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General Discussion => General (Off-Topic) Discussion => Topic started by: LucasM on February 11, 2012, 08:35:52 PM

Title: Some Information on Head Injury Effects
Post by: LucasM on February 11, 2012, 08:35:52 PM
NOTE: I initially wrote and edited this as best I could at the time, but I inadvertently left out some important things.  Because of that, I have revised it multiple times since I first posted it, sometimes to clarify what I'd written, sometimes to add new information.  [Although even when initially written, I massively surpassed the board's 20,000 word post-size limit, so I had to break this 'first' post into three.  That post-size upper limit, plus forgetting things needing longer explanations until later, meant that some of that additional important info was later added in subsequent posts I wrote, after others' responses to these first three posts.]

I initially started writing this in response to the thread To Our Friend, Bob.. (http://forum.rifftrax.com/index.php?topic=23377.0).    When I started it, it was intended to give Bob a 'heads-up' (so to speak) about some things to keep an eye out for following his head injury, so that he could get the help needed to recover as best he could, as quickly as he could.  I also initially was writing it to possibly help people understand some of what Bob is going through, since he's 'one of us'.  [EDIT: since Bob says he is doing much better, and to reduce the 'required' reading, I've moved the information specific to him into 'spoiler' areas.]

As I wrote more (and more, and more), I realized that everyone should have some level of knowledge of head injuries.  This is to hopefully dispel some of the incorrect knowledge of what 'a bump on the head' can do, as virtually all media gets it massively wrong.  Think of this the next time you consume some fiction in which someone gets knocked unconscious, and, when they wake, they are the same as before.  Or think of this the next time you hear about someone around you who has been hit in the head.  And, for anyone who hasn't yet had a head injury, think of all of this and keep it in mind when there is something you might be doing that could result in a head injury.  e.g. Soccer and football players - even those just playing in high school or for fun - suffer repeated head injuries even one of which can potentially ruin their life.  Things as 'minor' as hitting a soccer ball with one's head is sufficient to cause measurable brain damage, as well as potentially things like lifetime depression that because its symptoms originate from injury, is not as easily treated by medication and therapy as is non-injury-related depression.

Sadly, from my experience, most people in the general public do NOT understand that something is wrong after a head injury.  There are a multitude of reasons for this, but I think the largest is simply: media.  Cartoons, comics, books, TV shows and movies ALL have people repeatedly getting knocked unconscious with no effects on their functioning whatsoever afterwards.  ANY impact that disturbs the brain's functioning enough to disrupt consciousness (or even just briefly altering perception; hell, even some impacts that do neither) is causing some degree of permanent damage.

Unfortunately, that results in what can be inconsiderate treatment of the head injured by a large number of people.

Spoiler directed to Bob:
Spoiler (click to show/hide)

In case the people reading this haven't seen it mentioned in my posts elsewhere on the boards, I was a trained Neuropsychologist, having studied neuropsychology in a doctoral program (when there were only 10 accredited universities in the country offering that special focus), and then I did my APA-approved Internship under the then-director of the International Neuropsychological Society.  My undergrad degree was pre-med (Biology major with Chemistry minor), and then in the doctoral program I had a minor in Biopsychology/Physiopsychology.  Because of that, I learned what happens on a cellular level what my Clinical Neuropsychology training showed on a behavioral level.  But in addition to all that, I've had three head injuries of my own [auto accidents, none my fault, in '95, '96, and '99].  My life was affected differently by each of them.  And each was more damaging than the last.  Those gave me an insider perspective that I was able to understand because of my training, but that also expanded my awareness in different ways from what my training had given me.

To write this out has taken effort by me during the course of over two weeks.  That is because of both its length and detail, as well as the mental drain (and recovery time) it takes for me to write (coherently, at least: I can write incoherently with relatively little effort ;) ).

The following may be WAY more than you wanted to know.  But I felt it was all important, and information that you might want to keep an eye out for.  Though if they are occurring, you may not notice these things even if you know they are possible.  I know that I am too often so overwhelmed I cease to notice large sections of my environment, as it is so exhausting to even attend to the things I have to (you know: little things like 'remembering to eat', 'resting when I am tired', 'shifting my position when my soft tissue spinal injuries flare up').

Spoiler directed to Bob:
Spoiler (click to show/hide)

How Impacts Affect the Brain
Now it is important to remember that the brain is far softer than any other organ.  It has the consistency of Jell-O or room-temperature butter.  So one can understand how very easy it is to damage it when it comes into contact with the hard, and often rough or sharp, interior of the skull.

The brain's movement with an impact to the head:
(http://i66.photobucket.com/albums/h275/rvr2/03/03001/brainhitgiphy_zpsqqds8pdv.gif) (http://s66.photobucket.com/user/rvr2/media/03/03001/brainhitgiphy_zpsqqds8pdv.gif.html)

The rough and sharp interior of the skull that cups the underside of the brain:

Obviously the area directly under the impact site receives the most damage, and the most focal damage.  That can result in a disruption of most any functioning, depending upon where that impact was.

With every head injury, the area directly opposite to the impact site has almost as serious damage, but somewhat less focal.  This is called the 'contra-coup' [and has nothing to do with US Presidents illegally trading missiles to Iran to help groups of Central American rebels].  The reason that that opposite side of the brain gets damage is because the brain bounces off the inside of the skull at the impact site, and then rebounds off the opposite wall.  "The area directly opposite" would factor in the direction of the force of the impact, like a cue ball being hit, then hitting another ball at the opposite side of where the force was administered.  That includes things like 'english' being put on the ball and such.
Spoiler directed to Bob:
Spoiler (click to show/hide)

On top of the contra-coup, the difficulty with any head injury is that ALL of the outer parts of the brain are likely to get damaged to some degree, as the brain scrapes against the very hard, and quite rough protrusions on parts of the interior of the skull.  The temporal lobes, the frontal lobes (particularly the area directly above the eyes), and the base of the brain (near the brainstem) are all particularly susceptible to such scraping.

The scraping of the brain on the inside of the skull injures or kills off the most 'superficial' (top) layer(s) of neurons in the areas affected.  The more intense the impact, the more layers are likely to be killed off.  Unfortunately, the superficial neurons do much of the final coordination of signals.  They assemble the information that the deeper layers of neurons have analyzed and so they do some of the final synthesis of thoughts or perceptions.  For example, at the back of the head (the occipital lobes) is where visual information is processed.  The deeper layers of neurons will analyze things like "straight line-horizontal", "straight line-vertical", and "movement left-to-right", subsequently higher layers of neurons will ultimately process those into - say - perceiving a car moving towards oneself.

Though I have never read it proposed anywhere, I believe that may contribute to why those with head injuries are far more concrete in their thinking [have less capacity for abstract thought]: because the top layer of neurons that would do the 'final comparisons' in the areas responsible for dissecting different but related concepts and thereby interpreting abstract thought have been injured.  Having concrete thinking was very true of me closer to my accidents, but has improved since [though the more I am exhausted past my limits the more I get concrete in my thinking again].  This difficulty with abstract thought often results in disruption of interpersonal relationships, as subtext and subtle social cues are often misinterpreted, or lost completely.

Effects of the Top Layer of Neurons Being Injured
The next two things are considered to be the result of the damaged 'superficial' neurons, and the damaged connections and need for rerouting.

People with head injuries are often overwhelmed by tasks they are so familiar with they used to be able to do them in their sleep... much less new tasks requiring different thinking or perceptive patterns.  Driving, going out to a grocery store, things like that all require processing power.  With the brain having to reroute so much, that becomes overwhelming with the number of things that need attending to ALL having to basically be rerouted to some degree or another.

The other is confusion.  It is likely obvious by the above why confusion takes place: if there are so many things that need attending to, and the usual patterns of responding are blocked, confusion is the result.  It can also be caused simply by being somewhere with multiple choices, and your 'too many choices' can be as simple (to the non-brain-injured) as a fast food restaurant menu.

