Severe Versus Mild Prognosis

I got this email exchange this week, about something I wrote more than a decade ago:

Is this a typo?

http://www.waiting.com/recoveryexpect.html
A so-called “mild” brain injury may result in substantial deficits which may affect a person’s life permanently, while a person who has suffered a “severe” brain injury may be able to return to a life that is, while not identical to, close to the one they had before the accident.

I answered this email as follows:

No, I don’t think it was a typo. What did you think was the mistake?

That sometimes people with mild injuries can have worse results than someone with a severe injury?

Attorney Gordon Johnson

I got this response back:

Yes, the MILD = worse recovery than SEVERE. Its not something I wanted to hear I guess. My sister was diagnosed with Diffuse Axonal Injury. I guess even though there is no visible damage there is the possibility that more of her brain was actually damaged in comparison to a blunt force. Thank you for your help. Your site has been informative and I am sure it will be a tool we use going foreword.

Today, this news story came across the wire.

Assault and Battery – Florida
Man gets $12.8M for punch that resulted in severe head injury

A jury awarded $12.8 million to a man who nearly died after he was punched in the head at the University of Florida. In 2003, Brandon McArthur, then an 18-year-old baseball player at the school, was struck by Jonathan Head just outside a bar and grill on University Avenue. The attack was unprovoked and without warning. Head pleaded no contest to assault charges, but didn’t appear at the civil trial. McArthur sustained a severe head injury that required surgeries to remove blood clots and relieve presssure on the brain. He was injured when his head struck the sidewalk several times during a grand mal seizure. He remained in the hospital for about a month. He eventually recovered and was able to continue playing college baseball.

That someone got a substantial reward is wonderful, and the lawyer involved should be greatly congratulated. But what struck me about the story was the part in boldface, He eventually recovered and was able to continue playing college baseball.

I had a friend, who was a survivor of a severe brain injury, who rose to a leadership role in the Brain Injury Association, both on the national and state level. I was new to this field when I met her, and I have never forgotten a statement she said: “You know the goal of brain injury rehab is to get severe brain injury survivors to the level of mild brain injury survivors. ” This was the first time I ever thought about this issue, but in my experience, too often the lines of recovery don’t start to run parallel near each other, they cross over in opposite directions. My theory is that severe brain damage, that does also involve diffuse damage, is easier to rehabilitate, because the brain’s capacity for plasticity gives us something to focus on in rehab. On the other hand, mild injury, which often involves significant but not visible injury to the brain’s connective communication network, is hard to pinpoint and even harder to rewire.

A good example which many people will understand: a small electical fire will often completely total a car, because of the difficulty in rewiring an entire car. A high speed front end collision, will often not, because those parts are on the surface and easy to repair or replace.

The other lesson from today’s news story, is you cannot base brain research on the pattern of recovery of young jocks. They just do better in terms of recovery. Far too much of our research, our brain modeling is done based on what we learned about young jocks. They survive much better than do 40 something women. Basic fact. When they start studying 40 something women, then we will learn something about mild brain damage. See http://youtube.com/watch?v=E2Tml2QaSEM

Watch for my coming blog on the good and the bad about basing the next generations brain injury research on Iraq war injuries.