How do Head Injuries Affect Difficulties in Communication? - What happens to your brain when you suf

Introduction

Most people have a friend who has suffered multiple head injuries. They might have played a contact sport in high school or worked in a job where there is a high risk of injury. Usually, we do not think too much more about it than that. Concussions feel like a normal part of growing up, and it almost seems odd if someone hasn’t ever gotten one. In fact, the University of Pittsburgh Brain and Spine Injury Program reported that “in the United States, the annual incidence of sports-related concussion is estimated at 300,000”(5). This number is staggering, and explains why concussions seem like such a commonplace in our society. However, what is not often discussed is the ramifications of this high incidence.

In recent years, brain injuries have become increasingly prevalent in the media. In 2015, a high-profile court case against the National Football League (NFL) caught the attention of the nation. Over 5,000 former football players sued the NFL on the grounds that repeated head injuries during their careers were the cause of more severe conditions that developed later on in their lives. Many players were suffering from degenerative neurological conditions such as amyotrophic lateral sclerosis (ALS) and Parkinson’s disease. Others suffered from chronic depression and some even committed suicide.

The players asserted that the NFL downplayed the consequences of repeated concussions. They ended up winning the case, settling for up to $5 million per player. This case highlights a gravely concerning attitude that most people have towards head injuries: that they are ‘no big deal’ and that, beyond a few months of recovery, have no further implications.

However, this is simply not the case. Mounting evidence from multiple longitudinal studies of athletes indicate that repeated head injuries can lead to dysarthria (a disorder that affects the muscles of the tongue, jaw, and face) and apraxia (a disorder in which the patient’s word comprehension is intact, but formulation is halted in some capacity). Reports also indicate that repeated concussions lead to life-long depression (Guskiewicz et al) and can contribute to onset of ALS and Parkinson’s disease (Bazarian et al).

So what is really happening to your brain when you get a head injury?

When your head collides with something or is struck with enough force, the brain immediately activates its protective damage-control mechanisms. Firstly, the skull provides an incredibly hard external layer. This can help prevent an open head injury, in which the skull is punctured completely (by a piece of shrapnel, or say, a railroad spike). However, this boney shell around the brain can sometimes be counterproductive, as a significant impact could cause the cortical surface to collide with the inside of the skull, possibly resulting in lesions, swelling, and internal bleeding. The meninges, three layers of protective tissue of the brain, begin to essentially bruise. If the impact is great enough, this could potentially cause even more widespread damage to the neurons, which is seen most commonly in Traumatic Brain Injuries. Concussions tend to be less severe, but certainly result in some degree of damage.

What about Neuroplasticity?

Most people have heard about the concept of neuroplasticity as is applies to language learning and general human development. The basic idea is that the brain has the capacity to recover and reorganize after injury. This capacity is vital to the continual functioning of our brain, and aids in recovery of cerebral function following anything from a concussion to the complete surgical removal of an entire cerebral hemisphere. Our brain’s ability to carry on is truly astounding, and numerous studies have been conducted in this area of neuroscience.

However, this reorganizational capacity can only go so far, especially in instances of repeated damage. Although the brain can specialize other neurons to “pick up” functions that other neurons can no longer perform following damage, once significant cell death has occurred, the neurons cannot regenerate and those areas are permanently damaged.

What does it look like when someone has suffered from repeated head injuries?

The clinical presentations of someone who has suffered repeated head injuries varies. It largely depends on the sight of damage in the brain. Most frequently, head injuries involve damage to the frontal or temporal lobes. These are hugely important regions of the brain that are responsible for several higher-order functions. The frontal lobe mediates personality, executive functioning, problem solving, and short term memory. All of these aspects are crucial in effective communication. Someone who has suffered repeated neuronal damage to this lobe will have trouble formulating coherent ideas. They might struggle to come up with words, forget what they are trying to say, and spend a lot of time getting their ideas out. This can be frustrating for both the speaker and the listener, and requires a great deal of patience from all parties during communication. Damage to this region could also affect the musculature of speech, leading to dysarthria and potentially other neurodegenerative disorders (such as Parkinson’s disease and ALS). In this case, prosody- the rhythm of speech, so to speak- is affected. The individual might have slow, slurred speech that is difficult to understand. They might pronounce things incorrectly as a result of not being able to properly coordinate the muscles of their jaw and tongue.

Repeated concussions that result in significant damage to the temporal lobe severely affects communication, as this region houses the primary cortical areas for processing speech and language. Damage here could result in difficulty with verbal expression and/or the ability to understand speech.

Why should you care?

For these reasons, any kind of head injury should not be taken lightly, whether it is a minor concussion or a full-blown TBI. If the brain is damaged, its plasticity can only go so far. Repeated damage and cell necrosis will make it even harder for the brain to recover, especially for those who are reaching the end of adolescence and nearing the end of their brain’s development. While the immediate effects of repeated brain damage might not be as obvious as the tremors associated with Parkinson’s disease or the dysfunction of muscle coordination in cerebral palsy, they can still have a huge impact on the everyday life of those affected. Not being able to make quick decisions, struggling to remember basic information, and having to adapt to changing situations are all characteristic symptoms of individuals who have suffered multiple head injuries. But these are all easily written off as the individual being “forgetful”, “lazy”, or “slow”. It is time for us to look at the real consequences of repeated head injury and take them seriously.

Works Cited

Almasy, Steve, and Jill Martin. "NFL Concussion Lawsuit Settlement Approved." CNN. Cable News Network, 22 Apr. 2015. Web. 22 Mar. 2017.

Bazarian, Jeffrey J. J., Ibolja Cernak, Linda Noble-Haeusslein, Samuel Potolicchio, and Nancy Temkin. "Long-term Neurologic Outcomes after Traumatic Brain Injury." Journal of Head Trauma Rehabilitation 24.6 (2009): 439-51. Web.

Guskiewicz, Kevin M. M., Amy R. Matthews, Johna Register W. Mihalik, Stephen W. P. Marshall, Julian C. Bailes, Michael Mccrea, Herndon P. Harding Jr., and Robert C. Cantu. "Recurrent Concussion and Risk of Depression in Retired Professional Football Players." Medicine and Science in Sports and Exercise 39.6 (2007): 903-09. Web.

Kieslich, et al. “Neurological and Mental Outcome after Severe Head Injury in Childhood: a Long-Term Follow-up of 318 Children.” Disability and Rehabilitation, vol. 23, no. 15, 2001, pp. 665–9

University of Pittsburgh University Marketing Communications Webteam. "Concussions." University of Pittsburg Neurological Surgery. University of Pittsburgh, 2017. Web. 27 Mar. 2017. <http://www.neurosurgery.pitt.edu/centers-excellence/brain-and-spine-injury/concussions>.