The above two things can be caused by, or massively aggravated by, the reduced ability to separate what may be 'relevant' input from 'irrelevant' input.  The head-injured often have to consciously rule out non-relevant perceptions (or thoughts).  That, obviously, results in slower processing of what is happening, and a lot more mental energy being used to process it [when a healthy brain already uses about 25% of all calories burned].  That, of course, results in the head-injured person being easily fatigued.

Interior Damage to the Brain: Connections
But it isn't just the outer parts of the brain - the neurons as a whole - getting damaged that cause problems.  The axons (and dendrites though those are rarely mentioned because they aren't as susceptible because they are much shorter), ALL the 'wires' connecting neurons are incredibly sensitive to tearing during any head injury.

Axons are the 'outgoing' connections a neuron makes.  They are incredibly thin and can be up to two to three feet long.  Dendrites are the threadlike protrusions for input to a neuron (tho neurons can receive signals all over their surface from the axons of other neurons, dendrites 'reach out' for important 'wanted' incoming connections).  Dendrites are MUCH shorter, so less affected by the tearing occurring in head injuries.

The damage to the connecting 'wires' results in two major things (and a multitude of others).  The primary one is that the loss of connections between neurons means that any task governed by those connections is disrupted.  The brain has to work harder to do things that at one time were simple, even automatic, if it can do them at all, because it has to find another, less direct, path from one neuron to the other.  And this is often with dead or scar tissue blocking the way.  So in addition to actions and thoughts being slowed, the person is very likely to get fatigued far easier than they used to.  [Think of it as driving from Michigan to Mexico via Anchorage, Alaska.  It takes a LOT more time and gas to do so, than by going direct.]  The second major thing that axonal tearing can cause is almost as devastating, and that is that the brain, having lost so many connections, tries to rewire itself, but with all the damage present, and the speed at which it tries to repair itself, it can rewire itself wrong.  So there can be new problems from a head injury starting as late as six months or more after the injury itself, as those incorrect connections start to cause further disrupted behavior.  That is why early therapies for lost abilities are very important: they help the brain make many more correct connections than wrong ones.

Memory and impulse-control problems are very common effects of head injuries.  [To Bob:] I haven't seen enough in your comments since returning to the forum to tell just how much you were affected by such things, though I did notice in the course of just a few days you repeated, nearly verbatim, that your doctor was pleased with your weight loss.  [And s/he has good reason to be: not only did it signal that you had had great follow-through on your own prior to the head injury (which may bode well for your cognitive rehab following the head injury), but according to SPECT studies by Dr. Amen http://www.amenclinics.com (http://www.amenclinics.com) slimmer people have better functioning brains (thanks, in part, I would guess, to better blood flow).  http://www.amenclinics.com/newsletter/article/?articleID=320 (http://www.amenclinics.com/newsletter/article/?articleID=320)]
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: LucasM on February 11, 2012, 08:37:16 PM
Bob: Your injury was described by someone (in a post I can no longer find) who said it fractured your skull and cheekbone on the right side.  With the location, with that description, it could have hit anywhere from more in your face to the side nearly back by your ear.  Almost all of the area likely to have been directly hit would be the frontal lobe, but different parts of the frontal lobe do different things.

If more to the side of your head, it might have hit the motor strip which would disrupt movement on the left (opposite) side [that would explain your typing 'around' the letter 'd' as mentioned above, but also could affect walking and other movements, where I do not know if that is the case].  Just to the rear of that (at the back-most part of the frontal lobe) is the sensory strip, which could also impair movement because it would limit the reception of feedback from the nerves which tell one what their body is feeling.

While damage to the motor area might cause difficulty walking and other movements that would be more obvious to onlookers, if the injury was closer to the front it may be far more disruptive to behavior than awkwardness in movement.  It would make others' seeing someone's head-injury-related problems MUCH more difficult, because there is no obvious problem like a limp or 'dead' arm to cue someone to the fact there had been an injury.  [My injuries were pretty much all like that: not obvious to onlookers.]

The Frontal Lobes
The frontal lobes are nearly universally damaged in any impact.  Bob: they would be likely to have been more injured than usual with your impact where it was, particularly if it was more towards the front (nearer your face).

The frontal lobes control many things, a few of which I'll mention here.  They play a great role in the ability to pay attention to things (many, if not most, head injured people have difficulty with distractability).  They play a large role in sequential thinking and being able to put memories in proper order for which happened first.  They also govern impulse control and self-monitoring; being able to tell what condition you are in and what is happening with yourself.  That can result in difficulty assessing personal safety.  (Bob: That is likely why the program had you retested for driving, as they could not be sure your assessment of your remaining abilities were accurate.)  The frontal lobes control some of the ability to process and express emotion.  And they regulate the initiation and cessation of action [inability to stop an action is called 'perseveration'].  The inability to start particular actions can be misinterpreted by uninformed doctors after head injuries as depression about an injury and inability to get things done from that, rather than the organic problem that it actually is.  Depression and head-injury-caused inability to initiate actions have VERY different treatments.  [Antidepressants usually have a sedating effect.  If they are given when not needed - e.g. following a head injury - they can make initiating actions that much more difficult.]

The frontal lobes are believed to be central in decision-making.  Following a head injury, what used to be a simple choice can become overwhelming.  [For an example here's something from just after my first head injury, while I was still working.  At the end of a day's work I had three things to do before I could go home.  They were: write the progress note for the last person I saw, prepare the billing for that person, and to prepare the next day's materials.  They all had to be done before I left.  None of them was 'urgent'.  But I sat for a minute or more, near tears, because I could not figure out which to do first.]

Head injuries most often include a change in overall personality.  This can be subtle, or it can be dramatic.  That personality change includes the way a person feels and expresses their emotions, but also the things I mentioned before (difficulties with social situations often occur as social cues, and subtlety, and hints, may be missed).  But the person may overreact (or underreact) to emotional events in their environment.  They may 'hyper-respond' to emotional cues, such as crying easier than previously or getting angry easier (e.g. if one runs into difficulties putting dishes away, one may start crying about it, or one may get angry and break things [I've done both at one point or another since my head injuries; a few years back I actually stomped a VCR into rubble because it was messing up]).

Those With Head Injuries Functioning in Crowds
After a head injury, until one knows that they can handle them without stress, crowds are generally to be avoided, particularly right after a significant head injury (especially during that first 6 mos), as overwhelm is likely.  That is because the head injured usually can't filter out things like other conversations, stray noises, lights, movement, so it is often very difficult for them to focus on what they need to do, or intended to do.  [One of the ways I developed for myself is to ALWAYS wear an iPod and headphones when I was out, and play familiar music.  The muffling of surrounding sounds helped reduce the demands on my brain when grocery shopping, for instance.  Another thing I worked out was that I also wear sunglasses whenever I am out during the day, or in stores at night, as the dimming of the light reduces the amount of processing my brain has to do.]

Bob: because of that difficulty with crowds, I was rather concerned when I read your comment that you were "missing meetings", as I believe it was referring to your job.  Such things may be overwhelming and extremely hard to process.  DO NOT be afraid to accept and mention that to the people working with you in the rehabilitation program.  They may help you interact with your employer about it.

Desire for Life to 'Return to Normal'
Unfortunately, the freshly head injured just want 'things to get back to normal' so they most often push themselves to do everything they were doing before the injury.  The difficulties freshly head injured people run into with that often cause both functional problems and emotional problems.  And very often, because of the memory problems which occur regularly with head injuries, it is possible for them to not remember how much difficulty it causes them from one day to the next (or one minute to the next).  So they just continue doing whatever, and they cannot remember enough to report it to the cognitive therapist who could potentially help them learn strategies to help them process it.  Often the freshly head injured end up doing nothing about a problem they've noticed, or worse, devising their own ways of trying to manage whatever it is, which, because of their injuries and not understanding what is happening, can often be maladaptive.

What someone freshly head injured may be wondering is, "will I recover, and if so, how much?"

The truth is, there's no guaranteed way to gauge that.  But there are some things that may be helpful to know.

1. It used to be believed that length of coma related to the degree that previous functioning might return; the longer the coma = the less recovered functioning.  [Bob: if your coma was induced to reduce damage from swelling, then that doesn't apply.]  And, there are exceptions to most any health-related rule: some people have been in comas for long periods of time and recovered most of their functioning.

