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Traumatic Brain Injuries: Staying Safe this Winter

Hot cocoa, winter jasmine blooms and hopes for snow — we’re in the midst of another beautiful winter season. Winter activities are starting to beckon many of us outside and into the mountains, to enjoy skiing, ice skating, sledding, snow tubing and other winter sports. While these sports provide much enjoyed thrills, they can also come with falls. January is National Winter Sports Traumatic Brain Injury Awareness month — a perfect time to learn how to protect our brains, one of our most valuable assets.

Traumatic brain injury, or TBI, typically happens when there’s a violent bump or jolt to the head. Winter sports that involve physical contact, such as ice hockey, or that involve the potential of falls, such as skating and skiing, are common causes of TBI.

In North Carolina alone, over 70,000 residents suffer a traumatic brain injury every year. And moderate to severe TBI can have a significant, long term impact on a person’s quality of life. In fact, over 200,000 North Carolinians are currently disabled as a result of a TBI.

Mild, Moderate or Severe?

Even a mild TBI can result in temporary changes to the brain, as happens in a concussion. A person might have difficulties with balance or dizziness, or be slightly confused and sensitive to light. While mild injuries can still be serious and require medical attention, they will often eventually resolve themselves.

Moderate to severe TBI, however, poses the more serious problem. In a moderate to severe injury, changes to consciousness and responsiveness can be more prolonged, and in some cases, permanent. Coma and brain death can result from a severe TBI.

Even when complications aren’t quite as severe, many people will have long term intellectual, emotional and behavioral changes.

Physical complications from a moderate or severe TBI can also be significant. Seizures, hydrocephalus (fluid buildup in the brain) and paralysis can occur.

To put it simply, the brain controls much of who we are and how our bodies perform. When it’s injured, our entire life can change.

Preventing Brain Injuries

The easiest and best way to prevent a TBI during winter activities is simple: wear a helmet.

You should always wear a helmet when you’re riding anything that moves, including snowmobiles. You should also wear a helmet when you’re playing a winter sport that requires physical contact, i.e., ice hockey. Heights are important too — don’t take a ride down a slope without head protection. Make smart decisions when enjoying winter activities. This isn’t the time to push yourself far out of your body’s comfort zone. One risky decision on the slope has the potential to impact your quality of life down the line. You should understand your limitations and make sure you’re familiar with your surroundings before jumping into any activity.

Keep an Eye on the Kids

Kids can be even more susceptible to impacts from TBI, as their brains are still in their formative years. They’re also the ones most likely to be the first to run outside to enjoy the winter weather. Little ones, especially, need adequate supervision and safety gear that fits well and is in good shape.

Teenagers may be more likely to try to avoid wearing a helmet and safety gear, especially when hanging out with friends. Don’t just make it a rule — try to help them understand why it’s so important.

Rehabilitation and Restoring Skills

For people who’ve suffered a brain injury, WakeMed Rehab provides integrated, comprehensive delivery of rehabilitation services. Through our Brain Injury Rehabilitation System (BIRS) program, our treatment teams collaborate across clinical specialties to evaluate the patient’s impairments, activity and participation limitations to determine rehab needs and potential for functional improvement. Learn more about BIRS.

With limited tolerance for activity in the early stages, teams — including Physical, Occupational and Speech Therapists — maximize what they can do to help restore the patient’s functional abilities. Nurses also play a pivotal role because they are constantly at the bedside of the patient and act as a great sounding board for family members.

When patients first arrive at the emergency room, they are put through a Glasgow coma scale test to determine the extent of the injury. Symptoms of a TBI may include sensory, motor, cognitive, speech and visual impairments.

Laura Helen Murray is a WakeMed Physical Therapist who works primarily in the ICU and is one of the first to engage the patients in therapy. She says, “All the ways patients interact with their environment could be affected. It depends on how the brain was injured and if it was global or a certain part of the brain. Patients who can engage and move their bodies may go to a floor. Severe injury lands them in the ICU.”

