Traumatic Brain Injuries An Invisible Epidemic
Transcriber: Rhonda Jacobs
Reviewer: Eunice Tan
Hi. Thank you for that introduction.
To start, I invite you to think of a time
that you, your loved one
or a friend hit their head.
Perhaps a small little bump.
Maybe they fell
or hit their head on a door.
Or maybe you know someone
who plays a contact sport,
and they hit their head hard on a ball.
A doctor once asked my mom
this reflective question,
and she immediately said,
“No. I have no history of head hits.”
Then she said,
“Oh, wait. When I was a kid,
I got hit in the head by a baseball.”
She said she also fell off a horse
and fell through
a staircase onto concrete.
Then she thought of a time
that my brother hit his head,
resulting in a huge bump on his forehead
that was ignored since he was just a baby.
My point in asking you this
is to invite you to reflect
on how often small hits to the head
have affected your life
and how these occurrences
are often minimized and ignored.
In a report to Congress, the CDC
referred to traumatic brain injuries,
or TBIs,
as an invisible epidemic.
According to the Journal of Neurosurgery,
69 million people a year across the world
sustain a traumatic brain injury.
I am one of those individuals.
I used to be an avid soccer player.
Consequently, I signed a release,
as most all soccer players do,
that stated I knew the basic
signs of a concussion
and I would tell someone
if and when I hit my head.
I thought a concussion was quite rare
and telling an adult
was largely common sense.
But when I hit my head,
things were not as black and white.
When I was in sixth grade,
after a mild bullying accident,
I was slammed into a steel cabinet
at the school I was attending.
It’s important to me that I bring up
that it was a very mild,
seemingly insignificant bullying accident
because many kids don’t know
that these bullying incidents
can change a person’s life forever,
as happened with my life.
Now, after I hit my head,
everything immediately changed.
I have very little memory of the day
as a result of post-traumatic amnesia.
A few classmates say they thought
I was out cold for a few minutes
based on the time it took me
to get up from the ground.
I remember that just prior
to my head injury,
there were about 30 students
in the classroom,
and when I had come to,
there were about three.
I felt like I was in a war just to walk.
I was grasping every desk,
every wall I could
just to walk a few feet.
I tried to walk to my desk,
and when I finally sat down,
my neck was in screaming pain.
It felt like a battle to lift my neck
to look at the clock
to see how much time I had left
in passing period just so I could rest.
Everything was dizzy and spinning.
I was a bit nauseous.
I had a physical education class
immediately after this,
and I felt too sick to participate.
So I told the person at the front desk
what had transpired.
She immediately did
the concussion screening.
However, I knew the day of the week,
who our president was,
and my eyes were not dilated.
I was told I did not have a concussion
and was sent back to class.
My next memory is about four hours later.
I was in the lunchroom
and asked one of my friends
to walk with me to the trash can.
I felt like my feet
wouldn’t grasp the spinning ground,
and I was afraid I would fall down.
Then, an hour later, I remember
being in my study hall class,
and I casually mentioned to a friend
of mine that I had hit my head.
He jokingly said, “How many
fingers am I holding up?”
I said, “Four.”
He laughed and said, “Two!”
Then he held up all 10 of his fingers,
and I was so confused.
It wasn’t until that moment
I realized I was seeing double.
I didn’t understand how a human being
could have 20 fingers.
One of the last memories
I have of that day,
it was just a few hours later,
when I was in the last class of my day -
choir.
The accident happened during
my first of eight classes of the day.
We were doing sight-reading
that day in choir,
so I was unfamiliar with the sheet music.
I whispered to my friend,
the same person I just mentioned
that held up his fingers -
I asked him, “Which line of music
are we supposed to be reading?”
He looked at me,
grabbed my hand and rose it up.
I was seeing two lines of music,
and there was only one.
He knew something was wrong
and exhorted me to tell the teacher.
Now, I was previously told
that I did not have a concussion,
so I thought I was fine.
Having been a committed
soccer player growing up
and with the mentality
that for almost all injuries,
you get back in the field
and be a team player,
I normally shook off any injuries.
However, this time
I did not have that choice.
My teacher had previously
had a concussion,
recognized the symptoms
I was experiencing,
and so she didn’t play it down.
