Often times, TBI or Traumatic Brain Injury, is termed as a silent epidemic since, for several years, such injuries failed to receive proper diagnoses and, therefore, went untreated. To compound the situation, the medical profession frequently dismissed complaints of personality changes, memory loss, and decreased mental processing ability as completely unrelated occurrences. Thankfully, TBI recognition has changed significantly today, and TBI patients have access to different resources in the community to address their impairment and handicap (like vocational rehabilitation, neuropsychological testing, brain injury medicine fellowships, etc.).
As life care planners, we get consulted long after the date of the injury and when most of the injuries have healed. It behooves us to keep in mind that some of the cases we work on involve patients with undiagnosed TBI.
The following are 3 very important concepts all life care planners should keep in mind when authoring plans on the TBI population.
1. Difficulty of TBI patients obtaining gainful employment
TBI patients face several hurdles in finding gainful employment. For younger individuals with limited or no work experience the challenge can be acute and can potentially drive them to despair. Persistent impairments like difficulty in reasoning, communication, problem-solving, memory, as well as difficulties in focusing in even simple tasks can further accentuate the challenge. In some instances, TBI can leave people with physical, behavioral and emotional problems further impacting their employability. There may even be a social barrier in the workplace, where co-workers and employers have concerns or fears on working with/employing patients with TBI. Social support groups and going through a Brain Injury Program, like the Mary Lee Foundation (in Austin, TX) can be life changing. These programs help train TBI patients to enter a work setting that suits the individual. A main focus of the rehabilitation aspect of a brain injury patient is the achievement of independent living.
2. Increased risk of developing early dementia and early Parkinson’s Disease
Early dementia and early Parkinson’s Disease are among the most feared long-term consequences of TBI. Several studies have shown that individuals who experienced a TBI in the early or mid stages of their life have an enhanced risk of dementia in the later years of their life (DH Smith, VE Johnson, W Stewart – Nature Reviews Neurology, 2013). The risk factor can be as much as 4-fold depending on the severity of TBI. However, mild head injuries, which are also sometimes termed concussions, are not well documented and retrospective studies may be impacted by recall bias. But these mild TBIs can come into focus particularly when the affected individual is an athlete (boxer or football player, for example) or a military person.
3. Dependence on social support in order to function on a daily basis
Depending on the severity of the brain injury, there is a likelihood the victim may become fully dependent on others in order to function. Even if the patient is independent for most ADLs (eating, bathing, dressing), he/she may not have the wherewithal to communicate effectively outside the household. In these scenarios where the functional impairment is not too obvious, the caregiver’s account of a day in the life of the patient is key in assessing the degree of impairment. If the patient still has good introspection of his/her disability, he/she may develop symptoms of helplessness and depression, which compounds the problem. In these circumstances, social and emotional support are invaluable to the wellbeing of the patient.