Traumatic brain injury occurs when an external force causes injury to the brain. That external force could be from an automobile accident, a fall, a gunshot, a sports concussion or a roadside bomb (IED as they’re called in Iraq). TBI is normally classified as mild or severe, depending upon numerous factors.

Traumatic brain injuries may not be diagnosed during early treatment. Each year, thousands of persons suffering from brain injury are sent home from hospital emergency rooms because of a lack of symptoms or, quite possibly, a lack of brain injury knowledge among ER personnel.

Dr. Antoinette R. Appel has stated: “Left to fend for themselves, the victims of traumatic brain injury, already confused by their inability to be the people they were prior to the injury, now face the daunting task of demonstrating that an injury they do not understand and cannot comprehend is producing the confusion they cannot communicate.”

Dr. Appel has a Ph.D. in psychology from the City University of New York and has devoted herself to the understanding of types of brain injury and the role of the neuropsychologist when it comes to identifying, proving and treating brain injury. Her statement in the previous paragraph is one of the best summations of traumatic brain injury we’re seen.

Confused by Their Inability to be the People They were Prior to the Injury

People who are familiar with Brain Injury Survivor’s Guide will identify this confusion as part of the Cycle of Response discussed in chapter six. Brain injury affects memory. Beth Jameson, co-author of Brain Injury Survivor’s Guide, could not remember how to cook or how to put on her makeup.

Courtney Cox, co-author of I Can’t Remember Me, could not remember her husband or family members. Claudia Osborn, the author of Over My Head, had a terrible time when shopping. She said she would either forget her list or take the list and forget to take money or forget how to get to the grocery store. (Both books are available at the Brain Injury Bookstore on Amazon – see left column.)

These are just three examples out of millions of people who were confused by their inability to be the people they were prior to their brain injuries.

Demonstrating that an Injury they do not Understand and Cannot Comprehend is Producing the Confusion they Cannot Communicate

How do you explain to someone something you don’t understand and cannot comprehend? Beth mentioned in her book that there were many occasions when she stood silent in the middle of a sentence, trying to remember the words she wanted to say.

Has that happened to you? Did the other person say to you like they would say to Beth, “That happens to me all the time”? Beth said she simply wanted to scream, “NO, that doesn’t happen to you ALL the time; it happens to ME ALL THE TIME.”

Difficulty finding the correct words at the correct time is a very common problem among people who have suffered a brain injury. Just because it’s a common problem does not make it any easier to live with. Not only is it confusing, it leads to frustration which leads to guilt which leads to depression (also from Cycle of Response in Brain Injury Survivor’s Guide).

Earlier you read that traumatic brain injury is classified as mild or severe. Please understand that any injury to the brain is traumatic for both the injured person and family members, whether it’s caused by an external force or not.

Strokes can also cause brain injury, so can lack of oxygen. So can drug use. And so can many other things. While these are not officially called traumatic brain injuries, the results are the same.

Some physical symptoms include nausea, vomiting, headache, dizziness, blurred vision, some loss of vision, difficulty sleeping, getting tired easily, lethargy and other sensory losses such as smell or taste.

Some cognitive symptoms include the inability to concentrate, short attention span, difficulty finding words and memory problems.

Some behavioral problems include disinhibition, becoming easily irritated, being very quick to anger, etc.

Beth Jameson insisted that a message she desperately wanted to convey in Brain Injury Survivor’s Guide is this: Knowledge is Power to a Brain Injured Person. Victims and family members must learn more about brain injury. They should attend support groups if possible. They should find Internet support groups and share information with others…and learn from others.

A brain injury, in many instances, can be overcome. But, it will not go away.

Traumatic Brain Injury Effects

Traumatic brain injury effects are the result of a physical injury to the brain. These effects do not stem from a mental illness and can, in some way, be likened to broken bones. Broken bones must be rested and allowed to heal. During the time of healing, the patient must compensate for the injury.

For example, a person with a broken leg cannot run very fast if at all. The broken leg may prevent any kind of self-propelled movement, including not being able to walk. A cast is put on the leg to prevent normal use. Crutches are used to compensate for not being able to use the leg. The crutches, in this instance, are a “substitute” leg.

Traumatic brain injury affects the brain in many ways: memory, cognitive and behavioral. We cannot, however, put a cast on a brain and let it rest. The brain will rest, and that causes a different set of problems for many brain injury victims.