She told me to call my mom
to pick me up and take me to a doctor.
My teacher told my mom later that I was
slurring my words and stumbling around.
When I finally got to the doctor,
my doctor said my symptoms were so bad
that I probably should have gone
straight to a hospital ER.
One of my eyes wasn’t moving at all,
which is why I was seeing double.
The doctor ordered me
to have a week of doing nothing.
I was to sit in a dark room and rest.
She gave me a doctor’s note
excusing me from school for a week.
Now, for me, this was like
a death sentence.
I loved school,
and the notion of missing school
for any period of time was a nightmare.
This week for rest turned into a month,
and I became diagnosed
[with] post-concussive syndrome.
Then, a year later, the diagnosis evolved
to a mild traumatic brain injury.
It wasn’t until two years
after the accident
that we learned this incident
had also caused a spinal cord injury.
The symptoms were debilitating.
I had about 20 severe,
stabbing headaches a day,
significant, immobilizing
neck spasms every day,
double vision, light sensitivity,
dizziness and more.
My symptoms progressed into nerve pain,
difficulty walking and weakness,
tremors, episodes of amnesia,
and then the pressure in my head,
and my vision was starting
to go blurry and black.
This was supposed to be
a week-long speed bump in my life,
and five years later, it has proved
to be more than a detour.
Now, when you look at me,
you might not have guessed
that I had a traumatic brain
and spinal cord injury,
which brings me to the topic
of an invisible illness.
I generally look normal.
I don’t have crutches
or something that visibly marks me.
However, I have constant neck pain.
Physical pain is not something that can be
easily seen or easily measured.
Now, some people that suffer
from severe traumatic brain injuries
do have noticeable changes.
Implications from brain injuries
that are noticeable can be devastating.
People might look at you differently.
And unfortunately,
this is made even more detrimental
by stereotypes about people
with disabilities.
We are all unique.
We all think differently, act differently,
and if we hit our head,
the symptoms manifest differently.
We are all capable of different things,
so generalizing people with disabilities
can be hurtful, inaccurate and unfair.
For me and so many others,
having a hidden or invisible disability
has been a source of incredible pain.
People look at me and say,
“Well, at least you look great!”
They can question
your credibility or integrity.
People suffering from invisible illnesses
are so often ignored,
and this leads to ineffective help.
A 2002 US census found
that 96 percent of people with an illness
characterized that illness as invisible.
Many people with invisible disabilities
choose not to disclose it
to their employer
for fear of retribution.
By not disclosing this information,
these people are limiting themselves
from receiving the necessary
and appropriate accommodations
that could help them feel supported
and enable their success at work.
This apprehension to disclose
has its root in a fear of judgment,
prejudice and stereotyping.
Stereotypes based on disabilities
that depict an undesirable
image in our society
build barriers toward those suffering
from these disabilities
seeking help, treatment
and accommodations to succeed.
However, it gets even worse.
These stereotypes are to a degree
prevalent in the medical field as well.
The World Health Organization
called patient profiling
and diagnostic overshadowing
a human rights emergency.
Routine underutilization
of screening and treatment guidelines
for patients with mental illness,
as a result of this profiling,
has led to countless unnecessary deaths.
I personally have experienced
this type of discrimination
as I sought treatment
for my traumatic brain injury.
While there are so many incredible doctors
that do truly listen and care,
there have been quite a few
that have disregarded my physical pain.
The issue of believability
that prevents patients from getting
the health care they need
disproportionately affects women
and people of color.
We are talking about basic medical care
being denied to a large
portion of society.
Now, outside of prejudice,
because mental illness,
traumatic brain injuries
and countless other invisible illnesses
are hidden from the outside world,
there is a significant lack
of clear physical treatment.
By discounting women suffering
from these illnesses as being “emotional”
or people with brain injuries
as being “lazy,”
we aren’t just hurting the patient,
but we are hurting the medical field.
We need to pay attention
to these illnesses
so we could research effective treatments.
By encouraging these people
to step forward
and the medical community to take note,
we can maximize our chances
to capture data critical toward treatment.
We need to do our part
to break the boundaries in our society
built up by the stereotypes
surrounding people with disabilities.
