Research Question #3
What cognitive, emotional, behavioral, physical, executive, and perceptual motor deficits occurred as a result of TBI?
Pre-TBI.
Twenty-five individuals out of the 30 answered a supplementary series of questions regarding whether or not they had any deficit or problem areas prior to their TBI. They were asked to report whether or not they had cognitive, physical, emotional, or other problems prior to their TBI. Some of the areas assessed included memory, attention, coordination, balance, light sensitivity, and startling. Startling referred to the tendency to physical or emotionally alarm (flinch, fidget, grimace, etc.) at the occurrence of a surprising event. Surprising events could include a sudden, loud noise such as a car backfiring or a book dropping, or could be of a physical nature such as the unanticipated intrusion of another into one’s personal space.
A rating scale consisting of very severe, severe, moderate, mild, and no problem categories was used. Specifically, very severe was equated with “always a problem”, and severe was associated with “frequently a problem”. Moderate was indicated for an “occasional problem”, and mild was to be used to report “seldom a problem”. The format of this section of questions was more difficult than the rest of the survey as the participants had to make judgments along a five-point scale as opposed to merely answering yes or no. This may explain why several people did not attempt this series of questions.
Three did not recall the pre-TBI period either because they had been very young at the time, or because they have few memories of the period. Of the remaining 22 individuals, 14 (67%) reported no problem in any of the named categories. Eighteen percent (4 of 22) reported a mild problem with tiredness or sleep disturbances. Fourteen percent (3 of 22) reported mild problems with memory, crying, and getting going. Nine percent (2 of 22) had mild problems with headache, getting organized, lights, noise, concentration, crowds, startling, nausea, detachment, or anxiety, fearfulness, or uneasiness. Five percent (1 of 22) reported trouble talking, finding words, following a conversation, or grappling with personality changes.
There were still fewer reports of any moderate level problems pre-TBI. Nine percent of the participants (2 of 22) indicated a moderate problem with headaches, memory, getting organized, dizziness or vertigo. Five percent (1 of 22) reported anger, loud noises, detachment, and coordination problems before TBI. One individual who reported many mild or moderate pre-TBI symptoms had had polio as a child.
The only reports of any severe pre-TBI difficulties (with tiredness, balance) and very severe difficulties (with concentration, fearful feelings) came from an adult individual who had sustained an earlier, second TBI when a teenager. Therefore, the data pertaining to this individual was not included in this section because it did not reflect a pre-TBI state.
The most interesting finding of the pre-TBI period was that for most there were no moderate, severe, or very severe problems of any kind. Discounting the multiple TBI case above, 100% of participants reported zero severe or very severe problems in any category. One-hundred percent reported no problem of any severity level with reading. Ninety-two percent (23 of 25) reported no moderate, severe, or very severe problems with lights, concentration, startling, nausea, or with uneasy, fearful, or anxious feelings. Eighty-eight percent (22 of 25) reported no moderate, severe, or very severe problems with crying excessively or getting organized. Eighty-four percent reported no severe or very severe problems with headaches prior to TBI. Eighty-four percent reported no severe or very severe problems getting going or getting angry prior to TBI. In conclusion, there were relatively few problems of any kind reported in the pre-TBI stage.
The first-two-years post-TBI.
Using the same scale discussed above, the participants were asked to rate their problems in the first two years after their TBI. Seventy-seven percent (23 of 30) answered this series of questions. Thirteen percent (4 of 30) provided no data. Ten percent (3 of 30) stated that they had no clear recollection of the period due to their age at the time or because of the nature of their injuries. Occasionally a participating survivor did not answer a particular question within this subset, which also resulted in a no answer classification.
The two most frequently reported very severe problems were with memory trouble (57%) and getting organized (52%). Forty-three percent reported very severe trouble talking or finding words. Thirty-nine percent acknowledged a very severe problem concentrating. Thirty-five percent reported very severe problems with tiredness, reading, or balance.
