I Learned The Hard Way That Concussion Isn’t Just For The Young
Monday, April 13, 2015
I think I knew what was happening even before my head bounced off the hard kitchen counter on its way to the even harder stone floor. I was rapidly losing my connection with reality. My wife, Tabitha, later estimated that I was out for 10 minutes. When I emerged from unconsciousness I heard the sirens on the street in front of the house. It seemed as if half of Tucson's fire department was streaming through the front door.
I was scared. At my age, which is old, you laugh at any childlike faith in your immortality. In this case, what brought on the unconsciousness was apparently a quick turn of my head while reaching for an onion to peel for the night's dinner, followed by the knockout blow from hitting the floor.
An enormous hook and ladder and an ambulance were drawn up in front of the house, sirens winding down. The commotion was embarrassing, but it was comforting to know that my wife was in the next room, had called for help, and that 911 had responded to her call as it was supposed to.
The emergency room doctor said I had a concussion — a blow to the head that our new and improved language calls a MTBI. This scared me as much as the ambulance ride itself, since it stands for "Mild Traumatic Brain Injury."
To me, "brain injury" meant something sinister and probably permanent, something I had not seriously considered before. I foolishly had assumed that I could continue relying on my uninjured brain, along with my ultra-speedy two-finger typing, to make my living for the rest of my life.
It's not hard (if you're an emergency room physician), to spot the condition: a fall accompanied by a blow to the head. In my case, the mind's sudden descent into unconsciousness, followed by a slow return marked by a slurring of speech; inability to remember ordinary things like the words I use frequently; and a shockingly clumsy way of balancing myself and ambulating (the firemen first assessed my condition as drunkenness, but I hadn't touched a drop). My wife feared that I had suffered a stroke, but brain imaging at the hospital ruled that out.
In the past few years there's been increased attention to traumatic brain injuries in organized sports. But we old folks have the highest rates of TBI-related hospitalizations and deaths.
The Centers for Disease Control and Prevention estimate that traumatic brain injuries in a year averaged 52,000 deaths, 275,000 hospitalizations, 1,365,000 visits to emergency rooms overall. Falls were the primary reason for the ER visits in the youngest (0-4 years) and oldest age groups (65 years and older). In those age groups, falls accounted for 72.8 percent of the children's TBI-related visits, while for those of us 65 and older, it was 81.8 percent.
There is no one-treatment-fits-all for TBI's victims, but rest is universally prescribed — during which improvement can be can be maddeningly slow. And while there is abundant research on classifying concussion in all of its forms and degrees, researchers are still working on figuring out what happens inside your head when you thump it.
Perhaps the best explanation, and one that's used often, is that a concussion produces a "cascade of events." These may include interruption of the brain's blood flow, wildly firing neurons, release of glutamate in quantities big enough to stimulate nerve cells, an increase in the levels of lactate, and imbalances in chemicals such as potassium and sodium. (Tests at the hospital revealed that my sodium level was far too low. That alone can bring about a crash.) You may be peacefully unconscious on the kitchen floor, but your head may become a maelstrom of activity—one that, because of all the chemical and physical changes that go on inside it, researchers like to call an "energy crisis."
I spent a week being observed in the hospital, followed by another week in a facility that rehabilitates people whose brains have been scrambled. There I had physical, speech and occupational therapies for three hours a day and rest for the other 21 hours. I relearned how to brush my teeth and became rather deft at piloting a wheelchair. A sign at my door warned everyone who passed by that I had a risk of falling. A therapist helped me relearn how to walk without tumbling over. Another expert watched patiently as I struggled with a large jigsaw puzzle.
Sudoku puzzles helped. Even better was a game that challenged me to perform deductive thought. As I was ending my stay at rehab, a therapist told me about a Web-based set of puzzles (paid but worth it) named Lumosity, which has become my favorite. The program, which was developed by people with PhDs after their names, combines the entertainment of playing games and solving puzzles on a computer screen. It's far more interesting than Sudoku or any of the mindless games that clog various app collections.
Now, months later, I still have not completely recovered. Writing on my computer yields an exhausting exercise in typos that I, after all these years as a reporter and book writer, have no business making. My balance and gait could be described as lurching, and I sometimes find myself forgetting the directions to my doctors' offices and the archaeology meeting we attend on Tuesday nights. (I think it's Tuesdays. Thank goodness for my cellphone calendar and the GPS on our car's dashboard.)
I don't blame my doctors and therapists for my lack of a complete recovery. Despite the reams of scientific papers, conferences, website definitions and cognition-building games that are out there, recovery from concussion seems to be a crap shoot. It must largely depend, as does recovery for most malaises, on the strength and resilience of the afflicted.
Youthfulness undoubtedly helps, but that one's out of the question for me. But how do you bring back stuff you knew so well that you've long since taken for granted? A computer password? The correct spelling of a friend's name? In my case, how to relearn my two-finger typing? How to drive to a favorite restaurant? On one occasion, my own phone number?
I'm heartened by the story of George Clooney, who suffered a concussion while filming Syriana in 2005. (He was tied to a chair, and someone bumped over the chair.) Even he had to struggle to regain memory, and resorted to writing down his lines on random bits of paper. He later won an Academy Award.
It's easy to start feeling sorry for yourself, especially when your thinking is so heavily contaminated with typos. I do a lot of reflecting about the concussion, and when I start to get despondent, I recall the experience of our next-door neighbor. She's a young and energetic woman, full of vitality and good humor. After I returned home from the hospitals, we gossiped over the fence about our experiences in the scary world of brain damage. "I crashed my bicycle 11 years ago," she told me, "and I still have trouble remembering things."
Fred Powledge is the author of scores of articles and 17 books, six of them for young readers. He lives in Tucson with his wife, who is a science writer.
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