Traumatic Brain Injury (TBI) is from a sudden jolt or blow to the head. The severity of the injury can range from mild (mTBI) to severe, and are defined by different levels. There are two different scales used to define severity of injury: the Glasgow Coma Scale and the Ranchos Los Amigos Scale of Cognitive Functioning.
Per Medscape’s website, TBI defined by the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine:
“The Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine defines mild head injury as “a traumatically induced physiologic disruption of brain function, as manifested by one of the following:
- Any period of loss of consciousness (LOC),
- Any loss of memory for events immediately before or after the accident,
- Any alteration in mental state at the time of the accident,
- Focal neurologic deficits, which may or may not be transient.”1
TBI is not a death sentence, but it, and its sister syndrome, post-concussive syndrome (PCS) can compromise the quality of life. PCS is a complex disorder which is not completely understood. What science does know is that multiple concussions have a cumulative effect on the brain, which can lead to permanent PCS.
As mountain biking becomes mainstream, TBI and PCS is becoming prevalent in our sport. One can sustain a concussion, not experience any symptoms, but may still be injured. While MRI’s and CAT scans are used to ascertain trauma, symptoms of TBI can fall under the radar. Symptoms include behavioral changes, like depression, personality changes and mood swings. Other symptoms may include headaches, sensitivity to light and sound, memory loss, inability to sleep, seizures and nausea. mTBI is defined as the loss of consciousness, for under 30 minutes, and disorientation and loss of memory. Severe TBI, and PCS, includes all of these symptoms, and more, such as the inability to speak, or understand when spoken to, slurred speech, and inability to read and/or write. There may also be a partial or complete loss of sight, intolerance to light, tinnitus, chronic pain and paralysis.
From TBI, PCS may arise. Scientific literature shows shades of grey between the two terms. Western medicine hasn’t unraveled the cause and effect of the injury and its symptoms, or have been able to differentiate definitively between the two. For this article, TBI is the acute injury, with PCS being the resulting symptoms. These symptoms can manifest at any time after sustaining a blow to the head, and last for months. If one experiences three or more of the above symptoms, one may be diagnosed with PCS. PCS is controversial, as it seems that Western Medicine has yet to accurately explain the causal effect of TBI, with the resulting symptoms. Science does not deal in shades of grey, hence different definitions for the same problem. One thing is certain, though, that a hit to the head is serious, and even if one does not lose consciousness, one should definitely see a doctor.
Wearing a helmet may not be considered cool by some people, but it can be the difference between life and death. Or compromise the quality of one’s life permanently. Part of the fun in mountain biking is the risk associated with the sport. But do not risk your life because of your helmet. So, how do you know if your helmet is broken? Scott Sharples, the Marketing Manager of Bell Bike said:
“While there is no simple answer, generally anytime a helmet sustains a hard impact from a crash it should be replaced. Sometimes in a crash it is hard to tell if the helmet has been hit – the trauma from the impact makes it difficult to recall if the helmeted head hit a surface. Look for any impact signature showing crush or cracking, inspecting both the inside and the outside of the helmet. Impact evidence can be hidden behind the microshell, so check the outer shell for evidence such as deep scuffing. Sometimes you can feel crush by carefully pressing on the microshell and feeling if the liner material underneath has been compressed. If there is any dent deeper than about an eighth of an inch, or any cracking of the liner or shell, replace the helmet.
Always, when in doubt have the helmet inspected by a qualified expert at the manufacturer. Most US based manufacturers offer a free inspection of helmets which may have been damaged. If an inspection is not available, or if the helmet has had more than three years of use, replace the helmet.”
It is imperative to wear a helmet while participating in any risky sports. Head injuries can occur anywhere, even on the playground, much like pro downhiller Amanda Batty. She sustained her first TBI when she was 2, when falling off of a slide at the playground. An active lifestyle includes inherent risk, and Batty is no stranger to TBI’s, and their resulting symptoms.
WIth “a total of 28 concussions over 28 years,” Batty has sustained them from “Horseback riding, treehouse building, snowboarding, mountain biking, and I think I fell down the stairs once (seriously). I didn’t think helmets were important until about six years ago after a level III closed-head trauma after which I was life-flighted and [I was] in the ICU for six weeks and unable to speak accurately for nearly two months after a snowboarding accident. Three life flights, all from snowboarding without a helmet.” Batty says about her symptoms:
“PCS and brain tissue degeneration have affected my daily life in irreversible ways; my irresponsibility as a young adult led to an uncertain future and a delicate brain.
From mood swings, affected vocabulary and reading skills, memorization, self-control, depth perception, sleep patterns, attention span, and personality, TBIs have affected every single part of my life. I’m sensitive to light, experience crippling migraines and my work, social and family lives all suffer. I also am flighty, forgetful and often have to leave explicit instructions for myself.”
As the Mayo clinic states on their website, “researchers haven’t determined why some people who’ve had concussions develop persistent post-concussion symptoms while others do not. No proven correlation between the severity of the injury and the likelihood of developing persistent post-concussion symptoms exists.”2
So, whereas Batty has had severe TBI, no one injury can be attributed to her specific symptoms. Much like Michelle O’Connell, out of Denver, Colorado, who grew up in the circus. O’Connell has sustained multiple TBI’s, who’s symptoms run the gamut, as she said:
When I started snowboarding and downhill mountain bike racing eight years ago, I started a fresh pattern of monthly mild to severe concussions. On three separate occasions I had severe crashes resulting in serious head trauma that I had trouble hearing and thinking coherently for some hours afterwards. One day in 2010, I lost my vision for about 30 seconds…That was when I decided to ease up, to give my brain a chance to ‘heal’. I was aware that I didn’t feel like myself, I wasn’t sad but I also wasn’t happy and would describe it best as ‘being stuck in a soft grey fog’. When I would feel excited about something, I wouldn’t remember what it was and would have to carefully backtrack on what had happened in the past hour or so to try and remember. I forgot best friends’ names and had words stuck in my mouth that my brain couldn’t help me remember how to say. To this day when I drink I have ‘black-out’ periods, even if I haven’t drunk much. I would say longterm effect on my personality is I feel ‘sensitive’ in life now, and am quicker to react badly in a situation. Whereas the old me was a lot more laid-back and relaxed about perceived slights.
This is how TBI can affect one’s life – on every level. Lisa Mason, the founder of the Women’s Freeride Movement, said, “Take your time after a concussion. If you go back too soon, you risk a relapse. I passed out in front of my campers two weeks after my largest concussion. And it not only spooked me, [but] it made me reassess what I value in life. When the doctor says the next you might not wake up, you kind of take stock! Play with friends, you may never need to save their bacon but I’m sure they’ll be happy with you and vice versa. Enjoy life and wear your helmet!”
2 http://www.mayoclinic.org/diseasesconditions/ postconcussionsyndrome/basics/causes/con-20032705
Joh Rathbun, owner of Ride On!, is a mountain bike coach and action sports writer currently based in Santa Cruz, California. To stay uptodate on West Coast events, like her Facebook page.