[vini]

hi all

this question needs to be answers

PCS the patient can recover from in time ?

TBI the patient can adapt to over time ?

your views on this would be appreciated as the waters are muddy ed, how do we know what condition we have ? the above is my take on the subject

Thanks

[Mark in Idaho]

Regarding PCS recovery and TBI recovery:

The main stream medical community holds to these statistics.

85% of concussion patients will recover fully.

15% will suffer from long term dysfunctions and struggles of varying intensities.

At first observation, these statistics look promising.

When these statistics are viewed through the lens of those who do more in-depth analysis, they mean something entirely different.

The 85% need to be redefined as to their recovery limitations. The vast majority of these 85% recover to a condition that appears similar to their before concussion condition. This full recovery is limited to their functional capacity during non-stress efforts.

The simple fact that the subject can walk, talk and chew gum is often considered a full recovery. The other subjective complaints such as cognitive and memory problems are left just that way, subjective. This is easy to understand as who among us has not had cognitive or memory struggles during an illness or head ache, even before any concussion?

Some doctors appear to take a position of, "If I can't image it or treat it, then there must be nothing wrong."

It is only when there are neuro-psychological assessments done that these subjective complaints get objective support.

This is a very rare situation due to the cost of a full neuro-psych assessment. Mini-neuro-psych evaluations are sometimes done but are often discounted. This may be due to the evaluator being a 'plain Jane' psychologist without neuro-psychologist credentials.

Of the three psychologists that have evaluated me, the one non-neuro had the best understanding of my condition. Go figure?? The two neuro-psych credentialed evaluators both diagnosed dysfunctions but labeled them as psychological, not physiological/concussion caused. They both were oblivious to my mentioned struggles caused by the testing environment (sensory overload). The 'plain Jane' was quick to make a few minor accommodations.

Many in the 85% are considered fully recovered due to a basic neurological exam that does not include any neuro-psychological assessments.

It is not uncommon for neurologists to perform only the motor function tests. The Mini Mental Status Exam is often not performed unless the patient is in latter years with cognitive complaints. The excuse is, "The patient is too young to have cognitive/memory difficulties."

Many of these neurologists are getting paid by a personal injury liability insurance company. They get continued work with these insurance companies by being cautious about their diagnoses that can negative impact the payer. They are not outright lying. They are just tweaking the evaluation to fit their biased opinion.

There is a large industry in the USA of specialists who work for insurance companies and their attorneys. They have very streamlined report writing organizations that leverage the few minutes of the M.D. or Ph.D. into reports that can be voluminous.

Of those 85% who appear to recover to high levels, this can often be attributed to their concussion history. If this was their first concussion, their level of recovery is often greater. The more concussions in the subjects history, the more problematic the recovery. The subject will likely be more susceptible to relapse/decompensation during times of stress of all varieties.

There is also an 'assumed recovery' when the concussion subject does not seek follow-up treatment. As I mentioned in an earlier post, any later complaints are often discounted due to a lack of a specific diagnosis of concussion in the original medical record using the ICD-9 or ICD-10 code 854. Often the subject does not understand that their later complaints are tied to the prior concussion, especially when these later complaints are not noticed until weeks later.

Accurate diagnosis/prognosis of concussion subjects will continue to be unreliable until the post concussion diagnosticians start to use stress as a factor in their diagnostic evaluations.

The TBI population is an entire different group from a long term perspective. I know many who have been comatose for weeks and months after their injury, including many who had closed head injuries. The rehabilitation parameters for this group tend to set lower recovery standards. The goal is often a return to ambulatory function and ability to maintain basic Activities of Daily Living (ADL's). Many, if not most, cannot live totally without access to support at some level

One could categorize them as recovered to the level of the 15 % of concussion subjects during their worst period. They may exhibit: a tendency to over-react, poor decision making/judgment, communication difficulties, sensory overload, problems with balance and coordination, vision difficulties, behavioral abnormalities ( schizoid, gullibility, ambivalence, apathy, depression, etc.)

Of the TBI subjects I know, once they are accepted for their behavioral idiosyncrasies, they tend to be much more tolerant of their own and others struggles. The PCS subjects, especially those in denial or rejection of their current condition, tend to be the most difficult in behavioral areas.

This whole problem can in some sense be tied to funding. Why should the health care system do any better at diagnosing concussion when those subjects can "Walk, Talk, and Chew gum" when there are people with treatable conditions lining up at the door?

Time to get on my Soap Box

Those with PCS are not dismissed without a cost to society. They overpopulate our prisons, homeless shelters, and other social welfare programs. Society loses their productivity by dismissing them. We will gladly use resources to help the obviously disabled but not the invisible wounded.

[shezbut]

I am a little confused by your question, vini.

Is there a difference between your terms: PCS and TBI?

I was diagnosed with a minor traumatic brain injury. The occupational therapist that worked with me once said that people who have the most difficult time recovering are those with "minor" TBI's. Her hypothesis was that our general intelligence isn't affected by the injury, but our slower processing speed and newly lowered limitations cause a lot of frustration and distress.

Commonly, only those close to us can see a difference. A lot of times, even they can't pick up on the struggles. Those with the injury, however, remain very aware of the difference. It's very hard to accept our limitations when others cannot see it. In my opinion, anyway. As a result, I often question what I can and cannot do. I'm not very good at reasoning, yet I push myself to do it. (It's a personality characteristic I've always had.) If I can't, I want to know why. Why, why, why. Jeez...ridiculous!