“Right away, we will try to wake them up and sit them up,” says Laura Helen. Equipment used to support awakening and strengthening may include a hospital bed that will sit them up to stimulate some arousal. ICU stretcher chairs are used for those who are more tethered to lines, preventing staff from moving them too much. Eventually, teams attempt to transition all TBI patients to wheelchairs. Tilt wheelchairs help prevent falls while encouraging arousal when kept in a more reclined position. ICU walkers and canes are used by those who can get up and move. Additionally, many patients have broken bones and may require a lift to safely mobilize them if they are non-weight bearing in certain areas of their bodies.

TBI treatment also involves helping patients engage their families because familiar sounds and objects can help. Laura Helen says, “We do a lot of education with families on how to engage patients, so they are safely stimulated, but not overstimulated.”

Laura Helen is most inspired by watching her patients’ incredible recovery. She says, “Patients will interact with the environment a bit more as the brain swelling goes down. It is cool to watch as they are able to start engaging with their families more.”

Therapeutically, WakeMed teams look at the TBI Rancho Scale. This helps the treatment team determine where a patient is in the recovery process and where to send him or her for next steps — going to a floor unit or going to rehabilitation.

Christine Fernandini is a WakeMed RN Manager who supports nursing staff caring for patients sent to a rehab unit. Her nursing team supports patients and their families with disconcerting changes in the patient’s abilities, memory and personality. For example, patients may not remember important details or people, leaving them confused and fearful.

Christine says, “A book of keywords might be developed for patients to help them say what they want when they can’t find the words. Certain technological tools can be used, especially for patients who have had a stroke, so they can connect something on the screen with a hand movement, for example.”

For personality and other changes, nursing teams focus on supporting families who may feel that they are dealing with a person who is unfamiliar. Christine says, “We urge families not to get in disagreements with the patient, but rather to offer support and manage the episodes to help conquer the fear or aggression that is surfacing. Distraction works well, such as getting the patient to talk about something they enjoy or someone they love. We also have a Brain Injury Support Group, so families can compare experiences and have support as they walk through the situation. Brain Injury Association of NC has been helpful as well.”

At WakeMed, support doesn’t exclusively extend to TBI patients and their families. WakeMed also supports staff to ensure they have the tools in place to take care of patients the best they can. Christine says, “We offer classes. We typically have a monthly CEU offering related to brain injury. That way, our staff are able to learn and share that information with the family.”

Christine says, “We love to see patients recover. They come in unable to walk or talk and by the time they leave, they can do those things. Often times, patients and families will come back to visit. Seeing patients happy and back to the things they used to do is very rewarding.”

Melissa Mizelle is a Clinical Case Manager who supports patients in returning to their normal life through rehabilitation and progressive reentry. As a Licensed Clinical Social Worker (LCSW), Licensed Clinical Addictions Specialist (LCAS), Certified Rehabilitation Counselor (CRC) and Certified Brain Injury Specialist (CBIS), her role is critical to the biggest step in patient recovery — returning to functional daily life.

Melissa says, “It is wonderful to follow along as patients make progress and their families gain a better understanding of brain injury. I find it an honor to support patients and families who are on this journey of adjustment and recovery following a TBI event. The personal connections I make along the way are really special and often endure years after a patient leaves the hospital. I am very proud of the Brain Injury programming that WakeMed provides.”

Winter Sports Emergency? We’re Here 24/7.

If you or someone you’re with has a sports-related or other head trauma emergency, remember that WakeMed emergency departments are always open — 24 hours a day, seven days a week. For less serious or orthopaedic-related injuries, we also offer orthopaedic urgent care.

Sources:

https://www.bianc.net/

https://www.biausa.org/brain-injury/about-brain-injury/basics

https://www.biausa.org/brain-injury/about-brain-injury/basics/under-standing-the-injury

https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

https://www.wakemed.org/care-and-services/brain-and-spine/rehab-and-physical-therapy/brain-injury-program/program-information

https://wakemedvoices.com/2018/12/5-winter-weather-tips-to-keep-you-safe/

https://wakemedvoices.com/2017/03/brain-injury-awareness-month/

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