My son did two stints in the Army, the second included a tour in Iraq for 15 months. He suffers TBI from artillery concussions.

He is working at the local VA hospital doing odd jobs to make some kind of income and is also on unemployment.

He called just now to say he blackout this morning while driving and jumped a curb. I tried, by phone, to get him to go to the ER TONIGHT at the VA hospital...he won't go. He is afraid, 1) his auto insurance won't cover the front end damage to his alignment and 2) his drivers license will be taken away...DUH!!

What truly scared me was that after this even this morning he drove nice 11 yr old niece 30 miles to visit relatives and this could have happened again while he was driving 60 miles an hour with her in the car.

He has been told he is having mini seizures...Complex Partials I think they are called.

I need advise as to how to make him get medical care when this happens...within a hour of the event. This time he decided to wait until he get to work at the VA hospital on Monday where he will tell the social worker who oversees in work program.

I am so frustrated.

Dear Stitcher

You are doing something. And honestly I hope you will make sure that
he doesn't do anymore driving of other people. I am really sorry he isn't
listening, wishing I was close enough to give you a hug.

He will still have to live with the experience probably even on Monday of
losing the experience of driving. When he tells the person at the VA
hospital. Because hopefully this person will get him into a doctor.

He needs to get onto medication. And you have the diagnosis correct
it is Complex Partial and honestly it might not have mattered if he had
gone right in. They still might not have seen a seizure.

But I'm going to say some prayers that he and any he are around stay safe.

I have two grown sons. And one 18 year old that has experience seizures
for 12 years. He wont be able to drive.

Donna

Hi Stitcher,

I can understand how scared and frustrated you must be. We brain injury victims are not always the easiest folks to deal with. The damage often robs us of our capacity to be self-reflective and once we get an idea in our heads… I understand too your son's fear of losing his independence. I often want to do things that transcend my abilities and my family has to intervene.

I’m afraid that’s what you might have to do here. If he continues to drive in his current condition there is a strong chance that he will kill or injure himself or someone else. If he doesn’t tell his doctor about his blackout, you’ll have to. He might be angry with you for a bit. However, you know that without the TBI, a young man who would signed up to protect the interests of his countryman in a foreign land, would never want to put them at risk at home. I just wish more people understood the high price many servicemen and women are paying on their behalf.

Your son is lucky that he has you looking out for his interests.

If I may ask, have they categorized your son's TBI as either Post Concussion Syndrome (PCS) or Diffuse Axonal Injury (DAI)? Fewer than 30% of DAI patients ever drive again.

Good Luck

Hockey,

Interesting statistic about DAI. I thought DAI was just a common form of PCS. I have not read anything about diagnosing DAI vs PCS. What reports have you found.


Regarding driving. Some states have stricter laws than others. call the DMV and ask them about how your state handles such issues.

I am confused at to why your son is not on a medical retirement from the military. Sounds like he should qualify. Has he applied for SSDI yet? He should give it a try.

Some metropolitan areas have ride assistance to people like your son, If there is a mass transit bus system and such, they are required by ADA to provide door to door service to people like your son.

Here in Idaho, we do not have a bus system so I do not have access to the service. In California, it is very common to find the door to door service. It is often called Paratransit.

Has your son had a rehab therapy using the light board? It is a common driving analysis tool. The flashing lights can also evoke a seizure.

Your son is missing out if he has not asked about seizure medication. If it helps, he could keep driving. If he waits too long and has an accident, meds might not get his drivers license back for years. They usually want you seizure free for a year or so to get your license back after an accident.

I know what he is going through. I had a few sidewalk scares before I fessed up and stopped driving eight years ago. I went to rehab recently and the therapist tried the drivers training car with me. I was fine on quiet streets but was overwhelmed on narrow busy streets.

Hi Mark,

While they share some common symptoms, my neurologist and neuro-psychologist both consider PCS and DAI different conditions.

There are quite a few distinctions but here are the big ones:
1. Manner of injury: DAI is caused by the violent rotation of the brain inside the cranium (shaken babies, car accidents, etc...) as opposed to contact with an external object.
2. Unconsciousness: Unconsciousness is a major indicator of DAI. Ninety percent of DAIs never regain consciousness. The ten percent of us lucky enough to wake up have severe impairments compared to our pre-morbid function.
3. Damage: As opposed to PCS where damaged can be localized (focal point), DAI causes significant damage to all areas of the brain. In scans, the DAI brain shows considerable shrinkage and torn and damaged axons in all lobes.
4. Diffuse axonal injury is permanent. There is little improvement over time, even with therapy.

Thank you all for you replies. My son is 35 yrs old. He is not a kid anymore.

I just got off the phone with him and he isn't going to listen to me or anyone else. He wants for "someone to just fix this. Everyone is making this more than it is."

The only reason he saw a doctor today...and that frustrated him because he never sees the same doctor in the VA clinic (welcome to the VA system)...is because I called the hospital and sought out the Social Worker who is assigned to him and who placed him into a job in the hospital delivering office supplies...he isn't happy about this either, but he can't find a job in the "real" world.