2. The largest amount of functional recovery takes place in the first six months.  During that period it is because of the hyperactive axonal formation, and while the injured, but not dead, superficial neurons heal.  This is the same time period as the delayed functional problems from a head injury occur (and partly for the same 'healing' reason: axonal formation, but also because this is when scar tissue can form).  But - particularly when receiving appropriate cognitive rehabilitation - the good connections far outweigh the bad, so there's a net increase in function, even though some new problems may still occur.

But especially during this six month period with the rapid brain repair going on, it is ESSENTIAL that things like alcohol and tobacco be avoided, as they put stress on the neurons.  If the neurons are injured, alcohol and the anoxia (lack of oxygen) caused by cigarettes can very well kill them (one of the main outputs of cigarettes is carbon monoxide: the same thing people die of from concentrated car exhaust).  That results in lost functioning that could have been retained.  Unfortunately, many, many freshly head injured people self medicate with alcohol (or drink to forget the functioning they can tell that they've lost).  [Even I, who learned all this about the brain and injury, self-medicated for a time after the first one; every day that I worked I was so far past capacity that I'd come home and need to shut my brain off, and I drank hard liquor to 'shut down'.  I had help stopping that.  I have now had very little alcohol in the last 16 years, and none since getting on the proper anti-seizure meds.  And between those meds and reducing what I try to do during the day so I'm not as intensely over-taxed, I have not wanted any more.  That is because the anti-seizure medication keeps me functioning at a relatively normal pace (well, 'post-head-injury' normal, at least), but I also avoid it because, with the alterations in my functioning from the head injuries, I treasure every bit of consciousness I can get.]

It is also important to eat properly, and according to research [http://www.amenclinics.com/ (http://www.amenclinics.com/)], make sure to take a multivitamin (the B complex is especially important), and get a lot of good quality Omega-3 fatty acids (about four grams a day).  Taking the Omega-3s as fish oil is far preferable to flax-seed oil, as only 1/34th of flax-seed oil is usable by the brain and body, when compared to fish oil.

3. Additional fairly easily noticeable increases in functioning continue for the next roughly two years.  During that time it is possible to see functional improvement with some speed.  Although it can be helpful for resolving functional difficulties at any time post-head injury, this first two years is when most focal neuropsychological/cognitive rehab has the best effects.

4. Some functional increases can continue for a decade or longer after a head injury, but during this time span (2 years to 10+ years) it is usually VERY slow, and can only be seen when comparing one's functioning to how one functioned, say, 6 months to 1 year before.  [I still have little improvement 'bumps' that occur.  They are never major things, but every bit of functional improvement helps.]

One uses the functioning and brain areas that are retained to work around those that were damaged.  But the unfortunate fact is, despite what some may say (especially those who have been head injured), there is NEVER a full return to previous functioning after a head injury.  [People's claims that they are back to normal are generally a combination of the self-monitoring parts of the brain being injured and psychological denial from being unable to emotionally process the lost functioning.]  The inability to return to full previous functioning is particularly true for a moderate to severe head injury (one causing a coma, or requiring an induced coma).  People may get 'close' and appear 'back to normal' in the way they act.

Because there is no part of the brain that is not used in everyday life, there is no part of it that is expendable.  So any damage will have some permanent results.

Appearing 'back to normal' is just that: appearance.  How the person thinks, and how they manage to do particular tasks mentally, will never be the same.  [I am just over 17 years post-my first head injury, and 13 years post-my third/final one, and I STILL miss my premorbid (i.e. "pre-injured") personality and functioning, though I have learned to accept and work around most of my limitations.  In face-to-face and phone conversations with people, they've told me, "you sound perfectly fine!" (as if that is meant to be reassuring).  The thing is, they don't get that it may take me up to two weeks to recover from a one-hour in-person discussion (or a 20 minute phone call), and it has taken over a month to recover from interactive evenings lasting a few hours.  It takes two weeks to recover from a quick doctor's appointment or just going grocery shopping.  During that recovery time, I may not be able to follow a TV show plot (even as predictable as they usually are), hearing words may give a spike of pain in my head with every syllable, reading is out of the question, and so forth.  (So, "you sound perfectly fine," is - at best - an irritant, but often angering because it ignores the devastating consequences of an interaction for me.)]

Other Things to Look Out For
Memory is very frequently, if not universally, affected by head injury.

'Lost time' is possible.  That is where you become aware that you were not aware of your surroundings for a time (and is about as difficult to recognize as seeing an invisible man; one can only tell this from things like noticing that the last thing one remembered, they were in the middle of a TV show and now they are in the middle of a commercial, with no memory of anything in between).  This needs to be followed up on, as it can be a sign of what is called 'subclinical' seizure activity.

The drug Neurontin has been found to be helpful to those with head injuries for a number of problems (attention, memory, lost time, and more).  Sometimes it is routinely prescribed.  But, since the brain can be much more responsive to most all medications following a head injury (particularly medications with brain side-effects, such as making one tired), the dosage may require significant adjustment to be truly helpful.

Sleep disruption, or appetite disruption (the ability to tell when you are either hungry or full), or what seems like a balance issue (walking on an angle such that one may hit walls or people), or double-vision can occur with brain-stem damage.  This can happen since the brain-stem is at the base of the skull.  So not only abrasions from scraping the skull, but 'tugging' on the brainstem can also damage it, as the brain moves during impact, but the attached spinal cord at the other end tries to hold the brain in place.  The brainstem, being between the two, takes the brunt of that tug-of-war while being encircled by the foramen magnum (the hole in the skull the spinal cord passes out of).

But walking on an angle and double vision can also be from a specific type of brain damage that results in Vertical Heterophoria Syndrome.  That is a misalignment of the images produced by the two eyes.  It occurs with some frequency with head injury, and can often be fixed very simply by getting glasses with prisms in them, to take the strain of trying to realign the images off of the brain.  [I have a pair of these each for reading, computer, and distance viewing.]  To those having a head injury, one of the foremost researchers in that area is at this site, with an online test that helps decide if that may be a problem for you: Vision Specialists of Birmingham (http://www.visionspecialistsofbirmingham.com/)

Treatment [Overwhelm], and Recovery
Proper medication (if needed), and proper cognitive rehab can help tremendously, especially in the earliest stages: right after injury to two years-post.  But that rehab can ONLY be helpful if it truly takes into account the current functioning of the injured person, and is tailored to not overwhelm them.  That generally is not the case with most outpatient cognitive rehab, as the 'simple' act of just GETTING to the facility may be more than enough to wipe out the functional capacity of the person for that day.  [That was the case with me, but, knowing I 'should' do it all, I did it, and it - instead of helping - made some things worse and likely slowed my recovery.  Overextending myself past my capacity may have also amplified my 'abnormal electrical activity in the left temporal lobe' [the quote from my EEG report...  'abnormal electrical activity in the left temporal lobe' = seizure activity].]

Bob, when you mentioned that the program you are in was testing your ability to make burgers, or your ability to drive, it was clear that one of the things it sounds like the program is doing is testing 'daily living skills'.  This is a very good thing.  When someone has had a head injury, particularly one as severe as this one must have been [a coma and a metal plate replacing broken skull], testing to make sure that someone can still do tasks that are required to function on a daily basis is necessary (things such as making themselves food to eat, or driving safely so as not to endanger themselves or others).

Important Point to Remember
Rest when you are tired.  Accept that your brain - which, when NOT injured, consumes about 25% of all the calories your body takes in - is going to need extra rest and is going to consume more of your energy, leaving you more tired than usual.  It is just like someone who was a runner prior to a knee injury: if they start back by doing a marathon, they will, inevitably, stay injured and take longer to heal.  One needs to start recovering slowly, and build up again, going just a tiny bit beyond current functioning.  Only then can recovered functioning be retained.  [The thing that was hardest for me to accept was that repeatedly pushing myself well past what my capacity was was actually slowing my recovery.]