Okay, I'll get off my soapbox now too. I hope that I've answered your Q adequately.
Shez

[vini]

hi
thanks for reply,s

it is just I find the division of the terms unfair to the sufferer as you rightly describe shez MTBI is a better term please see cut and paste . I just feel the term syndrome seems to suggest. to the uniformed more of a psychological malady than the real injury that it is

I have been diagnosed the following is an abstract of my report


The following cognitive abilities were assessed:
• Pre-morbid intellectual and memory potential
• Neuropsychological status (dementia screening)
• Working memory ability
• Speed of information processing
The results are as follows (test description in Appendix 1):
Estimated Intellectual memory Potential
####### pre-morbid intellectual memory abilities were estimated to be within the 40 to 75 range

Neuropsychological Status
His performance on measures of attention, immediate and delayed memory, language and
visuospatial/constructional ability are summarised in a Total score that indicates overall
neurocognitive status below the 20th percentile for his age-group, and is strongly indicative
of an acquired impairment.

His most prominent deficit areas are the attentionai and memory indexes. His immediate
memory index is below normal, probably due to the result of impaired attentional/working
memory ability and on account of this poor initial processing of information, his delayed
recall index is also below average.

His language (confrontational naming and semantic fluency) and visuospatial/constructional
abilities are relatively preserved. ( my note relatively preserved dosan,t feel like it )
Working Memory
His working memory (auditory and visual) is consistent with Borderline functioning (4th
percentile) and in stark contrast with the estimated pre-morbid ability.
Speed of Information Processing
His information speed registered in the Defective range (4th percentile) and also represents
a significant change from pre-morbid functioning.
Summary
is a 47 year old man with an acquired brain injury subsequent to an assault
during December 2007, with ongoing deficits with attention, memory and an executive
function in the context of a relatively stable mood.
Recent initial neuropsychojnetry confirmed a clearly unfavourable neuropsychological profile
with deficits in attention, working memory, memory and speed'onnformation processing "-
all of which are inconsistent with pre-morbid levels of functioning.

thanks mark for you in depth answer, based on the above what class am I in MTBI or TBI 2 years plus injury ?

please note CSF leak post injury so I lost the cushion around the brain on impact

and night epilepsy





NET DEFINITION

Traumatic brain injury (TBI) can significantly affect many cognitive, physical, and psychological skills. Physical deficit can include ambulation, balance, coordination, fine motor skills, strength, and endurance. Cognitive deficits of language and communication, information processing, memory, and perceptual skills are common. Psychological status is also often altered. Adjustment to disability issues are frequently encountered by people with TBI.

Brain injury can occur in many ways. Traumatic brain injuries typically result from accidents in which the head strikes an object. This is the most common type of traumatic brain injury. However, other brain injuries, such as those caused by insufficient oxygen, poisoning, or infection, can cause similar deficits.

Mild Traumatic Brain Injury (MTBI) is characterized by one or more of the following symptoms: a brief loss of consciousness, loss of memory immediately before or after the injury, any alteration in mental state at the time of the accident, or focal neurological deficits. In many MTBI cases, the person seems fine on the surface, yet continues to endure chronic functional problems. Some people suffer long-term effects of MTBI, known as postconcussion syndrome (PCS). Persons suffering from PCS can experience significant changes in cognition and personality.

Most traumatic brain injuries result in widespread damage to the brain because the brain ricochets inside the skull during the impact of an accident. Diffuse axonal injury (Figure 1) occurs when the nerve cells are torn from one another. Localized damage also occurs when the brain bounces against the skull. The brain stem, frontal lobe, and temporal lobes are particularly vulnerable to this because of their location near bony protrusions.

The brain stem is located at the base of the brain. Aside from regulating basic arousal and regulatory functions, the brain stem is involved in attention and short-term memory. Trauma to this area can lead to disorientation, frustration, and anger. The limbic system, higher up in the brain than the brain stem, helps regulate emotions. Connected to the limbic system are the temporal lobes which are involved in many cognitive skills such as memory and language. Damage to the temporal lobes, or seizures in this area, have been associated with a number of behavioral disorders. The frontal lobe is almost always injured due to its large size and its location near the front of the cranium. The frontal lobe is involved in many cognitive functions and is considered our emotional and personality control center. Damage to this area can result in decreased judgement and increased impulsivity.

[Mark in Idaho]

vinni and others,

Many health care professionals will mix the two labels, PCS/concussion and mTBI. It is better to look at the progression of symptoms. No LOC, coma, no motor or psyche amnesia (minor amnesia for the event is common to concussion), no brain bleeds, etc. by most would be labeled PCS or mTBI.

The coma and amnesia with motor or psyche (thought/memory recall) becomes labeled a TBI. Some pros will try to diagnose different levels of concussion. I think this is a very hap-hazard effort with current diagnostic techniques in use.

vinni, Your neuro-psych sounds a lot like mine. Mine says, processing speed 10%, short and immediate visual and auditory memory in the bottom 5 to 12 %. My intellect is intact but hampered by the others. Besides my memory struggles, I am continually struggling with word finding, a symptom not tested well in the neuro-psych. The evaluator did comment about some of my strange word responses.

I did not get any estimations of pre-morbid abilities except an offhand comment about high intelligence evident due to high post morbid levels (90 to +99%). Most high intelligence suggests high pre-morbid memory function. It is difficult to develop a high intelligence without also having high memory functions.

This conflict between high intelligence with low post-morbid memory is considered a strong reason for the high level of functional/cognitive/memory complaints from the high intelligence PCS community. In my case, I had a very photographic memory. I could easily memorize/remember visual pictures, along with word and number pictures.

I don't get caught in a definition puzzle. I just label myself as brain injured. Very few ever understand any more specific definition. If somebody asks about my brain injury, I just say that I have had too many concussions resulting in a loss of visual and auditory short term memory functions.

The doctors definitely do not care about definitions. They just make-up their own opinions/diagnoses.


My best to you all.