized the problem as a TBI and sent me to the other side of the state to see a neuropsychologist, Dr. Konewko, in Fargo.
After testing, Dr. Konewko diagnosed me with a TBI and described my situation as one of a walking wounded. If your arm is in a cast, people see the injury and understand; but with TBI you may look normal, but you aren’t functioning as you once did. He went on to explain how the brain bounces in its fluid back and forth in an injury situation and connections are severed. I needed to give my brain time to reconnect, possibly in new ways, to rebuild what it lost. In his opinion the time frame for the brain to recover—as much as it was going to—was about a year. He said the worst possible situation during the initial brain recovery period was to be in a busy environment because I wasn’t allowing it to work on repair. Instead, I was pushing it past its current limits (the foreign language phone incident was an example). His recommendation was to work in a private office for a couple of months to allow brain recovery time.
The Next Hurdle
Most employers hearing their once-valuable staff now has a brain injury think the worst, that it’s permanent and they won’t be good employees again. That is so not true, but for someone going through this process, with their brain trying to recover and the pure exhaustion they are feeling, they are terrified to reveal to their employer that they may need an accommodation even for a short period of time to get better. Fortunately, Kari from VR came along with me to request accommodation from the director where I was employed. The director had that dreaded reaction at first—if she can’t perform her duties, then we need to find someone else. Kari, bless her heart, had to explain that we needed to allow the accommodation for a short term to allow recovery. I was one of the lucky ones, in that it was granted.
Along with the stigma people assign to someone with a brain injury, the injured person has to deal with exhaustion—things that I normally would have breezed through took longer as I thought myself through the task. I had a 4-year-old daughter at home, and my husband worked nights, so I didn’t have the luxury of going home and taking a much-needed nap. I also was taking college courses including math the semester I was in the car accident. Another thing I noticed was I became depressed. I am normally an “up” person, but someone might bring up a subject that would trigger me to feel sad. It was a strange world to suddenly be thrust into.
Turn off the radio while driving, remove distractions! Working in the quiet office for two months was a revelation—I wasn’t as tired and my brain started to figure things out. When I rejoined the noisy masses, I no longer had the various problems I was experiencing. In about a year, the exhaustion and depression were gone as well.
As years went by, I recovered much of what was lost. For example, I used to always have a song in my head and after the car accident it was gone. I hear music again now (in my head) while I work, I don’t need the radio. In the past I relied on my brain to remember everything and it did. Now I find that making detailed notes can be super helpful. For the most part I don’t need the notes, but it is a comfort to know I have made good notes. Sticky notes are great, too! But most importantly, as an employee, I function every bit as well as I did before the car accident.
The work that Jean Herauf does with TBI patients is amazing. Everyone has a different story and different path to recovery. Jean will hone on their issues and provide them with solutions to work on which will encourage their brains to regenerate and reconnect!
I will have vertigo issues my whole life, but every time the ear crystals break loose, I see Cory Ash, PT, who is fantastic at getting them to settle back to where they belong. Sadly, back when the crash occurred, the local MDs had not heard of the Epley maneuver. Fast forward to now and we get referrals for clients with vertigo all the time.
About a year after the accident, Dr. Konewko paid for me to travel back to Fargo and speak to a group of MD residents about what I went through. He wanted them to know what to look when treating someone with a possible brain injury.
Candy has worked for us since 2017. I can attest that if she hadn’t shared her history of brain injury, I would not suspect she’d had one. Many people aren’t as fortunate as Candy in their recovery, but most can make improvements with focused treatment, modifications and strategies.
Although Candy’s TBI was from an accident, it’s important to note that the majority of brain injuries are the result from a fall. Most people assume it’s from car accidents or sports injuries but that makes the role of therapists all the more important.
Therapy for brain injuries can be life-changing for people. They just need to know that it’s a possibility. It’s our job as therapists to educate them.