You may have heard the term “concussion” many times before.
It is usually associated with a head – or more specifically, a brain – injury.
Such injuries are usually caused by motor vehicle accidents, falls, assault, or more recently, sporting activities.
Meanwhile, cognitive ability involves the processes of thinking, learning, reasoning and understanding.
The aspect of cognition has gained interest and awareness of the impact it has an individual in recent years.
Its importance goes beyond just being “sane”; instead, it is a hallmark of being a productive member of society.
In the era of the internet, social media and artificial intelligence, more and more jobs require more than mere knowledge; they need the ability to understand and process information to facilitate critical analysis.
Structural and cellular damage
American forensic neuropathologist Dr Bennet Omalu was the scientist who brought to light chronic traumatic encephalopathy (CTE).
This is a condition where the sufferer develops behavioural problems and dementia over an extended period of time due to the multiple head injuries they have suffered.
Dr Omalu uncovered this condition by examining the brains of a number of former professional American football players, who had experienced repeated concussions and head injuries due to the rough nature of the game.
This discovery started a cascade of renewed research into head injuries, including exploring treatments that go beyond the brain structure alone to tackle the more abstract functions, like processing information, behaviour and judgment.
Brain injuries like CTE occur by direct damage to the brain and on a cellular level.
Direct damage may be remedied through surgery and critical care.
Cellular damage typically involves the accumulation of damaging proteins in the person’s brain.
Some of these protein elements are linked to cases of dementia, including Alzheimer’s disease, which have limited treatments and no cure.
Most common cause
In our country, head injuries are most commonly caused by road traffic accidents and falls.
Those most at risk are riders and passengers of the motorised two-wheeler (i.e. motorcycles).
While safety helmets do protect the head and brain from gross injury, violent impacts can still have effects on the brain’s cells and tissues.
These effects tend to be delayed and only noticed by family members or friends, as they tend to involve change in behaviour, difficulty in returning to work or in performing their daily routine.
During an accident or impact to the head, the brain bounces back an forth within its fluid in the skull.
With adequate force, it could result in the brain crashing into the skull, causing damage to the brain.
Depending on the force involved, the person may have symptoms as mild as confusion to as serious as a loss of consciousness, and even more seriously, permanent brain damage that results in disabilities like paralysis.
Symptoms may be physical, cognitive and/or psychological.
The physical symptoms can include headaches, disturbances in vision, nausea and dizziness that persist.
Such symptoms may be treated with medication.
The cognitive and psychological symptoms on the other hand, are more challenging.
Unfortunately, concussions cannot be seen on imaging like a computed tomography (CT) scan or magnetic resonance imaging (MRI).
Affecting skills
Cognition involves speech, memory and judgment, which are important in daily life.
A person’s ability to repeat a learned skill is dependent on their cognition.
Learning a skill and repeating it may seem simple to us, but I am sure that the first time we had to learn something new, we struggled to get a hang of it.
Eventually, after much repetition, the act becomes muscle memory.
But this is actually due to the brain’s ability to create a neural highway for us to perform the routine without much effort.
This involves forming a step-by-step completion of the skill, followed by storing it in the memory portion of the brain.
Practice of the skill helps to finetune our motor abilities (e.g. movements of hands, legs, fingers, etc) to perform the task with ease.
The amount of time needed to develop the pathway is based on the complexity of the task.
For example, combing your hair would be a simple task, but fixing a car engine would be more demanding.
Hence, the saying “Practice makes perfect” does indeed have bearing.
A person suffering from cognitive damage, will have difficulty accessing previously-built pathways.
More importantly, their ability to form new pathways will be impaired, thus making it difficult for them to learn new skills.
Change in personality
Psychologically, an affected person’s mood and behaviour may change.
It may start slowly and gradually worsen over time, and may only be noticed by family members and friends.
One of the most common conditions that can manifest is post-traumatic stress disorder (PTSD).
This term is very broad as it can involve psychological issues ranging from anxiety, nightmares and irritability to mood changes, depression, anger issues, social withdrawal/isolation and impulsiveness.
The symptoms tend to affect family members more than the person himself or herself, especially when they are not aware of the aggravating factors.
Many times, they ignore or just get silently frustrated with the behaviour of the affected person, without taking any further action.
Unfortunately, this allows the person to spiral further downward, making it much more difficult to help them.
A historical case study was of an American named Phineas Gage, a mild-mannered, pleasant and hardworking man.
In 1848, he suffered a freak accident that resulted in a metal rod being propelled through his left cheek into his brain – destroying much of his left frontal lobe – and out of the top of his skull.
He remained conscious throughout the incident and was able to be brought to the hospital for treatment.
He miraculously survived the entire ordeal, returning back to his normal physically-functioning self.
He did gradually return to work, but those around him noticed that he had become aggressive, easy to anger, started consuming alcohol excessively and could not learn new skills.
In fact, he was often said to be “no longer Gage” by his colleagues and friends.
Treatments available
Gage triggered a newfound understanding of neuroscience, indicating that recovery from a brain injury might require more than surgery and medication alone.
With advancements in neuroscience, neurosurgery and rehabilitation, many techniques involving cognitive training, physical therapy and psychological counselling have been developed.
Certain medical centres, including the Socso Tun Abdul Razak Rehabilitation Centre in Malacca, have ventured into many neuromodulation or neurological recovery programmes to treat this problem.
Brain stimulation procedures are a new form of therapy to help the patient’s recovery, which have been rising in popularity in recent years.
Many of these procedures are non-invasive (i.e. does not involve surgery), although some countries are researching more permanent brain stimulation techniques that may involve an operation.
The recovery process is usually very long and many take at least one year before improvements can be seen.
ALSO READ: Why rehabilitation is important to recover from a stroke or injury
Therefore, patience is key during the recovery process.
There may be many frustrations and hurdles faced during this time, but the patient’s well-being is important, especially so that they do not feel like a burden to their family and society.
The best we can do is be supportive and not dismiss someone’s symptoms, but instead, help them to find help.
ALSO READ: When the brain experiences traumatic injury
Dr Ramani Thiagarajah is a consultant neurosurgeon. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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