If someone ends up with a bruise or a bump that one can see on their head from an impact, most likely their brain was damaged to some degree as well.  One can work around that damage, or create alternative pathways in the brain to bypass it, but that doesn't mean that it 'goes away'.  A dead neuron is a dead neuron: it isn't resuscitated.  A broken axon is a broken axon: it MIGHT be regenerated if JUST the right combination of effort is exerted, but most likely that pathway is gone for good and a more roundabout path is generated.
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: LucasM on February 11, 2012, 08:37:41 PM
What comes back first, or last, or not at all, depends on many things: what functioning is most damaged, and how much effort is placed on recovering that functioning.  The brain is very resilient up to a point.  Sometimes those who have lost eyesight can later hear better or their sense of touch can be more sensitive.  That is directly related to that resilience.  When there is effort placed toward certain functioning, the brain can rewire areas that weren't originally designed to do a particular task to do it following injury or damage to the brain.

With all the broken axons, the brain rewiring itself following a head injury requires more effort to perform whatever task that one wants to get back than one is used to giving to that task [remember the Michigan-to-Mexico path, via Alaska].  It requires at least the amount of effort it took to learn it in the first place, possibly more than that, and always requires more mental energy to manage and sustain the roundabout way.  Needing more effort and energy for the brain to perform tasks as it rewires itself is responsible for the incredibly common effect of head injuries resulting in people getting tired more easily than they used to.  [After my first head injury I went from being able to manage occasional ten hour days at work to being exhausted and stressed by working three hour days.]

After a head injury there are no 'spare' neurons to take over for the injured brain tissue.  Contrary to belief even 10-20 years ago, the brain can actually form new neurons later in life.  But it is unlikely in the time remaining in one's life for it to replace all those that were lost.  Beyond that, the lifetime of experiences that resulted in the brain being wired the way it was simply can't be replicated.  So one will never be exactly like they were before a head injury.

Example of my functioning/recovery:
Spoiler (click to show/hide)

Believe it or not: what I've written here is just scratching the surface of what is involved with head injuries.  But I tried to cover as broad a range of functioning as I could, in enough depth to make sense.

Directed to Bob:
Spoiler (click to show/hide)

Reiterating: Four Important Points to Remember Immediately After A Head Injury, to Help Recovery
1. Try as hard as you can to avoid alcohol and tobacco, especially for the first six months.
2. Try to eat as well as possible, with a multivitamin and about four grams of Omega-3 [fish oil] supplements every day.
3. Pushing yourself too far, too fast, will only slow your recovery.
and 4. Rest, any time you feel tired.

If there are any questions you have (or anyone else has) on any of what I've written, please post below and let me know what you'd like clarified or explained, and I'll do my best.

Take care.

EDIT:  Note to readers, there are a few posts I made below others' comments that further describe head injury difficulties.  I talk about things such as memory and sleep disruption.
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: Tripe on February 11, 2012, 08:40:36 PM
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: Bob on February 12, 2012, 11:38:50 AM
Thanks from me too!
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: LucasM on February 12, 2012, 12:22:26 PM
Thank you for the responses Tripe and Imrahil and Bob.  You are very welcome.  It is nice to know that at least a few people that looked in on the thread made it through the whole thing ;) and that it was appreciated.  Given the opportunity that was presented, both to help Bob, and to educate anyone who would 'sit' through the entire thing, I felt it was important to use my writing capacity for the last couple weeks composing it.

A simple addition to what I wrote above is this: head injuries are often referred to as "TBI"s.  That stands for 'Traumatic Brain Injury'.  [A friend once asked, "and there are brain injuries that are NOT traumatic?!"]

[As tends to be the case when I've gone past my limits... this next addition is WAY longer than intended (I thought it would be about two average-size paragraphs when I got on here to write it  :P ).]

I forgot something important about head injuries that - ironically - was demonstrated by being able to write all this without any research (i.e. it was off the top of my head, just needed organizing).  And that is related to memory following a head injury.

In the vast majority of cases, memory for things happening, or learned, prior to the injury is largely unaffected.  This is especially true of vocabulary, which is the least affected of any prior learning.  This leads many with head injuries to believe there is nothing wrong with their memory, and can result in people who interact with someone who is head injured saying things like, "you seem fine" [which can result in both denial of any real problems, but if one recognizes the damage that one sustained, it can be angering].  But despite the nearly-unaffected prior learning, completely new learning can often be difficult, with either retention or retrieval affected.

Retention is the ability to encode new learning [form new connections and associations between neurons] and the brain holding onto that.  Retrieval is the ability to access that memory, once it has been encoded.  Often the two are, very superficially, identical, because both show up in daily life as 'not remembering'.  The difference is that with memory cuing [being reminded of some aspect of the learned thing] the memory can be retrieved if the brain was able to encode it.  But if the brain areas governing retention for that memory were damaged (or if distractability prevents attention being maintained on something new long enough for it to be encoded clearly), no amount of cuing can bring back the memory.

From my history, a good example of this occurred within three days of my third - most severe - head injury.  My left knee was bothering me right after the accident, but I was so overwhelmed that I didn't mention it to the EMS or ER people, so nothing was checked with it when I was taken to the hospital.  I did not have any conscious memory of that for years.  It was only three to four years later, when I was required to go through all my receipts and itemize them [luckily I had help with that] that I was reminded of the event.  During that, I found a receipt dated two or three days after the accident for a visit to the Internist I've seen for the last 26 years, and a receipt for X-Rays at a nearby hospital.  At first I couldn't remember anything about it, and, honestly, I believed it was a mistake!  But, with some struggle I was able to gradually remember the knee problem.  I still cannot remember anything from the visit with my Internist, but with significant effort I was able to get a single 'still picture' of the waiting area for the X-Ray in my mind.  I also was able to recall an 'objective' awareness that I had been told that the X-Ray area for the hospital had changed since I'd last been there and that I'd been given a map for how to get to it in the hospital complex.  But no clear memory of either of those things actually happening (no visual memory for them, awareness of whether I was told that in person or over the phone, by whom I was told it, or clear trust in my memory that they actually happened).

However, I have found that, if I remember an event clearly, then what I remember is very accurate.  My attorney told me once that it was 'scary' to him how accurate my memories were for some things.  That is, actually, how my memory was for most things prior to the head injuries, and I sorely miss that, since that extreme clarity of memory is the exception now rather than the rule.

With both, I have improved consistently since the head injuries took place.  Hopefully from these examples, what I was saying about memory problems can be better understood.  From what I wrote, it can also be seen that I have difficulties with both retention and retrieval (for things following the accidents, particularly the third).  For things closer to the head injury like the X-Ray events, my retention was almost non-existent, as I could not remember most of what occurred.  But since it took so much conscious effort for those little bits that I was able to get back, even when reminded of the events by the receipts, my retrieval was clearly impaired.

Sleep Disruption
Another thing I just breezed by under "Other Things to Look Out For" (again, somewhat ironically, because of how central it is to my day, every day), is that sleep can be disrupted.  One's sleep schedule can be thrown off significantly, and one's brain may consistently require more than one sleep period during a day.

To give you an idea of how this may play out, within the first few years of the third head injury I had a sleep study done (partly because brain-injury-caused sleep apnea was suspected; luckily that was not the case).  But in the sleep study they found that it took a long time for me to get to sleep.  [I could've told them that!  :P ]  Ultimately, since sleeping pills didn't work past about three days, I just had to accept that I wasn't going to be able to get to sleep until my body 'allowed' it, and my bedtime gradually moved to 6am, where it has remained relatively stable since.  Now, my current schedule is generally: wake up at about 1:30 to 2:30 in the afternoon and remain awake until 6pm at which point I am already exhausted and need to sleep again.  I usually sleep about two hours then, and am then awake from roughly 8-9pm until I have to start getting ready to sleep at 4am, usually getting into bed and to sleep at about 6am.  [Later edit: I have since figured out the possibility that my brain also may have partially made this day/night change to reduce sensory input.  The world is now dark and quiet when I am awake the longest, when unexpected sounds, and light, cause difficulties and excessive mental drain for me.]

