Heads Up – Undetected TBIs in Adults
Falling on ice or off a bicycle, falling while water skiing or working on the house – any of these activities can cause concussions or undetected TBIs (traumatic brain injuries). March is Brain Injury Awareness Month, and for good reason. It’s the time of year when people are ready to get outdoors after a long winter. Homeowners take to ladders to make home repairs, and families get out the bicycles for neighborhood rides. Yet danger lurks. Many everyday activities, even fun recreational hobbies, have the potential to cause serious brain injury.
Amy Zellmer, the founder of the website FacesofTBI and the #NOTINVISIBLE awareness campaign in 2019, is a good example. After taking a harsh fall on the ice in February 2014, Zellmer became a crusader for TBI awareness and giving a voice to survivors. Children and young athletes are vulnerable to head injuries, but so are adults. TBIs contribute to about 30 percent of all injury-related deaths, and those who survive a TBI often experience odd symptoms, a missed diagnosis, and short- and long-term health consequences. According to Zellmer’s website, TBI is the “leading cause of death and disability in the world” and “every single concussion is a brain injury.”
What is a TBI?
Americans suffer between 1.6 million and 3.8 million sports- and recreation-related concussions annually, according to the Centers for Disease Control and Prevention. Statistics are hard to track because so many TBIs go undetected and unreported. In addition, concussion awareness and prevention went overlooked for decades. Adults who fell out of a tree and hit their head, played tackle football, got into fights or even had a serious car accident years ago may have never received proper treatment.
Any bump, blow or jolt to the head that causes trauma or disrupts normal brain function can cause a TBI. Not all head injuries result in a TBI. Most are mild, resulting in a brief jarring or change in consciousness, and commonly called concussions. More severe TBIs can cause lasting symptoms and memory loss after the injury. The brain is protected by fluid and protective membranes in the skull. On impact, it crashes into the skull and then often bounces back and hits the rear of the skull, leading to bruising, bleeding, nerve damage or more severe injuries. It can even twist atop the brain stem as well. Concussions also can be caused by whiplash or even shock waves from an explosion. For active-duty military, blasts are a leading cause of TBI and can lead to PTSD.
Falls, Recreational Activities Top the List for Head Injuries
Sports-related concussions get the spotlight, especially among younger age groups, but falls, being struck by an object, and automobile accidents are the leading causes of TBIs. In 2013, nearly 50 percent of all TBI-related ER visits, hospitalizations, and deaths in the United States were the result of everyday falls, according to the CDC. Falls are most prevalent among the elderly, accounting for nearly 4 in 5 TBI-related emergency visits, hospitalizations, and deaths in adults aged 65, according to the CDC. Falls also cause the most TBI-related deaths among persons over 65 years of age. As older adults lose balance, mobility, and vision, accidental falls become more problematic. But it’s easy for a person of any age to slip on ice, miss a step, lose their footing on a ladder, trip over a rug, or stumble over cords, toys, and other household hazards.
Beyond falls, these sports and recreational activities cause the most head injuries treated in emergency rooms, according to 2009 data from the U.S. Consumer Product Safety Commission.
- Baseball and softball
- Water sports, such as diving, surfing, water skiing, and others
- Off-road sports on powered recreational vehicles such as ATVs and go-karts
- Skateboarding and scootering
- Accidents in gyms and health clubs
- Winter sports (skiing, sledding, snowboarding, snowmobiling, and others)
Signs and symptoms of TBIs
TBIs and concussions can cause various and vague symptoms, which many active and busy adults may overlook or hope will just go away. People may look fine even though they are acting or feeling off. That is why it is so important to have any head injury or concussion checked out. Family and friends should monitor a loved one’s behavior in the days and weeks following a head injury.
Symptoms of a concussion fall into several categories:
- Cognitive: Difficulty thinking clearly, concentrating, remembering or recalling information, general brain fog, and trouble with executive functions
- Physical: Headache, seizures, blurry vision, seeing “stars,” dizziness, nausea or vomiting, sensitivity to noise or light, balance problems, feeling tired
- Emotional: Irritability, sadness, emotional, mood swings, anxiety, aggression
- Sleep disturbances: Sleeping more than usual, less than usual, or trouble falling asleep
- Hormonal disruption: Blood-sugar changes and endocrine problems leading to depression, anxiety, mania, or apathy
- Digestive issues: Microbial changes, motility problems, and increased gut permeability
Ways to Protect Yourself
A TBI can harm the brain in many ways and result in unconsciousness, coma, brain bleeds and clots, inflammation, memory loss, permanent disability, and even death. It’s not something to take lightly.
- Take precautions to protect your brain when it comes to recreational sports and daily activities:
- Be vigilant, especially when walking on ice or downstairs
- Wear good shoes with sturdy, slip-resistant outsoles
- Watch for trip hazards
- Keep your hands free to brace yourself for falls and use hand railingsInvest in a good helmet and wear it when playing sports such as football or hockey, bicycling, or skiing or snowboarding
A helmet is not foolproof to prevent a concussion or TBI. Football helmets do little to protect against hits to the side of the head, or rotational force, according to a study presented at the American Academy of Neurology’s 2014 annual meeting. On average, football helmets reduced the risk of traumatic brain injury by only 20 percent compared to not wearing a helmet. However, the study found that football helmets do protect against linear impacts, and those that lead to bruising and skull fracture. A helmet can cushion your head in recreational sports and activities, so it’s always worth wearing one, along with modeling good behavior for children.
What Should You Do if You Suspect a Concussion or TBI?
If you suspect a concussion or TBI in yourself or a loved one, pay attention to signs and symptoms. Get checked out by a professional sooner than later. Call 911 or visit the emergency department if there is a loss of consciousness, a major laceration or contusion, or any signs of bizarre behavior or prolonged disorientation. It’s better to be safe than sorry and suffer the consequences of undetected TBIs. Ivy Rehab offers a concussion management program, and a variety of specialized assessments to treat your post-concussion symptoms so you can get back to doing the things you enjoy!
Article Reviewed by Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA
Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA is a practicing physical therapist and a partner and Director of Clinical Services at Ivy Rehab Network. Deur is board certified as a geriatric clinical specialist and certified exercise expert for aging adults with more than 35 years of clinical experience. She is certified as an aquatic and oncology rehabilitation specialist and serves as adjunct faculty at Central Michigan University and Grand Valley State University.