Severity of TBI: Understanding Severe Brain Injury

Severity of TBI: Lori Part Two 

There are primarily two methods to classify the severity of  TBI, the length of coma (or loss of consciousness) and the length of amnesia.  In assessing amnesia, it is not so much the loss of memory for events before the injury that is significant (retrograde amnesia) but the length of time before amnesia ends after the injury (post traumatic or anterograde amnesia). We used these methods in determining the Severity of TBI for Lori.

Were you in a coma?

Yes.  Seven days.

Any traumatic brain injury with a coma lasting for more than 24 hours is considered a severe TBI. With Lori and the severity of TBI the first thing that she remembered after the injury was during rehab, remembering laughing while trying to use the balance ball.

The accident happened on April 25^th, you were in a coma until roughly May 2^nd. Where did  you get treatment after that for the severity of TBI?

I was an inpatient at the hospital until summer.  Sometime like June or so.  And then I needed complete assistance, and I had to move back in with my parents, and I was an outpatient for a long time.  And it seems like at least over a year I was an outpatient at the same hospital.

Now in terms of the memory of laughing while on the balance ball, where do you think that was in that time frame?

What I think and what I’ve been told is that it was probably when I first started therapy outside of my room.  So I was in the coma, and then I had bedside therapy for a period of time.  I don’t know if that was weeks, days.  But then I think it was within weeks that I started having therapy, and that’s where that first memory comes.

So in terms of categorizing your amnesia – and I do this because it is probably the most accurate way to compare the severity of TBI– you have only a few seconds of loss of memory before your accident and two to three weeks afterwards.

Yeah.

It is important to keep in mind that when assessing the severity of her amnesia and the severity of TBI, the one isolated memory (such as Lori’s the balance ball) does not mark the end of the post traumatic phase.  Amnesia ends when continuous memory returns. It is not unusual to have an island of memory in a sea of amnesia, particularly if that memory has an emotionally charged element, like laughter or something negative.  The geographic structure of the brain probably has a lot to do with that. The amydala and the hippocampus are located adjacent to each other in the lower brain, part of the limbic system.  The amygdala (the primitive emotional center of the brain) reinforces the hippocampus (the brain’s save button) in imprinting particular memories.

Next in Part Three – The Nature of Lori’s Brain Pathology