If my afternoon/early evening crash is missed, I end up losing virtually all of my frontal lobe self-monitoring, and generally can do things that are not in my best interests (e.g. write too much without stopping thereby pushing myself past my limits, moving or keeping poor posture or lifting things that result in aggravation of my soft tissue spinal problems, or inability to recognize that I'm full when I eat, etc.).  [It is, I figured out after a time, much like a toddler who misses their afternoon nap: irritability and poor overall control of themself.]  When that happens, it often takes as much as a week for me to recover from the sleep disruption (i.e. before my sleep normalizes again), and sometimes it takes longer than that for the functional consequences of what I did while my frontal lobes were 'off-line'.

If I am able to sleep restfully during that 6-8 or 9pm time, I've found that my best functioning - when my brain works the best - is during the 9pm-midnight time period.  [If someone takes a look at my stats here on the boards, they will show a very significant 'pooling' of when I post, most of which are during that time (when corrected for time zone).]  But to keep myself functional day to day, I still can't focus intently on anything for over an hour or so.  But it took me a long time for this to stabilize and for me to figure out when the best times to do things were.
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: Bob on February 16, 2012, 07:26:53 AM
Stupid hospital that was supposed my follow up meetings done all last week on Monday has not done them yet and can only tell me they will have "something" worked out for me all next week (and hour plus from my house) worked out by Friday.   They cannot say what will be in them yet.

This pisses me off since I have ZERO memory or ANY physical issues.  It cannot go on for weeks as I need to go back to work NOW!


Their lack of work is pissing me off.
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: RVR II on February 16, 2012, 08:53:24 AM
Stupid hospital that was supposed my follow up meetings done all last week on Monday has not done them yet and can only tell me they will have "something" worked out for me all next week (and hour plus from my house) worked out by Friday.   They cannot say what will be in them yet.

This pisses me off since I have ZERO memory or ANY physical issues.  It cannot go on for weeks as I need to go back to work NOW!


Their lack of work is pissing me off.
Don't blast one of those plates off your head.. :scared: :speechless:
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: Bob on February 16, 2012, 09:18:49 AM
Sigh, they are now telling me I will have all day classes on Monday, Tuesday, Thursday and Friday.   And then some more.  I better have this as last week or my lawyer is getting called............ :angry: :angry: :angry:
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: RVR II on February 16, 2012, 09:29:43 AM
Sigh, they are now telling me I will have all day classes on Monday, Tuesday, Thursday and Friday.   And then some more.  I better have this as last week or my lawyer is getting called............ :angry: :angry: :angry:
I'd have been in touch with him anyway about the incorrect prescription drugs you were given, but that's your call.. :o
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: LucasM on February 16, 2012, 11:41:14 AM
[EDIT: As has consistently been the case recently, my frontal lobes aren't quite functioning right now, so while I thought this would be brief, it is not.  I have to stop and go get breakfast now.]

For those reading this for general knowledge: most of this can be applied to head injuries in general, not just to Bob.

Sigh, they are now telling me I will have all day classes on Monday, Tuesday, Thursday and Friday.   And then some more.  I better have this as last week or my lawyer is getting called............ :angry: :angry: :angry:

The thing is, if you need additional therapies for the head injury's effects, then this first six months after the accident can be very helpful.  Partly because they will teach you how to work around some of the major problems.  But it is possible that with it being so close to the head injury that you haven't had time to recognize the difficulties you have been left with, so aren't motivated to either be there, or to work on the difficulties that they have found through testing, that you can't see yet.

One of the things that is very difficult for people who are freshly head injured, who are not back in their usual environment (home, work, etc.), is that they cannot as easily see the difficulties that they are having.  The new daily tasks of, for instance, a head injury rehabilitation program are so foreign, and often so overwhelming, that it is difficult to tell how one is actually doing, because the usual reference points for functioning that one has through being at home, with friends and family, and at work, are not there.  Until someone is back in their usual patterns, and not doing as well at them as they used to, they may not realize the effects that the head injury actually had.  Even then, some people, through both organic ['injury-related'] and defense-mechanism-based inability to recognize difficulties, have to have a lot of difficulty in their regular home life before they begin to see that they need help.  Hopefully this won't be the case for you.

You said
...since I have ZERO memory or ANY physical issues.
With the phrasing, I am unclear if you meant, "I have zero memory [function] and no physical issues," or if you meant, "I have zero memory... issues".  [The way it is phrased is unclear.]

If it is that you have limited memory function, then training yourself to reliably use a notebook you carry with you everywhere is a key point before returning to work.  If you meant you have zero memory issues, then you will be a step ahead in learning to compensate for the other difficulties you are having, and learning to compensate for difficulties is quite important.

If you feel that your memory is unaffected, then test yourself with it: write out everything you can remember happening from Monday; both everything you did at home before you left, everything you did during every therapy through the day at the rehab program, and everything you did that night.  That was only three days ago, and - as a 'first or last' day of the week, would stand out more in memory than a 'mid-week' day.  Then do the same for last Friday.  Then last week, Monday.  Then take those with you to the rehabilitation program.  That will either do one of two things: it may show you that there are gaps in your memory that you were not aware of before, or it will show the rehab program that your memory is intact for new learning and that you don't need additional focus on it.

Programs like that one don't keep people just because they can, they have more than enough applicants to keep them busy.  So the only reason that they would have you come in so often is because they are seeing difficulties that you aren't able to at this point.  [Whether the inability to see difficulties is the emotional defense mechanism of denial, or whether it might be from the frontal lobe damage isn't clear, and likely wouldn't be to anyone.]

But I realize there may be other reasons why you want to finish with the program and get back to work.  The first one that came to mind is financial.  If you are having monetary difficulties from being off of work for a long time, that is clearly something that the program needs to work with you on.  To get help that, because you are not working, leaves you unable to pay things like mortgage, utilities, etc. is not helpful, and can be very stressful.  [And stress is damaging to the functioning of even healthy brains.]  The second thing that came to mind was what I wrote about above: the "Desire for Life to 'Return to Normal'".  [In about the middle of this post Part 2 of the original 3 posts (http://forum.rifftrax.com/index.php?topic=23570.msg698059#msg698059).]

I'd have been in touch with him anyway about the incorrect prescription drugs you were given, but that's your call.. :o

I hadn't heard this anywhere.  What medications have been given, and what was the reason given for them?  Which ones were considered "incorrect", and was there a reason given for that?  [It is best to ask them why they gave them and what they were hoping they would do for you.  And I will not weigh in as to their appropriateness to you specifically, but I may be able to give more details as to what head injury effects they might have been trying to accomplish something with for any I'm familiar with.]

Some medications that don't seem to be correct may actually be appropriate.  And unfortunately, following a head injury in particular, there is no guarantee that medications that are known to help following a head injury will be helpful to you, personally.  It is also possible that the side effects of some medications may outweigh any functional gains you may get from them.  So there is a need for a knowledgeable doctor to experiment with which medications work for you.  That may take some time, and may take going through a number of 'wrong' medications before the right ones for you are found.  [It took until nearly six years after my third head injury to find just the right 'cocktail' of meds that was most helpful to me.]

Since we are discussing medications, I want to reiterate: Because of damage to the brain, the brain is likely to be far more sensitive to medications of any type that affect brain function.  That includes both medications that are supposed to affect the brain, as well as those that have brain effects as side effects (e.g. drowsiness with antihistamines).
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: LucasM on February 16, 2012, 12:09:08 PM
I think RVR is talking about the pills which originally caused the fall, but I may be wrong.

Thanks, Imrahil.  I didn't remember that it was medications that caused the fall (or may never have heard that in the first place; I don't know which).

Yeah: if RVR was referring to medications that caused the fall, particularly if they were not appropriate to Bob at the time, I'd at the very least consult an attorney about them.  Though there are sometimes so many disclaimers on medications that it's hard to get anything legal to 'stick', it'd still be worth a consultation given the devastating effects they had.
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: RVR II on February 16, 2012, 12:19:41 PM
I think RVR is talking about the pills which originally caused the fall, but I may be wrong.