More evidence that memory, concentration, and word finding or talking problems were substantial areas of difficulty for many survivors during the first two years post-TBI was produced when the very severe and severe categories were combined and these areas were again the most frequently cited. Many survivors also described many other symptoms as being very severe or severe problems during the first two years post injury. See Table 4.
__________________________________________________________________Table 4.
First-Two-Years Post-TBI Combined Very Severe and Severe Ratings
Percentage |
|
79% 69% 65% 61% 61% 52% 48% 48% 47% 47% 44% 40% 39% 39% 34% 30% 30% 26% 26% 26% 21% 13%
|
|
Survivors also disclosed a host of very severe and severe problems under the category of other. Survivors described additional cognitive impairments including difficulty doing logical reasoning and problem-solving. General confusion was also cited. Behavioral or emotional problems mentioned were frustration, impatience, fear of cars and trucks, loss of friends, denial of one’s own TBI or deficit areas, isolating behaviors (becoming a recluse), and loss of self-esteem. Physical gross or fine-motor problems named included inability to walk or to write. Particular individuals also reported slower reflexes, slower reaction time, and a tendency toward clumsiness.
Additional perceptual-motor impairments elicited were extra acute hearing and double vision. One person also identified a moderate problem with squinting and blinking.
Some categories produced substantial zero problem ratings. Forty-eight percent never had a problem with nausea. Forty-three percent never had problems with bright lights. Thirty-five percent reported no excessive crying or the tendency to startle. Thirty percent had no trouble with loud noises, and 26% were never dizzy or light-headed. But, for every person who reported absolutely no degree of problem in these areas, there were many other individuals who did report some degree of problems. Many of these symptoms were rarely reported in the literature except as short-term or PCS symptoms. Here, survivors acknowledged moderate to very severe problems as follows:
53% Noise sensitivity
48% Crying excessively
47% Startling
43% Light sensitivity
39% Dizziness, light-headedness, spinning sensations, or vertigo
21% Nausea
There were also mild ratings from 4% to 22% in the above categories. Standing alone a mild problem could possibly be tolerable for some; however, it should be remembered that these symptoms are generally reported within a large constellation of problem areas. The combined onslaught of problems of varying degrees can be quite devastating.
Some individuals clearly sensed personality changes. Thirty percent reported a very severe problem, yet a corresponding 26% reported no changes. The ratings for uneasy, fearful, or anxious feelings after TBI were not conclusive in any direction partially because 39% did not address the question. Three individuals placed a question mark by this question, perhaps indicating that they did not associate negative feelings with their post-TBI situation.
A related question as to whether or not survivors had uneasy, anxious, or fearful feelings when in a situation reminiscent of their TBI was answered by 82%. Problems with TBI reminiscent situations were reported as follows:
Very Severe 22%
Severe 17%
Mild or Moderate 13%
No Problem 30%
One person, who had been in a car accident, mentioned now being afraid of cars, buses, and trucks.
The difference between pre-TBI and post-TBI was most dramatic in the category of reading. No reading problems had been reported in the pre-TBI period, but in the post-TBI period 61% (14 of 23) reported either a very severe or severe problem.
At Present.
All participants at least two years post-TBI rated their current array of TBI-related problems, utilizing the same five point scale used to rate the pre-TBI and first-two-years post-TBI periods. The present period post-TBI ranged from plus-two years to many years.
The most interesting finding was that there were fewer very severe ratings. The only very severe ratings over 10% were memory problems at 21% (5 of 24), getting organized at 17% (4 of 24), getting going at 17% (4 of 24), off-balance at 13% (3 of 24), and coordination difficulties at 13% (3 of 24).
Severe ratings were also greatly reduced from the first-two-years post-TBI. No percentages in the severe category exceeded 30%. Trouble being in crowds rated a 29% (7 out of 24). Twenty-one percent (5 of 24) cited difficulty concentrating and also trouble reading.
When very severe and severe ratings were combined, as in the first-two-years post-TBI period, memory, concentration, and talking or finding words, continued to be substantial problem areas for many. But, the number of reports of problems in the very severe and severe range had dropped off. See Table 5.
