Rolando Amadeo, M.D. Edison H. Wong, M.D., M.S. Raymond H. Fiorini, M.D.
Board Certified Specialists
A brain injury can be an horribly traumatic event with long standing negative effects to both injured persons and all family members. Anything from a slight whiplash or a blow to the head can cause a range of symptoms to occur, of which can lead to catastrophic consequences.
The brain is extremely complex – and as a result, any injury to its delicate structure can cause far ranging effects. At MD Diagnostic Specialists, our goal is to determine what areas of the brain are injured, and offer the most specialized care and rehabilitation to maximize one’s potential for the greatest quality of life.
Frequency of Brain Injury
Brain injuries are common: as many as 1.4 million people sustain a brain injury each year according to the Center for Disease Control. The injury presents medicine with difficulties in both accurate diagnosis and effective treatment. As a result of injury, the brain demonstrates many symptoms that amount to a complex disease that demands the highest level of specialty to treat properly.
Mild to moderate brain injuries in many persons are first dismissed by physicians and psychologists who end up treating them later. Many professionals do not appreciate the significant functional loss from a Brain injury, as per the CDC’s announcement that concussion is now considered an actual brain injury.
However, due to the complex nature of brain injuries, it’s common to suffer one without realizing it because it can be very confusing at first unless the specialist has proper training and experience.
How Do You Know You Had A Concussion
50-86% of all brain injuries are classified as mild. The majority of traumatic brain injuries are the result of motor vehicle, bicycle, or pedestrian related accidents, followed by falls, violence, and sports injuries, according to the NIH. These “mild” brain injuries can still lead to major issues; as per an excerpt from the Neuro Medical Diagnosis and Management Post Concussion Disorders:
“Mild TBI patients may show some resolution of symptoms over time; whereas, others may have permanent impairments and permanent disabilities”.
However, what counts most is early diagnosis and the proper treatment of a brain injury. Here at MD Diagnostic Specialists, our focus is the proper and detailed history and testing required to properly document the injury to better offer the most appropriate and effective care.
Testing for Mild Traumatic Brain Injury
There are a number of certified tests for brain injury. Here are the tests we offer:
MRI: In minor brain injury patients, specialized MRI testing with state of the art software has been available to document evidence of diffuse axonal injury in patients who have normal CT scans. However, most CT scans reveal no abnormality when a traumatic brain injury has occurred.
Neuropsychology Testing: While traumatic brain injury is an organic injury to the brain, people with this injury often experience psychological and neuropsychiatric consequences with brain injury. These people often experience emotional instability, depression, anxiety, and sleep disturbance that often require therapeutic intervention and a Brain Injury Specialist to prescribe and administer medicine properly. Sleep disruption is the #1 complaint and will greatly slow down the recovery process.
Neuropsychological testing which can be defined as the administration of specialized psychological tests to patients with suspected focal brain injury. These tests then identify altered cognitive, behavioral, and emotional functions and factors that may influence the patient’s brain to function properly. Think of a hearing test, done to ensure that the tympanic membrane is intact after an accident.
As an example of such a test, a neuro-psychiatrist may ask a patient to remember simple sequences, like “A-B-C-D-E” or “1-2-3-4,” which are really not new learning or recent memory, but rather old rote memory, another area of the brain.
Another example are tests to evaluate the visual-spatial and visual organization capabilities of a patient, by asking them to copy a geometric figure, or draw a clock or a compass.
Specialized Imaging: Colorized DTI and Weighted SPECT Scans: Recent neuroimaging studies have been utilized in identifying loss of axons; however, in even severely disabled individual patients often have negative imaging studies, making these not optimal for all patients.
Even after proper imaging and diagnosis is complete, all brain injuries possess some form of consequence – at times permanent. We use all these tests to properly diagnose your injuries.
Loss of Function Following Traumatic Brain Injury
Functional changes following brain injury are different than a broken bone which heals over time. Studies show that even a fractured knee can, with rehabilitation, return to full strength anywhere between a few months and two years.
Yet while broken bones eventually heal, cognitive, sensorimotor, and behavioral deficits can result in lifelong changes in how an individual functions and socializes. Any one of the functional changes can significantly impact every aspect of the person’s life:
- Cognitive Impairments can affect activities of daily living such as hygiene, eating, household management, community reintegration, and many other aspects of day-to-day living. Memory is one aspect.
- Executive Functioning often becomes a problem with frontal lobe injuries. Ability to keep a business running requires organization, planning, creating, evaluating, and initiating projects and activities.
- Initiation Problems may result in a person failing to engage in important activities unless prompted. This makes most of life difficult, from exercise to hygiene and can even results in loss of interpersonal relationships.
- Changes in Thinking include lack of awareness of deficits (anosognosia), confusion such as disorientation to person place or time, distraction, reduced ability to pay attention, difficulty changing routines, difficulty with basic calculation, difficulty sequencing, lack of empathy, and other issues with reasoning.
- Behavioral Changes and emotional changes are common following brain injury. These symptoms include the inability to respond to requests, and a myriad of aggressive tendencies.
- Physical Difficulties occurs when injury occurs to the motor strip (posterior frontal), motor planning (prefrontal cortex) as well as coordination (cerebellum) with resultant poor motor control – the inability to properly coordinate your limbs and body.
Because of the nature of the brain, no two brain injuries are exactly the same. However, treatment for a myriad of brain injuries in all forms of severity are available.
Treatment for Traumatic Brain Injury
Medical treatment first requires identifying:
- The fact an injury occurred,
- What part of the brain is injured,
- Identifying all of the physical, emotional, and cognitive ramifications.
Many times the patient will lose their jobs, spouses, as well as other spheres of personal social influences due to the patient’s compromised abilities; leaving them only with professional providers for long-term care.
For these people, specific vocational rehabilitation will be necessary to try and bring them back to a reasonable level of function. Some brain injuries result in heavy damages, requiring proper life-long planning.
Life Care Planning
Our group of medical practitioners work as a team to produce a Life Care Planning document. A Life Care Plan is an active document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized and concise plan for current and future needs, with associated costs for individuals who have experienced catastrophic injury or have chronic health needs.
Life Care Planning Goals are created and discerned to improve or maintain the clinical state of the patient, prevent secondary complication, provide the projected clinical and physical environment for optimal recovery, and enlist support to the family, as well as prevent unnecessary complications. The treatments and care will never return the patient back to pre-injury levels of function or anatomical wholeness, but it will address several demands.
Physical Demands: Neurological and Orthopedic consequences produce (to varying degrees) reduced levels of function in sitting, standing, walking, reaching, holding, pushing, and pulling.
Cognitive Demands: In most instances, the changes from a less physically demanding workplace requires a progressive increase cognitive responsibilities. TBI prevents this from occurring.
Associated Responses to Anatomical and Cognitive Impairment: Associated responses to anatomical and cognitive impairments result in psychological disturbance, and social upheaval.
Life Care Planning is a process where long term professional, therapeutic, and supportive care is evaluated as well as equipment and pharmacological needs are assessed, as well as bracing, transportation issues and potential vocational support.
There’s no doubting the fact that a brain injury is extremely hard to come back from – but with the right support, knowledge, and the help of an experienced team of medical professionals, you can get your life back on track.
Edison H. Wong, M.D., M.S.
10 years specializing in Brain Injury.