The Impact Beyond the Impact: Mild traumatic brain injuries can have life-altering effects

Meredith Holt, INFORUM April 22, 2012

FARGO – It wasn’t until Richard Anderson sat down at Perkins for pie and coffee that he noticed he was bleeding and had shards of glass in his ear.

Eight months ago today, a car accident in south Fargo changed everything the 46-year-old Moorhead man knew about himself. “I’m still trying to figure out who I am,” he says.

After his vehicle was hit in the passenger side by a woman going about 40 miles an hour, Anderson didn’t do any of the things he normally would have. He didn’t get the name of the driver, they didn’t exchange information, and he gave the police officer the wrong insurance card.

Thinking he was fine, Anderson declined medical attention and walked across the street to the restaurant to wait for his wife to pick him up. He was seen at a walk-in clinic but sent home. Two days later, his wife insisted he go to the emergency room.

Although his CT scan was clear, Anderson suffered a concussion, or in medical terms, mild traumatic brain injury. The effects, however, have been anything but mild.

In the following days, weeks and months, Anderson’s wife noticed something was different. “Luckily, I had a caretaker that was able to provide for my needs,” Anderson says. “I don’t think I’m exaggerating when I say if I hadn’t, I might’ve been out on the street by now.”

Flickering Tiki Lights

Anderson and his wife had planned a Hawaiian vacation long before his accident. Though he was nervous, he was looking forward to it, especially enjoying a romantic dinner with his spouse.

“What I hadn’t anticipated were flickering Tiki lights at every table, Hawaiian cowboys playing ukuleles, and expensive food that I could not taste,” he says.

The mental overload was too much for Anderson. After nearly causing a car accident, Anderson handed the keys to his wife. But even riding in a vehicle as a passenger is difficult. “Everybody seems to be going 90 miles an hour,” Anderson says.

According to Brainline.org, concussion symptoms can include increased sensitivity to sounds, lights or distractions and loss of sense of taste or smell.

Most people don’t experience long-term problems after a concussion, but according to the Brain Injury Association of America (BIA), up to 15 percent have persistent, disabling symptoms.

Concussions can happen from a fall, an accident or violence, says Nan Kennelly, owner of Fargo’s Onword Therapy (outpatient rehabilitation), a group of speech-language pathologists who specialize in cognitive and communication disorders.

The BIA says 75 to 90 percent of the 1.7 million traumatic brain injury cases diagnosed in the U.S. each year are categorized as mild traumatic brain injury (mTBI). “Mild TBI is getting more and more attention,” Kennelly says.

Post-concussive syndrome, the set of symptoms that emerge after a concussion, often goes undiagnosed or misdiagnosed. “The connection isn’t always made to the injury,” Kennelly says.

Patients find their way to outpatient rehabilitation from other areas of health care such as psychiatry, neurology or pain management, sometimes years later. It is never too late!

Once there, “people say, ‘I’m so relieved to have a name for it. I thought I was losing my mind,’ ” Kennelly says.

‘I Knew Nothing’

Gwen Whitley, an emergency room doctor of more than 25 years, thought she knew a fair amount about concussions until she had one herself. “Then I discovered I knew nothing,” she says.

Last February, strong winds blew her car off Interstate 94, rolling it three times. She hit her head and was briefly unconscious. No cuts, no broken bones, no internal injuries.

After about a month of recovery, the 58-year-old Minnesota woman returned to work, but she quickly discovered it was too much too soon.

“I could do my job — and I actually did it very well — but I couldn’t remember doing my job after I got off work,” Whitley says.

In 2001, M.P. Mullen was walking across Fargo’s Fourth Street North for a meeting when she was struck by a car.

Before the accident, Mullen held a high-pressure job at what was then MeritCare. “I was very confident,” she says. “I could make big decisions.”

Afterward, in addition to her other injuries, she suffered from post-traumatic stress disorder and extreme anxiety. “To this day, I still have not gone by the street that I was hit on. I can’t,” she says.

The 55-year-old Fargo woman tried to return to work after a year, but it didn’t go well. She found she could no longer access the skills she needed in order to be successful in her position.

“I was in charge of a $14 million budget, and all of a sudden I can’t remember how to balance my checkbook,” Mullen says.

Kennelly says impact injuries can affect “executive functioning,” the brain’s highest level of cognition.

According to the National Center for Learning Disabilities, executive functioning is used to plan, organize, strategize, pay attention to and remember details, and manage time and space.

“I probably put out 30 fires a day, and they all needed 30 questions to be answered, but if I saw one of those fires now, I’d go ‘Ahh!’ and I’d run,” Mullen says.

New Reality

Kennelly says mTBI has been called an “invisible illness.” While people with post-concussive syndrome don’t look “sick,” they’re living with a new reality.

“I don’t go out a lot because I look fine on the outside and people might question why I’m not working,” Anderson says. “I don’t want to explain it to everybody.”

After her accident, Mullen struggled to define herself, and it’s something she’s still working on. “Everything I had done for 20 years was gone in an instant,” she says.

Slowly but surely, Kennelly and fellow speech-pathologist Katy Wiedenman help concussion patients manage their symptoms and regain the skills they lost.

At Onward, they work on attention, memory, problem-solving, organization, planning, reasoning, speed of processing, reading fluency, verbal fluency and executive functioning.

Treatment length and complexity vary, but all of them have shown improvement. “I’ve had people say, ‘This saved my life,’ ” Kennelly says.

Mullen credits her “dream team” of doctors and therapists for helping her continue to make progress more than a decade after her accident. “I wanted to give up, but they didn’t let me,” she says.

After about a year working with Kennelly, Whitley is ready to return to emergency medicine. “I have been tested and retested, and I am ready to go back to work,” she says.

Whitley says it’s easy to become angry about an injury and the subsequent recovery process, but it’s a waste of emotion. “There’s only one choice, and that’s to go forward,” she says.

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