How Much Of Math Is Necessary To Do Machine Learning Traumatic Brain Injury – The Critical Role of Family on the Road to Diagnosis Treatment and Recovery

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Traumatic Brain Injury – The Critical Role of Family on the Road to Diagnosis Treatment and Recovery

Brain injury is one of the leading causes of death in people under the age of 45. Many people who suffer mild to moderate injuries do not appear to be injured and have few outward physical manifestations of personal injury. In short, they “look” good, despite the fact that they have suffered serious personal damage that can mean the loss of work, the destruction of personal relationships and the anguish that accompanies the knowledge of all that has been lost.

Doctors will routinely reassure mild-to-moderate traumatic brain injury survivors that they will recover from their fatigue, slow thinking, and reduced memory, just as they expect to recover from cuts, bruises, and broken bones. The all too common belief is that time heals all wounds. For every rule there is an exception, and unfortunately, time does not heal all traumatic brain injuries. Over time, doctors address the objective physical injuries, but the head injury does not receive the special attention it requires and the TBI goes undiagnosed. As a result, many head injury patients with permanent disabilities never receive a full evaluation by a neuropsychologist, including neuropsychological testing. Without testing by a neuropsychologist, this personal injury cannot be diagnosed and these patients never receive the appropriate care and treatment for their physical, cognitive, psychological, sexual, and social disabilities. Family to obtain a complete copy of the survivor’s medical record, including rescue and ambulance. service, emergency and hospital records if there was an admission. A complete set is critical because it contains all the detailed assessments and objective measurements made by emergency medical technicians, ER nurses, and physicians and neurologists that are necessary to understand the nature and extent of this personal injury.

Because the brain regulates our state and level of consciousness, we can learn a lot about the extent of a brain injury by assessing consciousness itself. If the level of consciousness is different from normal, the head injury is serious, regardless of what a physical exam or other evidence may indicate. The categories of altered consciousness are:

  • confusion – The mildest form of altered consciousness, in which individuals have difficulty thinking coherently. For example, they may not be able to solve a simple math problem or remember what they ate for breakfast. They will often seem disoriented and may not talk much.
  • Astonishment – At this level, individuals are often close to a comatose state and unresponsive to normal stimuli. They can only be awakened by intense or painful stimulation, such as having their toe pinched or stuck with a needle. They may open their eyes, but only if they are forced to respond.
  • delirium – This intense state of altered consciousness is often the result of exposure to a toxic substance. People suffering from delirium are disoriented, fearful, irritable and hyperreactive. They do not understand what they see or hear and are prone to visual hallucinations.
  • Comma – The most serious form of altered consciousness, in which a person is completely unconscious and does not respond to any type of stimulus.

Doctors use a system called the Glasgow Coma Scale (GCS) to accurately assess and describe patients’ levels of consciousness. To understand the severity of a brain injury, the condition of the patient at the first assessment is important. The more severe the initial presentation, the more severe the injury and the lower the likelihood of a full and complete recovery. The scale is based on three individual responses that measure eye, verbal and motor responses. Clinicians consider the expression of a total GCS score of limited interest; what is more important is the score in each of the three individual categories. Each response level indicates the degree of brain injury.

The lowest score is 3 and indicates no patient response. An alert and oriented person would have a 15 year rating.

Any period of unconsciousness is a red flag to rule out permanent brain injury, meaning to assess the nature and extent of the brain injury. Loss of consciousness should always be considered significant. However, a report of no loss of consciousness does not mean that a brain injury has not occurred. Many head injuries result in a prolonged period of confusion with erratic memory. It is common for patients to be asked what they remember when they wake up. The most important thing, however, is when constant and continuous memory is reset. In many cases where there is no specifically identified period of loss of consciousness, continuous memory will not reset for many hours or days afterward.