Thanks, Imrahil.  I didn't remember that it was medications that caused the fall (or may never have heard that in the first place; I don't know which).

Yeah: if RVR was referring to medications that caused the fall, particularly if they were not appropriate to Bob at the time, I'd at the very least consult an attorney about them.  Though there are sometimes so many disclaimers on medications that it's hard to get anything legal to 'stick', it'd still be worth a consultation given the devastating effects they had.
Exactamundo! 8)
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: Variety of Cells on May 27, 2012, 07:56:51 AM
I just read everything and wanted to say that it was a very interesting and engaging read. The order made sense and I learned a lot. Thank you.
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: Bob on May 27, 2012, 08:04:32 AM
Well, the good news:

1.  My memory is 100% and my co-workers and pals all agree.
2.  My physical is 100% and I get to lift weights every other day and am 6 foot and 175 pounds as a normal person.
3.  Back at work 100% normal and all is well there.
4.  Basically, I am 100% with zero problems.
5.  My doberman enjoys the full energy power walks she takes me on daily.

I am sure if I broke my skull and brain 20 years ago this would NOT be such a good thing!

I am 100% now and living life normally.
Title: Re: To Bob, and Others: Some Information on Head Injury Effects
Post by: RVR II on May 27, 2012, 09:50:09 AM
Bob ain't brokeded no mores! :highfive:
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on December 07, 2013, 10:49:02 AM
This next group of posts started as a comment in the Animated GIF thread regarding this GIF posted there:


I realized after the discussion extended as it did, that they would be of more 'use' here, as well as moving them now 'un-hijacking' the Animated GIF thread.

Since I can only move my own posts, I have tried to keep all quoted material, so that where my comments/responses came from can be clearly seen.

I have also removed all the spoilers from them, as the content is appropriate here, where it wasn't there (so had been hidden as a courtesy to those wanting to merely see animated GIFs).
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on December 07, 2013, 10:50:26 AM
I gotta' say: head injuries and spinal injuries are HILARIOUS!
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on December 07, 2013, 10:56:48 AM
Quote from: LucasM on December 05, 2013, 09:22:46 PM in the Animated GIF thread

He's fine, you can see him laughing at the end.

People more often than not don't recognize how badly they've been injured immediately after.  Particularly if one is 'dazed' by the impact, which he clearly is as he 'wipes' and holds his face before and as the GIF ends.  With those who don't already know about head injuries, for months they often don't register they've got problems that were there from impact on.

An impact like that is likely to have left that person with neck problems and at least a minor head injury.  From falling on a sidewalk simply from slipping on ice, one of the people in my speech therapy group could no longer talk coherently without significant pausing, and had to basically stop the work she had been doing for years because she could no longer function enough to do it.  That, from falling from an upright position to the ground.

With the way the person in the GIF's head snapped after the impact to the chair, he hit quite hard.  The snap of his neck and head translates to even more brain damage due to the scraping of his brain on the inside of his skull than if he'd simply fallen to the floor.  On top of that is what appears to be significant rotation of his head at impact, which tears large numbers of axons, and provides even more scraping of the brain than a straight impact (without rotation).

[I've blocked the GIF so I no longer have to look at it, as it activates my PTSD.]
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on December 07, 2013, 11:02:20 AM
Quote from: LucasM on December 06, 2013, 03:50:07 AM in the Animated GIF thread

Spoilering this because this is on the verge(?) of hijacking the thread.  This is not a spoilered GIF.  This is discussing the 'falling down' GIF on the previous page, with my responding to some comments since.
[[spoiler removed because comments are appropriate to this thread]]
One thing in his favor, it was a padded chair that gave way some, so not like he hit something solid like a table or hard floor.

Well... yes and no.  Because he didn't hit a hard object there will be less focal damage.  But he hit something soft with a rather severe rebound 'snap'.  Because of that, it means a few things.  It means that he actually suffered twice as many impacts overall (his brain slamming into his skull when he hit the chair, and then again when he stopped falling when his shoulder hits the floor).  That snapping back and forth then stopping at the floor means that the grinding of the brain on the inside of the skull, and the increased rotational forces (from the twisting of his head to the side on impact with the chair) would result in a much greater degree of scraping of the superficial layers of neurons in the brain [those responsible for the final correlation of information from deeper neuronal layers] and likely a greater degree of axonal tearing than if he just was hit one solid blow with its rebound.

The double impact from hitting the chair then stopping at the floor, plus the increased scraping and tearing would result in more difficulty doing, well, pretty much everything.  So if he'd hit something hard it would've been massive damage to a more focal area (with somewhat less damage to the area directly opposite of that area [contracoup], and less scraping of the brain in the skull).  Instead he's left with 'lesser' global damage.  Honestly, having had accidents that did each, I'd rather have the single focal area than the global damage [depending where the 'single focal area' was, some areas are virtually impossible to work around].  With focal damage, when most other capacities are still relatively functional, it is more likely to be easier to work on the area that is 'singularly' affected, because there are some brain functions left relatively intact to compensate with.  The global difficulty (from a rebound and a 'soft' landing) basically leaves no functioning unaffected, so there are much more limited resources available intact anywhere in the brain to try to regain any functioning (extreme analogy: the difference between chronically forgetting where you put your keys and being fall-down drunk all the time; you can use other brain areas to train yourself to set up a way to store your keys in a place you can find them, if falling-down drunk there's nothing that you can focus on enough to do them well).  [Keep in mind, with my clarity here on the boards, this is after 14 1/2 years of working my ass off to get my writing to be usually coherent, losing many friends in the process from things not coming out right.]

I think Lucas cares quite a bit.
Yeah, it's a subject that means quite a bit to him.

Yes, QV, I do care quite a bit.  And yes, JU, it does mean a lot to me.  Thank you for recognizing that.  And it was enough of both of those for me to have devoted years of my life to gain the education to work with people who had similar injuries and spend years doing so.  Then it started to mean a great deal to me in a different way because it happened to me.  The combination of the two result in me being rather vocal about such things, both so people can potentially protect themselves better from the possibility of themselves having such an injury (or getting help if they do), and so they can understand what those with such injuries actually go through.

I found a GIF that made me laugh, so I shared in attempt to make others laugh. If you presume I had any other intention than that your wrong. If your offended I'm more than happy to not post another GIF of a dude falling.

I didn't presume you to have any other intention than to make others laugh.  [I don't think there is anyone on the boards who would deliberately do something malicious just for the hell of it.]  And others have given 'Like's to similar types of 'injury-based' JPGs and GIFs in the past, so there are other people on the boards that also feel such things are funny.  [Quite a lot the world over, actually, or such things would not get into GIFs and be circulated on the internet in the first place.]

And I'm not offended.  Yes, it triggered my PTSD, and I had to take extra anxiety meds to counter that, but that is my problem, not yours.  I have NO expectation or desire for people to censor their public behavior just to keep me (and other, less vocal, traumatic injury survivors) from being triggered.  I believe firmly in free speech.  I don't like everyone's 'speech', any more than I expect others to like any or all of mine.

But because it affected me so strongly, and because of what I know about the subject, and because I see what appears to be a lack of empathy in the world at large (to make 'injury humor' something that a great many people the world over appear to enjoy [Three Stooges anyone?]), I took the opportunity to try to educate people about what was actually going on in that particular GIF.  To share information with people that 'pratfalls' where there is the likelihood of others getting injured in ways that are likely to diminish their quality of life from that point on might not actually be funny.  If people choose not to take in the information or accept that, that is their choice.  I'm not here, writing all this, to change people's beliefs.  [Providing information is different from expecting other people to act on that information.]  I am here presenting people with some less commonly known information about events they may see.  How they react, and what they do with it - both with what I say, and to seeing similar events in the future - is their choice.

I think that's enough for me on this.  I've been having quite a rough time (I've been well past my capacity) since the power went out a couple weeks back and I had a suspected broken toe.  For my functioning alone I likely shouldn't have written anything in the first place.  Too bad the frontal lobes (self-monitoring of behavior) are the first thing to go when I'm past capacity.
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on December 07, 2013, 11:15:35 AM
Quote from: LucasM on December 06, 2013, 10:45:46 PM in the Animated GIF thread
[[Previous spoilers removed except the first one, which was quoting what I'd said in what is now the post directly above this one.]]