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Table 5.
Comparison of First-Two-Years Post-TBI and At-Present Time Periods Combined Very Severe and Severe Scores.
Percentage of Participants Reporting Difficulties |
Problem Areas |
First-Two-Years Post-TBI
|
At-Present |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Memory | 79% |
42% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Concentration | 69% |
25% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Talking or finding words | 65% |
12% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Reading | 61% |
25% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tiredness | 61% |
8% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Getting organized | 61% |
34% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Being in crowds | 52% |
29% |
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| Anger | 48% |
13% |
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| Following conversations | 48% |
17% |
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| Getting going | 47% |
21% |
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| Coordination | 47% |
34% |
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| Balance | 44% |
21% |
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| Detachment | 40% |
12% |
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| Sleep disruptions or disturbances | 40% |
8% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Uneasy or fearful feelings in TBI reminiscent situations | 39% |
12% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trouble with loud noises | 39% |
8% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Difficulty with bright lights | 34% |
8% |
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| Startling | 30% |
8% |
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| Personality changes | 30% |
12% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dizziness, light-headedness, spinning sensations, or vertigo | 26% |
4% |
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| Headaches | 26% |
12% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Crying excessively | 26% |
4% |
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| Nausea | 21% |
0% |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Uneasy, anxious, or fearful feelings | 13% |
4% |
Although very severe and severe ratings lessened in all categories, many individuals continued to report moderate or mild problems. See Table 6.
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Table 6.
Mild and Moderate Combined Ratings in the At-Present Time Frame
| Problems | Percentage of Participants Reporting Difficulties |
| Tiredness | 59% |
| Talking or finding words | 50% |
| Loud noises | 46% |
| Concentration | 46% |
| Sleep disruptions or disturbances | 42% |
| Anger | 42% |
| Getting going | 42% |
| Getting organized | 38% |
| Memory trouble | 37% |
| Trouble reading | 34% |
| Bright lights | 30% |
| Balance | 30% |
| Uneasy, fearful in TBI reminiscent situation | 30% |
| Dizziness, light-headnedness, spinning sensations, or vertigo | 26% |
| Startling easily | 26% |
| Following converstaion | 25% |
| Nausea | 25% |
| Detached feelings from others or the world | 25% |
| Coordination | 25% |
| Headaches | 25% |
| Being in crowds | 21% |
| Personality changes | 17% |
| Uneasy, anxious, or fearful feelings | 17% |
| Crying excessively | 17% |
There was an increase in percentages reporting no problem in the present period compared to the first-two-year period. This indicted that sometimes assorted problems tended to be revolved over time. For example, in the first-two-year period, 35% had no problem with excessive crying, but by the present, 75% had no problem. Table 7 reports the categories showing the greatest increases in no problem ratings from the first-two-year period to the present period.
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Table 7.
Comparison of Zero Problem Severity Ratings in the First-Two-Year-Period and
the At-Present Time Period
Percentage Reporting No Problem |
Symptom
|
First-Two-Years Post-TBI |
At-Present |
| Crying excessively | 35% |
75% |
| Feeling detached from the world or others | 22% |
58% |
| Following a conversation | 23% |
54% |
| Feeling uneasy, anxious, or fearful | 17% |
46% |
| Startling easily | 35% |
63% |
| Anger | 17% |
42% |
| Reading | 13% |
38% |
| Feeling uneasy, anxious, or fearful in TBI-reminiscent situation | 30% |
54% |
| Dizziness, lightheadedness, spinning sensations, or vertigo | 26% |
50% |
| Crowds | 22% |
46% |
| Nausea | 48% |
71% |
| Headache | 35% |
58% |
Lastly, individuals continued to report other problems in the at-present time period, but the number was greatly reduced from the first-two-year post-TBI period, especially in the very severe category. Individuals continued to mention problems with inability or difficulty walking or writing. Some individuals also cited slower reaction time or impatience. One participant spoke of having motion sickness when driving or being a passenger in a car.