The most frequent brain injury is a silent and elusive one. Called post-concussion syndrome, this personal injury is most often caused by what appears to be a harmless head injury. People can suffer a head injury but never lose consciousness and appear to be fine. The difference between a post-concussion syndrome and a traumatic brain injury is that PCS is temporary. TBI is not. Days or weeks later, people will experience problems with memory, reasoning, or judgment, or they may simply report feeling “off” and not being the same person they were before the accident. These injuries are not easily reported in the injured survivor’s medical records, but are well understood by family members, close friends, and co-workers who know that the survivor is “not the same person” they were before this serious personal injury. they changed their lives.

In today’s world of short medical visits, doctors do not have the time, and in many cases the training, to ask the patient about detailed changes in their ability to cope after a head injury. Because many people get better over time, reassurance is the usual form of medical care provided by a family doctor or general practitioner. The result is that “reassurance” denies the patient treatment because he does not get an honest diagnosis.

Family members are the first to recognize deficits and changes caused by a head injury, long before the patient is ready to admit chronic deficits, but unfortunately this significant information is not fully reported to clinicians. Also, by definition, asking a person with memory problems to detail their cognitive losses is problematic. It’s the equivalent of asking a patient “how long were you knocked out?” Once you’ve lost consciousness, you don’t know it, and rarely does anyone instantly regain full consciousness. Shifting in and out of acute awareness is common. For the same reasons, asking a person with memory problems what they cannot remember is not helpful. And there is no bright line between depression, fatigue, irritability, and memory lapses caused by brain injury or other causes, even though these symptoms are hallmarks of a brain injury patient. That’s why it’s so important to have a spouse, parent, or sibling with first-hand knowledge attend follow-up medical exams.

 

After 3 to 6 months, if deficits persist or improvement is slower than expected, report the most significant deficits in writing to the primary care provider and request a referral to a neuropsychologist.

In many cases, as a head injury survivor’s attorney, I have worked with family members to prepare a detailed letter to a treating physician that identifies changes in learning and communication skills, among others, that the patient has experienced and as a result have obtained a referral to a neuropsychologist for evaluation and testing. Obtaining appropriate medical care and treatment, especially for TBI survivors, requires the intervention and support of family members, and often a skilled attorney who knows and understands the signs and symptoms of brain injury.

A word of caution. Don’t be dissuaded by a doctor who refuses to order neuropsychological testing because a CT scan, or MRI, shows no lesions, meaning the images read as within normal limits.

 

First, CT cannot be used to diagnose TBI except in the most severe cases of fractures and hematomas. Second, the same goes for most MRIs. Unless the MRI was performed on a T-3 MRI machine, which employs sophisticated software to provide diffuse tensor imaging and fiber tracing that is studied and interpreted by a neuroradiologist trained in this protocol, the report of magnetic resonance is not definitive.

Note that an MRI using a T-3 alone is not sufficient unless software is used that provides diffuse tensor imaging and fiber tracing. This combination of hardware and software allows specially trained professionals to identify axonal shears and other finite lesions, which would otherwise not be seen on MRIs performed on T-1 or T-1.5 machines. More importantly, MRIs are not the first step in diagnosing a traumatic brain injury. The recognized method of diagnosing residual traumatic brain injury is through tests performed by a neuropsychologist trained to evaluate TBI.

 

When should we expect a recovery and to what extent? The general rule of thumb is that the shorter the recovery time, the more complete the recovery. Although each person is different, patients tend to recover sensory, motor and language skills more quickly and easily than writing and math skills, memory, attention, general intelligence and balance social/emotional In addition to the longer recovery time, the loss of these skills and abilities is usually more devastating.

Motor and speech recovery usually occurs between three and six months after the injury. Attention and memory are usually the most difficult to recover.

The rate of recovery is usually greatest during the first three months. The recovery then tends to slow down over the balance of the first year. This is one of the reasons why it is valuable to obtain a neuropsychological assessment soon after the head injury and use this baseline for comparison with later tests to measure changes and understand the extent of improvement.

In general, after six months there may be some improvement, but it is usually not significant. After this point, there is no healing in the conventional sense. Damaged brain cells and nerve pathways do not regenerate. People can and do learn to compensate for their injuries by using other skills and this is where rehabilitation specialists are of great help.

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