Trying to keep my responses short and directly in response to what others wrote about my prior comments.  Still spoilering just because they aren't animated GIFs.  Added bold 'titles' so the new stuff could be found more easily.

The very next thing [[in the one and only spoiler in these Animated GIF-related posts]] is my comments from above that were quoted in the two [[posts]] below:
Spoiler (click to show/hide)

I had a stroke last year. That's a stroke STROKE for those of you who can't spell. I got treatment quickly and even took part in a charity walk afterwards. I also learned during my treatment that I have some brain damage from a "prior incident" that I was not even aware of, and I am on medication for the rest of my life. There have been jokes about stroke victims in MST3K and (I think) even last night. Guess what? I laughed at them: because they were not directed at me and because they were funny. Rifftrax and MST3K are about humor, and sometimes that infringes on territory I consider "mine" (disabilities, my English origins etc) , but it's all fair game because it's comedy and it's equal opportunity. EVERYONE gets their fair share, and I am DAMNED if I am going to rage quit this forum because someone hurt my feelings.

My response to Uncle Des' comments:
I am sorry about your stroke and past head injury.  I'm glad you got treatment quickly for the stroke, as it likely prevented potentially much worse condition for you later.  I hope the meds you are on help with whichever symptoms you ended up with from the combined stroke and head injury.

With what you said at the end of your post, nor would I "rage quit the forum because someone hurt my feelings".  Nor were my feelings hurt by what was posted by anyone on the subject if you read what I wrote.  [If you were just commenting in general and quoting my lengthy comments for context, rather than specifically addressing what I'd written, then 'nevermind'.  I am currently functioning at a very concrete level so since others had been directly responding to my statements, I assumed you were too.]

And what I was commenting on was an actual injury that had been filmed and was being played back for an apparent comedic effect, not verbal humor about an injury.  There is a massive difference.  I consider a video of someone clearly getting a head injury as a milder version of the same type of film that includes the Faces of Death series of DVDs that I became aware of about 15 years ago, and snuff films.  Both head injuries and death can devastate a life and the lives of all those related to or friends with the person involved (and, as the massive number of post-Iraq vet experiences have shown in the last few years, and as recent publicized experiences of retired football players demonstrate, the life devastation from head injuries can themselves often lead to suicide [I have mentioned before on the boards that for about the first five years after the third head injury there wasn't a day that went by where I didn't either wish that the accident had killed me or thought about 'finishing the job' (killing) myself]).  The context of the head injury ('pratfall' or 'being hit by a car bomb' or 'being in an auto accident') is irrelevant to the fact that I think actual head injuries are not funny.

I have, some will likely recall, made jokes about head and spinal injuries on the boards here, including jokes about my own, and I don't generally find them bothersome in RiffTrax or, previously, in MST3K.*  Although, granted, if the comments are based on inaccurate information, I don't find them funny, just as I don't find inaccurate jokes about any other subject that demonstrate an ignorance of that subject funny.  But not finding inaccurate brain injury jokes funny is more from my professional background than it is from having had three of them myself.

But seeing an actual injury occurring in a video?  Yes, that bothers me.  And, personally, I think seeing an actual injury taking place should not be seen as funny.  That's my opinion.  Others have different opinions.  If their thinking it is funny is from their not actually understanding what is happening in what they are seeing, then possibly my explaining what is going on may help.  If they understand what is going on and still think someone getting a possibly lifetime debilitating injury is funny, then that is their business.

Like I said: I only share information I think others may appreciate or learn from.  What they do with it is their choice.  [When I was a practicing therapist and doing this, I was once told I was, "giving away the farm".  That pissed me off, as educating people by itself is easily more effective than trying to do therapy with those ignorant of what is going on internally.]

* (re: accuracy in MST3K comment: I found the 'Brain Guys' song 'When I Held Your Brain in My Arms' absolutely hilarious because of the wonderful puns they made from the names for different brain areas.)

First of all I can empathize with you Lucas because I have a severe spinal injury/chronic pain and knowing how you feel about that brand of humor will make me think twice about posting that type a of GIF again because making you or any of my other friends on this forum feel bad or anxious is the last thing I want to do. Second I appreciate humor of all kinds and I really don't feel bad in any way about finding that GIF funny, I do, however, feel bad for making you feel anxious so I'm sorry for that.

Thank you for the empathy.  I'm sorry you've had spinal problems and chronic pain too.  It sucks, as you well know to have to think about how you are going to do most every action, or even inaction (such as having to consciously think "is my posture perfect?" every time one sits down).

If you find such GIFs funny, and others here clearly do also, go ahead and post them.  It is, as I said, my problem I react to them, not yours.  If you feel mixed about it even with my assurance, then you could do what Relaxing Dragon started for GIFs of car accidents (which I greatly appreciate): he spoilered them with 'car accident' as a label for the spoiler, to explain what was inside.  If you want to do that, that is fine, and I would personally appreciate it greatly.

But, honestly, while I appreciate the thought, out of the couple/few dozen people who post here, I think it would be mighty selfish of me to expect to get singled out for special treatment by others on the boards.  And a large part of me basically feels the same way about that that I do about the trend toward 'childproofing the country'.  [i.e. that childproofing the country goes WAY too far to potentially protect a small minority, while inconveniencing and 'dumbing down' many others.]

Of course, with this likely near the end of this discussion, I just now thought I probably should have moved the discussion to the thread linked to in my sig line with my first comment, as it would have fit there quite a bit more than this extended discussion in a GIF thread.

Sorry, Lembach, for hijacking the [[Animated GIF]] thread for the last couple pages. :(  If you'd like I can move all my posts from the last couple pages over to the Head Injury Info post linked in my sig line.  Just let me know.

[[He did request it, so I moved all my posts here.  Only adding the things in double brackets like this and removing spoiler functions.]]
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on December 07, 2013, 12:06:28 PM
Quote from: LucasM on Today at 10:43:18 AM in the Animated GIF thread:

I will be moving all of my responses, including this, to the Head Injury thread starting now.  But this response will be here very temporarily as I will be transferring them in order so as to not get completely confused.  So with it lowest in the 'transfer queue' my response will remain here [[in the Animated GIF thread]] in the interim.

Spoiler (click to show/hide)

Lucas: I see your new point, and IF any of the impacts actually resulted in brain damage then it is sick to mock it, but we will never know for sure. I am from the country that invented "happy slapping" (physical assault) and am sickened to see how this has evolved into the "knockout" GAME (game???!!) which by definition intends to cause severe brain injury.

What provoked the guy going down the escalator to do the stupid and reckless things he did resulting in some level of injury to himself and possibly harming others comes under "serves you right", and is the reason I made the evolution comment.

On another note about PTSD treatment:

For clarification: all my comments were about the person trying to look 'cool' and his foot slipping off of an office chair which slid out from under him, with him subsequently hitting his head on the chair his foot was originally intended to go on (that GIF showed two clear concussions), not the escalator (which didn't show a clear head injury).  [The one comment I had on the escalator I'd actually deleted before the chair GIF showed up, as I realized my comment on being triggered by it were too 'me-specific'.]

Very disturbed to hear of the 'knockout game'.  Christ, if only people had some clue about what this will do to their capacity to enjoy their life for the rest of their life. :(  [[Hence my taking all the opportunities I can - such as this animated GIF - to educate people about these things.]]