I refer you to Chapter Six of Brain Injury Survivor’s Guide: Cycle of Response. The five steps of the Cycle are mental fatigue, confusion, frustration, guilt, and depression. The brain simply says, “I’m tired, and I’m not going to do any more work.” We all have those times during the day (usually between 1:00 and 3:00 p.m.) when our cognitive functioning drops down a few degrees. A person living with brain injury may experience mental fatigue several times each day.

Mental fatigue affects memory. Memory affects cognitive functioning. Reduced cognitive functioning affects behavior. Behavior problems may exhibit themselves as anger, crying, cursing and, even, sexual disinhibition. Think of the Incredible Hulk. In an instant, a mild-mannered guy turns into a menacing, angry monster. For the Incredible Hulk, it was anger that triggered the transformation. For a brain injury victim, the trigger could be mental fatigue.

Signs of Mental fatigue

A person loses the ability to focus on concentrate. The attention span shortens considerably. There may be vocal expressions of confusion and frustration. “Why can’t I remember…?”

When this happens, it’s time to take a break from whatever is being done. Deep breathing, listening to music and taking a walk are three things that can help get away from situations that ignite the Cycle of Response.

Sexual Dysfunction and Sexual Performance

Sexual dysfunction and sexual performance issues are fairly common problems in the general population. A brain injury or stroke can significantly change the sex life of the injured person and that person’s significant other. You have heard us say time and again that no two brains are exactly alike prior to being injured and, thus, no two brain injuries are exactly alike. That holds true when it comes to sex. I will not go into problems associated with physical injuries caused by an accident. Let’s look at how the brain is affected.

The thalamus, hypothalamus, and limbic system are located deep inside the brain. Think of these three working together like a triage team at a military medical facility in a war zone. The thalamus is the first point of contact for incoming information. That information passes through the limbic system to the hypothalamus. The limbic system helps prioritize the information, and the hypothalamus decides what is most important and passes it on for treatment, or a response.

The limbic system plays a significant role in controlling emotions and memories. Among the many roles of the hypothalamus are an emotional expression and sex drive. When it is functioning properly, the hypothalamus screams, “Have sex now! Stop whatever else you are doing, and have sex.” Fortunately for society, that information is sent to the frontal lobe for filtering that scream down to a suggestion such as, “Let’s find an opportunity to have sex.”

Two relationship problems are evident when we look at the triage team combined with the frontal lobe filtering system. Having sex may not be prioritized and sent out for action. Dr. Diane Stoler writes in her book, Coping with Mild Traumatic Brain Injury, about a real estate agent who suffered a brain injury and a loss of sexual desire – for two years!

Sexual Disinhibition is at the other end of the spectrum and manifests itself when the filtering system fails. Remember, the frontal lobe is where decisions are made. The hypothalamus screams, “Have sex now!” That piece of information rushes to the frontal lobe for a decision and action and is not filtered for polite society. Where is the Mango Princess by Cathy Crimmins contains quite a few examples of sexual Disinhibition she experienced as a family member/caregiver.

Here’s how one brain injury survivor described it, “It is kinda something that is tough to talk about because when it happens you just really have NO concern for who sees or where you are. Later, though, the embarrassment and shame sets in and I think, ‘My God!'”

During the early days of a brain injury, the victim may feel neither embarrassment nor shame. The brain may well have returned to child-like innocence or, perhaps better stated, total self-centeredness. With the known world revolving around self, nothing is wrong. Inappropriate touching, sexually harassing comments or solicitations, and, even, public masturbation is not unusual. By public I don’t necessarily mean out on a city street; it could simply be self-manipulation in a hospital room in view of others.

Medications can also cause a lack of sexual desire. There are many effects of brain injury that require medication, depression not being the least problem. Commonly prescribed medications include Valium, Dilantin, Elavil, Prozac, Calan, and Naproxen – all of which decrease sexual desire.

Another problem affecting sexual desire is the inability to concentrate. Short term memory problems are very common among brain injury victims, and this includes attention span. Shorter attention spans affect the ability to concentrate. Lack of sleep and the inability to relax are other issues that affect sexual desire.

So, what do you do? If you are taking medications, talk to your doctor. When he or she asks how you’re doing, bring up your concerns and your sex-related questions. It may be possible to alter your medications. I would also recommend you take a look at our free brain quizzes and puzzles. They can help improve your short term memory and cognitive skills.

If you are unable to relax, and I’m talking about letting go of everything if only for a few minutes, you should take a look at relaxation audio tapes. And, never underestimate the value of music.

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