She summoned him to her office and asked him about his weekend, etc. He told her all was fine, nothing happened. Now I can see that I should have given her permission to tell him I called, but I did ask her not to tell him. She did consider the fact that he had an event over the weekend to be "serious" which is why I called her.

I will call her again tomorrow and talk to her again. I told him on the phone just now that I worry that he will have an event while driving and kill himself and/or someone else. His reply, "That isn't going to happen. I know the time of the day that these things happen to me!"

My son is very hardheaded about things and difficult to get through too. I wish I lived back home, but I don't. I moved north three years ago to be closer to my grandchildren. My daughters both moved north about five years ago.

Push come to shove, I may just move back just to try to make him tow the line.

Dear Stitcher,

Like I said, we brain injury patients can be difficult. Now that I'm more aware, I'm so grateful to my husband for all the times he stopped me from doing things when I was really out of my head. The poor man took a lot of abuse. Frankly, as my awareness is still diminished, I think it's my family that suffers the most.

Just from your note I can tell that your son is hurting a great deal. Having a TBI is frustrating, confussing and just plain scary. Could the social worker get your son into a support group with other TBI vets? If he'd go, it might be the first step on the road to acceptance and recovery.

In the meantime, do whatever you have to do to keep him from driving.

Good Luck

Hockey, he refuses to even discuss a support group with me..."I don't have time to listen to all the stories." I don't believe he realizes how good it may feel to find that he is not alone.

I will mention this to the social worker tomorrow.

Thanks

Dear Stitcher,

I know where your son is coming from. At first I was too sick to know anything was wrong. Even now, after seeing all the diagnostic tests and living with all the deficits, I still have moments when I think it can't really be true.

Whether or not you can talk your son into going to his support group, you should consider joining one for TBI caregivers.

By the way, you're a great mom!

That is surprising information. I have never heard anything like it before. My research shows DAI as a common subset of PCS. The shaken baby/car accident can cause the same physical forces as a contact with an external object. Most car accident brain injuries are due to impact with an external object, i.e. A pillar, B pillar, roof, windshield, dash board. DAI is known to result from any traumatic impact or shaking of the brain.

All of my injuries have been along a single axis with a very minor rotational component. The coup contra-coup forces of a linear impact (concussion) have similar damaging effect as a rotational injury. If the linear force is strong enough, there is axonal tearing between the lobes and the corpus colosum and milder axonal tearing between lobes and within lobes. LOC (loss of consciousness) has proven to be a leak indicator of outcome except for those in a coma.

Many times, an impact with an external object can have both a linear component and a rotational component. As the head is whipped forward, it is stopped by the object. It was rotating about the axis of the neck and moving forward. The forward motion is stopped by the object and the rotational motion is stopped by the object.

A hockey illustration could be this. The player has his feet swept out from under him by a clipping motion (hit behind and below the knees)As he falls back and to the ice, his head has a vertical down component. He probably tuck his chin to his chest in a reflex action. As his back hits the ice first, his head rotates about his shoulders/neck with his forehead moving down and his chin moving horizontal away from his chest. This rotation stops when his head hits the ice. The downward impact (which is much more severe) also stops at the ice. Both may have a contra-coup response if the head bounces. This has the effect of doubling the impact force to the brain.

As you can see, there are both rotational and linear forces with contra-coup forces.

It appears your docs use the same information source as WIKIpedia. If you read beyond the first paragraph, it become obvious that the first paragraph does not fit with the rest of the information. Most articles about DIA and PCS overlap them greatly. In fact. mild DIA is often referred to as the cause of PCS. PCS is actually a cluster of symptoms that manifest days to months after the impact. DIA is the physiological damage done as a result of the insult, some immediately, some as a longer term result of cellular changes.

This discussion only shows how much of the PCS/DIA arena is still uncertain. Doctors, whether M.D. or Ph.D. or Psy.D. try to sound authoritative with whatever information they have gathered. A broader investigation shows how problematic it is to be authoritative with the lack of understanding even in the finest research studies.
They are right about the permanence of DIA. But PCS has permanent symptoms too. Neuro-plasticity can only go so far. DIA means a wide area of damage. Hard to rewire around such a wide area of damage.

<While they share some common symptoms, my neurologist and neuro-psychologist both consider PCS and DAI different conditions.

There are quite a few distinctions but here are the big ones:
1. Manner of injury: DAI is caused by the violent rotation of the brain inside the cranium (shaken babies, car accidents, etc...) as opposed to contact with an external object.
2. Unconsciousness: Unconsciousness is a major indicator of DAI. Ninety percent of DAIs never regain consciousness. The ten percent of us lucky enough to wake up have severe impairments compared to our pre-morbid function.
3. Damage: As opposed to PCS where damaged can be localized (focal point), DAI causes significant damage to all areas of the brain. In scans, the DAI brain shows considerable shrinkage and torn and damaged axons in all lobes.
4. Diffuse axonal injury is permanent. There is little improvement over time, even with therapy. >