Thank you for the interesting link to PTSD treatment.  There is a book from the 1960s that I read in my teens LSD Psychotherapy that had phenomenal results in trial after trial with using an extended psychotherapy session under the influence of LSD for treatment for childhood-originated PTSD which led to alcoholism and other self-destructive paths.  In one documentary film on LSD I saw in just the last couple years I was amazed and fascinated to see that there were actually film clips from some of those extended therapy sessions and that the documentary even mentioned those studies.  Both the improvement rate and the low recidivism rates were - dare I say - mind-blowing.  [I believe it took one or two sessions for lifetime alcoholics to stop and never desire to drink again with that treatment.]  Of course, then people started to use LSD recreationally to expand their thinking for themselves and the government, of course ::), had to stop that.
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on December 07, 2013, 12:15:43 PM
Addition While Moving The Above Post(s) Here From the Animated GIF Thread:

Some people may have felt the following comment of mine in the post above (quoted and spoilered in the one directly above this one) to be hyperbole:  "I consider a video of someone clearly getting a head injury as a milder version of the same type of film that includes the Faces of Death series of DVDs that I became aware of about 15 years ago, and snuff films."  It was not, and is not, hyperbole.

The truth is, with someone dying a family can grieve and, ultimately, basically finish grieving and 'dealing with' the loss of the deceased.  With a head injury a person's personality and capacity to function is changed, most often forever (though there may be some improvement with time).  [I used to be rather reserved and didn't share my opinions on things very often except with close friends.  Compare that to my extensive writings here on the forum.  That alone is a rather significant personality change.]

Because those with head injuries are changed forever, people who have known them for many years often have a difficult time ever stopping the grieving process, because they are so used to the - for instance - 'old LucasM'.  The new, head injured and different post-head-injury person is simply not the same person they were the instant before the injury.  To my parents I am not the same child they raised.  To my brother I am not the same person he grew up with.  To my friends, I am not the same person I was from my teens to just before my head injury.  I have a couple letters from friends written about my changes (written for the sake of Social Security disability hearings).  They were difficult for me to read when they wrote them, and they still are, because they so clearly describe the 'old me' that *I* have lost, and I still find myself at times having to grieve afresh for the 'old me' that is dead...  dead, while I - a new me with different personality and capacities - still continue.

There was a patient I worked with during a student internship.  He was about 18 years old.  During his graduation party he was beaten severely (for 'fun' by other party attendees).  He could no longer speak or write, he could not walk or get around on his own, and he was in such pain - not from his physical injuries, but from his central nervous system being so damaged - that he spent nearly all day, every day, screaming in pain.  [He was kept isolated in a nearly-soundproof room at the hospital while I was there.]  His parents would have to deal with and process that every time they saw him for the rest of his life.  Now: ANYBODY tell me that his parents would not ultimately feel 'better' or get over his injury easier if he had died.  To have to see their son unable to go to college as he had planned, unable to date, to marry, to have FUN ever again, and to be in screaming-level of pain and unable to communicate about it to anyone...  tell me that that is not something that belongs on the same continuum as Faces of Death DVDs or snuff films for 'severity of experience'.

Those with 'mild' head injuries [based on the criteria used for them, all three of mine were considered 'mild'] most often have to change the way they do many of the tasks that they used to do automatically.  For instance: when I am extremely mentally tired I have to consciously think of which muscles I have to move to get myself to walk up the few stairs between the levels of my split-level home (anyone here have to consciously think about having to tighten and then release their quadriceps to lift their leg to get it up to a step?).  I'm not even sure that level of awareness was necessary when I first learned to walk.  I have to set myself a very specific routine for sleeping (until I wake on my own) and eating (at specified times) or my functioning for every daily task gets even more impaired than it is at my 'ideal' remaining functioning.  Though my organizational skill kicks in after a bit, any sudden change since my head injuries - big or small - is met with near-panic because my resources are daily stretched so thin that any change at all in my expected routine can be devastating.

These things are true of virtually everyone who has had a significant 'mild' head injury.  Not just me.

So my putting a video of someone clearly sustaining a head injury [any time a head suddenly accelerates or suddenly decelerates] on the same continuum as the Faces of Death series of DVDs and snuff films I do not feel is a big stretch.  All are life-changing events that have often devastating ripples outward to everyone who knew the person who either died or sustained a head injury.  And the ripples from the head injured generally remain for the rest of the person's life, affecting them, and all around them, the entire time.  A death is 'over'.  And, because we as a species are aware of our mortality, death is expected at some point; an instantaneous, significant change in personality or change in ability to function on a daily basis, is not.

I hope that helps clarify the comment that I suspect some people reading it may have rolled their eyes at or dismissed off-handedly.
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on December 07, 2013, 12:40:28 PM
One additional thing I forgot to add regarding the original GIF:

Because the person in it intended his weight to stop at the chair, the physics involved means that he hit his head harder on the way down than if he had just tripped and fallen.  (e.g. because the foot was to stop higher than one raises one's foot while running, and he expected a majority of his weight to stop there, the impact would be more than the difference in impact to a foot hitting the ground between walking and running)  All of that additional force was transmitted to his brain on impact with the chair.
Title: Re: Some Information on Head Injury Effects
Post by: Bob on December 07, 2013, 12:49:58 PM
Heck, breaking my head and brain two years ago made me Il Duce faster.

So there is that possibility.

Title: Re: Some Information on Head Injury Effects
Post by: LucasM on March 13, 2014, 08:49:50 PM
Well, apparently it's Brain Injury Awareness Week (I wasn't aware of that before now ;)).  So I'll share a little something here to add to what has already been discussed.

From Dr. Amen's Blog (http://www.amenclinics.com/dr-amen/blog/).  Dr. Amen is a psychiatrist who uses brain imaging to help discern where people's problems lie ('pure' psychiatric ones like depression, as well as head injury related ones).

[The title is a link to the blog page containing the following:]
Even Non-Concussion Head Injuries Are Bad News for Brains
Posted on March 13, 2014 by Amen Clinics (http://www.amenclinics.com/blog/even-non-concussion-head-injuries-are-bad-news-for-brains/)   

Calling all mothers of young sports enthusiasts!  Please take note:  Repeated blows to the head – even without concussion – can cause brain injuries that negatively affect learning, memory, and mood.

A study published last year found differences in the integrity of white matter – which plays an important role in the speed of signals sent between neurons – within the brains of contact sport athletes, compared to non-contact sport athletes after just one season of college-level play.

The study involved 80 concussion-free varsity football and ice hockey players who wore accelerometers in their helmets, recording the number and force of blows to the head during all practices and games.  Any player that sustained a concussion was removed from the study.  The contact athletes were compared to 79 non-contact athletes involved in sports such as track, crew, and Nordic skiing.

Before and after the season, each athlete was tested for verbal learning and memory in addition to receiving an MRI brain scan, which measured the integrity of white matter in the brain.  Author of the study, Dr. Thomas McAllister, stated the following about his findings:

“The degree of white matter change in the contact sport athletes was greater in those who performed more poorly than expected on tests of memory and learning, suggesting a possible link in some athletes between how hard/often they are hit, white matter changes, and cognition, or memory and thinking abilities.”
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on March 26, 2016, 07:47:38 PM
Superb demonstration of just how impacts - even small ones - affect the brain:

(http://i66.photobucket.com/albums/h275/rvr2/03/03001/brainhitgiphy_zpsqqds8pdv.gif) (http://s66.photobucket.com/user/rvr2/media/03/03001/brainhitgiphy_zpsqqds8pdv.gif.html)

Thanks for finding this, RVR II!

EDIT:  I've now added it to the body of the first post in this thread, so that it has it's 'impact' where it is most helpful in the description of head injuries.
Title: Re: Some Information on Head Injury Effects
Post by: RVR II on March 26, 2016, 08:13:11 PM
I have a headache for some reason naow :speechless:
Title: Re: Some Information on Head Injury Effects
Post by: LucasM on March 26, 2016, 09:14:27 PM
I have a headache for some reason naow :speechless:

Yeah... that should help people grasp just how fragile the brain actually is.  And allow them to visualize what happens with even minor 'bumps' such as the one in the GIF discussed on the previous page (person slipping and hitting head on chair).  With the slow movement of the skull, that, right there, is roughly a 'header' in soccer, and is most certainly less than any contact in football.

That visual is superb at getting across just how easily damaged a brain is, and, hopefully, will help prompt people to think about what they are doing and protect themselves from such impacts... and protect their kids by not allowing them to play any contact sports.  [Anyone interested in the effects of contact sports should see the film 'Concussion', just recently released.]