Last summer, my youngest daughter fell at Miller Park during a Brewers' Game and hit the back of her head on the cement steps. She came home with a headache and nausea. She didn’t feel better the next day. In fact she felt confused and dizzy, too. She went to the Emergency Room here at Froedtert & The Medical College of Wisconsin. They scanned her head to look for any bleeding. Fortunately there was none. But they did diagnose her with a Traumatic Brain Injury. This was the first time I realized that a concussion is a traumatic brain injury. She was told she couldn’t work, couldn’t study, couldn’t exercise and couldn’t even think for a week. She was told to sleep or rest. If her symptoms did not improve, she was to come in to the Traumatic Brain Injury (TBI) Clinic in the Neurology Department. I work in the Neurology Department, and I didn’t know we had a TBI Clinic! That was before I met Mary Voegeli, Nurse Practitioner in Physical Medicine and Rehabilitation at Froedtert & The Medical College.
Mary informed me that falls are now the leading cause of Traumatic Brain Injury. Motor Vehicle Accidents moved into the No. 2 slot about 10 years ago as automobile safety improved. Violence is the third leading cause; sports the fourth and military incidents the fifth. Prevention is the only cure.
Mary is passionate about Traumatic Brain Injury. She has worked with people with TBI for 25 years — first at Sacred Heart Rehab and now here at Froedtert. She works with an amazing team. Kathy LaFavor, RN, is the program coordinator;
Mark Klingbeil, MD, is the medical director and the son of
Gerda Klingbeil, MD, who is a pioneer in the field of TBI.
Sara Swanson, PhD, is the interim division chief of neuropsychology. She and several of her faculty members evaluate people with TBI including Drs. Bobholz, Geiger, McCrea and Sabsevitz.
Mike McCrea, PhD, is a nationally known expert on brain injuries, especially those involving military and sports events. He has published numerous books and articles on “post-concussion.” He also conducts research funded by the U.S. Deptartment of Defense looking at the impact of concussion in the military.
Drs. McCrea (left) and Klingbeil review patient information together in the TBI clinic.
TBI can range from a mild concussion to coma. The injuries that result in a bleed, a clot or seizures often must be treated by a neurosurgeon. Sometimes a serious TBI will result in amnesia. The longer the amnesia lasts, the more serious the injury is. Repeated concussions can result in depression and other dramatic mood changes that can end in suicide. Behavior and personality can change and people can appear drunk. Athletes from grade school through professional sports are at great risk for repeated injuries. Dr. Julian Bales from the
Brain Injury Research Institute has performed autopsies on athletes and the effects of head injuries and the findings are distressing. In response to his findings, “Play Smart” was developed and is promoted by the
Brain Injury Alliance of Wisconsin. Play Smart is a statewide health initiative on concussion education and prevention that provides information on the signs and symptoms of concussion and how to respond appropriately. The material is intended for coaches, parents, athletes, volunteer coaches, athletic trainers and more.
Fortunately, over 75 percent of the incidents of TBI are mild and people recover. The difficulty for people on the mild range of the spectrum is that the disability can’t be seen. It’s an invisible injury and truly a silent epidemic. 5.3 million cases are reported each year and many more go unreported. If headaches or trouble focusing on school or work continue, the injured person must be seen by a medical provider. Brain imaging is ordered to rule out a bleed.
The person is treated in the TBI clinic by having a joint visit with Dr. Klingbeil who performs a physical exam including evaluating dizziness and balance and one of the neuropsychologists who tests to assess depression, cognition and concentration. If a brain injury is left untreated it can delay recovery. Fortunately there are some things that can be done:
- Speech and language therapy can assist in improving thinking and concentration
- Vestibular therapy and/or physical therapy offers help with balance and dizziness
- The Otolaryngology Department has a program for tinnitus
- The Neurology Department treats headache with a variety of non-narcotic medications
- Psychiatry/Psychology can work with the patient on depression or anxiety
- Occupational Therapy can access driving ability and develop a program for improving reflexes
As I think about TBI, I am embarrassed about an incident in my family some 20 years ago. At that time, my oldest daughter was a select soccer player. She was a fearless and aggressive competitor. I remember watching her in one game when she went in to head the ball at the same time her opponent had the same idea. Their heads collided and both girls went down. Sara vomited on the sidelines but insisted she was fine. She played the remainder of the game with a concussion. She went home to bed. I remember both my husband and I bragging that Sara was so tough that she had played two quarters with a concussion! I’d like to think that if I had known a concussion was “a traumatic brain injury” that I would have taken her out of the game. We are all beginning to know better; but more education is needed. Dr. McCrea is
conducting a clinic for any/all coaches and trainers on the subject.
From left, Drs. McCrea and Klingbeil, Mary Voegeli, NP, and Julie Janecek, PhD, post-doctoral fellow in neuropsychology.
Mary Voegeli knows that TBI is a family illness. It is difficult to be empathetic regarding a condition they can’t see. There are some unfortunate stereotypes associated with TBI such as the assumption that the patient was doing something bad when this happened or the observation that the person must be drunk when they are simply dizzy and confused. Often the person with TBI becomes uninhibited resulting in inappropriate talk or behavior. At those times teaching the family to use a quiet room and calm approach is helpful. Sometimes ambient noise is very upsetting to the patient. Even the noise in a grocery store can set someone off. Knowing and avoiding those situations keeps life easier.
Sadly, many people with more serious TBI lose friends and relationships. They can become bored and lonely. This can lead to a higher incidence of substance abuse. These situations “break my heart, “ Mary says. She encourages people to attend the
support group facilitated by psychologist Dr. Richard Markell for people with traumatic brain injury and their families. They meet on the 3rd Tuesday of every month from 6 p.m. to 7:15 p.m.
Mary’s hope is that people can return to work, driving, school and sports. Most patients can make progress indefinitely. “I don’t count anybody out!” Knowing Mary, that doesn’t surprise me.