Hitting your head on a locker or cabinet
might not sound that bad,
but sometimes these small injuries,
when added up, can be life changing.
As I mentioned earlier,
I was very committed to team sports
and of the mindset that you need
to get back in the game -
shake it off, get back
in there, help your team.
This mindset has been very common.
And in light of the football
chronic traumatic encephalopathy,
or CTE, stories that are rising,
the “just get back in there” mindset
has started to diminish.
However, its popularity has shown
how in the recent decades
there has been a minimization
of head injuries.
An example of this is the Supreme Court
of Ohio case, Schmitz et al. v. the NCAA.
The plaintiff, representing
a Notre Dame football player, Schmitz,
and other related cases,
argued that due to a football
coach’s negligence,
the players were unaware
they had gotten a concussion
and consequently got progressively worse.
In Schmitz’s case,
the now deceased football player
was playing for Notre Dame
when he hit his head.
In the case, it is written that Schmitz
was neither tested nor examined
for concussive symptoms,
nor was he advised or educated
about concussions
while playing football for the Notre Dame.
It goes on to say that coaching staff
ordered players to continue participating
in practices and games
following a head impact.
After hitting his head,
he was sent back into the game,
and his head injury
got progressively worse.
While not all head injuries
have significant symptomatic effects,
this culture minimizes
the impacts they do make.
A problem with this minimization
is that it can shine light away
from the issue and prevent innovation.
Many people feel that football players
are largely protected by helmets,
as promoted by the NFL’s recent initiative
to innovate on the helmet.
However, in an Academy
of Pediatrics study,
they concluded, like many scientists,
that the predominant protective gear
for football players against concussions -
helmets -
actually have little to no backing
for their effectiveness
in decreasing the severity
of a concussion.
They state that no conceivable helmet
will produce a large beneficial
effect in this regard.
Helmets are designed
to protect skulls, not brains.
With the recent CTE research published,
the effect of head hits is becoming
increasingly popular knowledge.
However, there is a barrier
that needs to be broken.
There needs to be an increase
in unbiased research
in head injury pathology and treatments.
As of right now, there is no cure
for traumatic brain injuries.
The cultural barrier created
by the “get back in the fields” mentality
needs to be broken.
You know, there are remarks
people jokingly make when they are annoyed
about hitting their head
against a desk or a wall.
There is even an emoji of someone
banging their head against a wall.
We live in a culture
that has historically turned a blind eye
from the issues of brain injuries.
The CDC reports
that there are approximately 3 million
emergency room visits and hospitalizations
caused by a traumatic brain injury
each year in America.
But five out of 10 concussions
go unreported or undetected.
Two in 10 high school athletes
per year who play contact sports
will suffer from a concussion.
This is a widespread issue,
and we need to pay attention
and do our part to help
by taking it seriously
and by being educated about concussions.
This brings me
to first responder education.
It is crucial that people are familiar
with ways to respond to a concussion.
I don’t have enough time to go
into the whole process with you here,
but I encourage you to go online
and find a reference card
or research this a bit more.
A few key things to keep in mind, though,
are that not all concussions
manifest the same.
So just because an injured person
may know what day of the week it is
or who the president
of the United States is,
that does not mean
they don’t have a concussion.
A few key markers to include
and look out for, though,
are confusion, headache, lack of memory,
difficulty concentrating, slurred speech,
double vision, dizziness,
imbalance, nausea.
However, there are many other symptoms
that can be observed or reported.
It’s important to not let
the person be unsupervised,
because if they are concussed,
they might be more confused or dizzy
and hit their head again,
which can cause severe repercussions.
These symptoms may not develop
for even 48 hours after the injury.
Further, if we disregard
concussion symptoms
that happen hours after an injury,
we may not notice them later.
These symptoms of difficulty concentrating
or mental fatigue can be present,
and months later,
people can be left without support,
wondering why they’re struggling
in school or work.
Sixty nine million people a year
suffer from reported
traumatic brain injuries.
Brain injuries and invisible injuries
are prevalent in our society.
We need to do our part
to support those suffering
by listening to them,
helping them to find care,
providing accommodations
to enable their success
and working towards
improved methods of treatment.
Take head hits seriously.
Care for people suffering
from invisible illnesses.
Let’s break barriers, not brains.
Thank you.