But all that changed 41Ú2 years ago, when Gabriel flew off her bicycle and struck concrete head-first. Her helmet may have saved her life, but the 35-year-old still struggles with the long-term effects of her brain injury and has been unable to return to work.
Gabriel has energy for no more than three hours of concentration a day before she needs a nap or rest. Her home is dimly lit and she wears earplugs at all times.
“It’s mostly the headaches,” Gabriel said. “You are already so on the edge of maintaining composure, so when there is noise, it is just too much.”
Nevertheless, it took 31Ú2 years before doctors recognized she had sustained a brain injury. Gabriel doesn’t blame them. She said the injury left her too befuddled to tally up all her symptoms for a one-time presentation: memory loss, nausea, poor balance, ringing in the ears, headaches, confusion and constant fatigue.
“It’s not like I would even remember to go into my GP and say, ‘I have all these symptoms’ because I wouldn’t remember to say ‘I have all these symptoms,’ ” she said.
One day, however, she talked to another brain-injury survivor who recommended she check out the Victoria Brain Injury Society, which has programs to help people deal with long-term effects. Gabriel is now on the society’s client list, which has grown by about 50 per cent in the past 18 months, from about 500 to 750, as understanding of concussions and brain injuries increases.
Doctors and brain-injury specialists trace that growing awareness to media reports about injuries suffered by professional athletes such as hockey player Sidney Crosby. The National Football League has also seen former players struggle to deal with long-term concussion symptoms and launch lawsuits against the league.
Shelina Babul, a sports-injury specialist with B.C. Children’s Hospital in Vancouver who focuses on concussions and brain injuries, said work in the field has been ongoing for the past decade. But in Canada, in particular, it wasn’t until hockey heroes started falling that the public took serious notice.
“It really was Sidney Crosby’s injury that raised the public profile,” Babul said in a telephone interview. “You turn on the TV or open the newspapers and you see something more being added.”
A concussion occurs when a sudden knock or jerk of the head moves the brain inside the skull, where it rests in spinal fluid. Typically with a concussion, the disruptive stirring inside the fluid leaves no detectable, structural damage to the brain. Sufferers usually recover in three to six months.
But Dr. Claire Sina, a psychologist with the Vancouver Island Health Authority, classifies brain injuries as something different. Symptoms may be similar — confusion, blurred vision — but a brain injury usually involves structural damage to the brain. A bleed or a bruise, detectable on medical scan, is often present.
“We separate concussions from a mild traumatic brain injury, a moderate traumatic brain injury and a severe traumatic brain injury,” she said.
Also, the concussion, while stressful, is an event from which a person usually recovers, providing the patient rests, physically and mentally, for a long enough duration.
Brain injuries and concussions often occur because of a sudden decrease in speed — hitting the head on pavement after flying off a bicycle, being in a car accident or slamming into the boards or taking a body check in hockey.
New research shows that in children, this brain movement can be even more catastrophic than in adults. A child’s head, relative to the entire body, is proportionately larger than an adult’s, so sudden deceleration can cause more significant movement. A child’s skull is also thinner and less resistant to blows. Additionally, neural pathways inside the brain are still being developed, and an injury can disrupt that development.
Unfortunately for the brain-injured and concussed, symptoms vary widely. Two people exactly the same age and size can sustain the same blow in the same way. But recoveries can differ widely.
Why?
“That’s the $64-million question,” Babul said.
But strides have been made, she said. Physicians, sport coaches and the public have become more aware of concussion dangers, causes and treatment.
Protocols have been developed to determine if an athlete can return to games or workouts. There are checklists for doctors to determine the likelihood of brain injury. Employers and employees are beginning to realize a return to work after a concussion should be gradual and slow.
“Ten years ago, you hit your head and were told, ‘Oh, you just had your bell rung, you’ll be fine in a couple of days,’ ” Babul said.
Complete physical and mental rest is essential until symptoms disappear. Activities such as reading, watching TV or studying for an exam fire up the brain and make it difficult for natural repairs to occur.
Coaches and parents are told not to push a young person back into games before they’re ready.
“Listen to your kids, if they are hurt or injured,” Babul said.“Don’t push them.”
Nicole Nelson, director of resource development at the Victoria Brain Injury Society, says the group has a wait list for the first time since it was formed in 1983, with about 40 people waiting for help.
The wait list is a real problem, Nelson said, because those with brain injuries are often well along a downward spiral before they even show up at the society.
In her experience, recovery from brain injuries can can take years. Symptoms can last indefinitely.
Unable to concentrate, stay alert or keep their memory functional, the brain-injured often can’t return to work. They lose their jobs. Debts can’t be serviced. Mortgages are foreclosed. Depression takes hold. Marriages split. Friends disappear. Substance abuse often occurs.
“For me to say to someone who has lost their wife, their home, their job, their friends and is now struggling with an addiction, ‘I’m sorry, you have to wait three months’ is just impossible,” Nelson said.
“It can take some people years to get back on solid ground — years,” Nelson said. “And we are talking about people who have had high-functioning, high-level jobs who’ve had their brain injury and now can’t work more than two hours a day.
“It’s devastating for them.”
> Physical contact in sports can have devastating effects on the brain, C11
