Making sense of traumatic brain injuries


DOVER –– Traumatic brain injuries cause 2.5 million emergency room visits, hospitalizations and deaths per year in the United States alone and March is set aside to evaluate ways to better prevent and treat these injuries.

James Mills

James Mills

According to the Centers for Disease Control and Prevention, a traumatic brain injury or TBI, is caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.

On a microscopic level, Dr. Jim Mills of Bayhealth’s neurosurgery department said that axons –– long, thin nerve cells that connect neurons in the brain –– are stretched, damaged or stop working all together.

The most mild TBIs usually come from a concussions related to sports or recreation, but with a concussion, the signs and symptoms may not be as obvious as those associated with severe TBI from a car crash or violence.

“Usually when someone has a sport-related concussion, there are people around to witness it like coaches, referees or parents,” Dr. Mills said. “The most important thing to look for is loss of consciousness. If someone loses consciousness, they need to see a medical professional.”

Symptoms range from dizziness to difficulty thinking clearly to changes in sleeping patterns. Some symptoms may be seen immediately while others may not be noticed for days or weeks after the concussion.

“Every concussion doesn’t require medical attention and people need to remember that the brain is able to heal itself from small injuries and the best remedies are rest and sleep,” Dr. Mills said.

But if symptoms persist, people may need to consult a physician to get on medication to relieve symptoms and in some cases, short-term therapy may be needed.

TBIs in young people

For the most part, traumatic brain injuries in young people are preventable. The most common causes aside from sports and recreation are car crashes, violence and falls.

ThinkFirst is a national organization aimed at preventing head trauma in kids to young adults. Their main focus is safety precautions like always wearing a seatbelt or helmet and avoiding drunk, drowsy or distracted driving.

Kathy Boyer, a trauma coordinator at Christiana Care, has organized ThinkFirst programs in Delaware for the past four years.

“Having a survivor, someone like me speak to them, I think it hits them harder than just a nurse or someone who comes in with a bunch of facts and statistics,” Sean Fillingham of Wilmington said.

Mr. Fillingham was in a car accident a decade ago when he was 24, just after college graduation, and 10 years later is still on the road to recovery.

“I was driving drunk,” he said. “I thought I was invincible like a lot of kids do. But after the accident, I was in a coma for three months and still don’t have my speech fully back and my balance isn’t 100 percent.”

Although finished with formal daily therapy, Mr. Fillingham still does at-home therapy regularly to keep improving.

Since he was 28, Mr. Fillingham has been a regular speaker for ThinkFirst and recently earned his master’s degree in special education.

“I want to show them not only that there are consequences for your actions but that people who have had brain injuries can be successful, but it did take me 10 years longer than expected to get here,” he said.

“Kids need to understand that choices they make now can affect them for the rest of their lives,” Ms. Boyer said. “It can put off that career they wanted or that career may not even be an option for them after a brain injury. They may face mobility issues, financial obstacles and might not even be capable of living on their own once they reach adulthood.”

Even if school-aged children are able to recover from a traumatic brain injury, it’s often difficult to get back on track because they’re plagued with memory difficulty and mental fatigue.

“Even if they are able to go back to school, they might only be able to take one or two classes at a time, they might need one-on-one tutoring and it can hold them back a year or more,” Ms. Boyer said.

In very severe cases for adults and children alike, Dr. Mills said that TBI patients may need to be admitted to a specialized care facility to relearn basic tasks like taking care of themselves and receive speech and cognitive therapy.

TBI in older adults

The most common cause of traumatic brain injuries in older adults are falls which typically result in blunt-force trauma.

“All older adults are at the risk of falls so the best thing to do is to prevent them,” said Donna Mabry, a registered nurse with the Division of Services for Aging and Adults with Physical Disabilities.

Preventative measures include keeping clear walkways in homes, using a walker when needed, making home modifications such as additional hand rails or even using physical assistance from a caregiver because one fall can be a major setback in health.

“Falls for the elderly can cause dramatic life changes,” Dr. Mills said. “Oftentimes, one fall can be an indication that someone needs full-time care and can no longer live independently. There can be serious complications too like bleeding.”

The effects of a fall don’t only rely on age, Dr. Mills says other medical conditions, medication and overall fragility take a large part in the outcome.

But the most common result of brain injuries caused by falls are memory loss or a change in behavior or personality in cases where the frontal lobe has been damaged.

“We try to educate caregivers on what the results of a fall could be and how to handle them because it can take patience and understanding to overcome the problems they’re faced with,” Ms. Mabry said. “And we have to always remember that no matter how someone changes after a fall that they’re still an individual and we need to respect that.”

She added that a good option for caregivers is to take their loved one to an adult day care facility a few days a week so their brains can be kept active through puzzles, games and physical activity.

“Although routine is important for a lot of older people, especially those recovering from a fall, it’s important not to keep them a prisoner of their wheelchair,” Ms. Mabry said. “Having them sitting all day with only their caregiver or having them wait at home or in the car alone isn’t going to help them improve.”

For those who have experienced a TBI and their families and caregivers, help is available right here in Delaware from the Brain Injury Association of Delaware.

“In Delaware we don’t have designated out-patient therapy for those with brain injuries and there’s a need for continuing care,” said Susan Lyons, president of the association. “So we have a good relationship with hospitals across the state to connect brain injury patients with us.”

The Brain Injury Association can offer not only information and guidance for care, but also support groups which many survivors and caregivers find to be a helpful outlet.

“A lot of people think they’re in this alone so it’s comforting to come to a support group and see others like themselves and know they aren’t alone after all,” Ms. Lyons said.

There are seven support groups across Delaware that work with different age groups and different types of injuries.

“We work with people of all ages and who have suffered from a wide array of brain injuries from car crashes, falls, strokes and even conditions like encephalitis,” she said. “Our mission is to create a better future through brain injury prevention, education, advocacy and support.”

“These groups aren’t a place people go just to talk about their injury, it’s also a place to socialize because during recovery or while dealing with the effects of TBI, people don’t always get the socialization they need,” Dr. Mills said.

When families first become interested in the Brain Injury Association, Ms. Lyons speaks with them personally to give them information about the organization and many individuals over 18 are connected with the Delaware Aging and Disability Resource Center.

As people suffering the effects of a TBI age, they may need assistance in paying for assistance devices and home modifications and the Resource Center can offer financial assistance in some cases.

They also offer help in applying for Medicaid or other health coverage options.

“We have seen people denied Medicaid or other health care because from the outside they may not seem like they need the help,” Ms. Lyons said. “There are plenty of people who appear to be fine from the outside because they’re clean and put together well but they may be a mess on the inside and genuinely need help. It isn’t always obvious who is suffering from TBI.”

To hold a ThinkFirst program, contact Ms. Boyer at and for more information about the Brain Injury Association and the resources it offers, call 1-800-411-0505 or visit

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