Coping with Persistent Post-Concussive Symptoms Following mTBI
Traumatic brain injury is a modern public health crisis that is of growing concern in military and civilian populations. Mild traumatic brain injury (mTBI), which is defined by a Glasgow coma scale score of 13-15 and symptoms of confusion and/or loss of consciousness for less than 30 minutes following injury, is particularly difficult to diagnose and treat. A period of rest following exposure to a mild head injury is critical to full recovery, but the conditions in which the head injury was sustained (i.e., in the context of military theater or during a sporting event) and ambiguity in diagnosis often prevent rest following injury.
Many people who have suffered single or repeated mTBI events struggle with persistent post-concussive syndrome (PCS) that cause long term cognitive deficits to include impairment of memory and attention, decreased concentration and increased distractibility, deficiencies in visual and verbal information processing, and difficulties with communication. As a result of these symptoms, individuals struggling with persistent PCS face challenges in such daily tasks as managing schedules, completing work projects, and maintaining social relationships. The ability to fulfill daily requirements of work and home life can be made easier with modifications of habits and implementation of coping strategies that help compensate for functional deficiencies due to persistent PCS.
Cognitive rehabilitation is a critical first step to learning mechanisms that can be incorporated into daily life to help manage the challenges of living with PCS. In general, many of the challenges that accompany PCS require patience and understanding from the individual suffering with PCS, as well as from family, friends, and work colleagues who interact with them. Attention and information processing deficits can be overcome with training to handle a single task at a time, to perform tasks in environments that are free of distraction when possible, and to take breaks when needed. Speech therapy can help address deficits in language and communication. Memory deficits, which are among the most common and most disruptive of PCS symptoms, are made far more manageable with the use of calendars and day planners to track activities, appointments, and work tasks.
Though cultural concern over the long-lasting memory deficits due to brain injury is relatively recent, awareness of these deficits has been reflected popular culture for many years. In the classic 1976 film Rocky, the long term cognitive deficits of the movie’s protagonist, amateur boxer Rocky Balboa, are evident. Throughout the film, Rocky struggles with word finding and with remembering information such as the combination to his locker at his boxing gym. Interestingly, the film also reflects common coping mechanisms for dealing with memory loss due to persistent PCS. For instance, Rocky writes down his locker combination and keeps it in a note tucked into his hat.
Since 1976, technological advances have developed that can be used to improve the quality of life of those struggling with PCS. As the use of smartphones has become increasingly commonplace, smartphone tools have developed that can serve the functional needs of those suffering with PCS. Smartphones provide a convenient, less cumbersome tool for managing daily tasks because many people keep their smartphones on hand at all times. They can be used in place of standard calendars and planners to document appointments, and, unlike planners, they can remind the user when the appointment is set to occur. They can be used as digital voice recorders at times when it would be otherwise inconvenient to write or type a note, such as while driving. As smartphones are a critical tool for social interaction, they can be used to manage social relationships, and to assist in re-learning social and community integration.
Though the use of smartphones coping tools for PCS-induced cognitive deficits has several advantages, some studies report disadvantages as well. Older demographics that are less familiar with smartphone use may find the devices to be difficult to learn and master. Small print on phone screens can be difficult to see and can cause eye strain, which is a significant flaw for patients whose PCS symptoms include chronic headache and/or migraine. In studies in which subjects were interviewed regarding their use of smartphones as compensatory mechanisms, patients reported concerns of battery life, loss of the device, and an ongoing dependency on the device for success; loss of or damage to the device can be catastrophic for one’s mental well-being and ability to function. Though more studies are needed to determine the full scope of benefits and challenges that accompany the use of smartphones for patients with PCS, it is clear that technological advances have provided more reliable and convenient coping mechanisms than were available to Rocky.