TBI – Updated

October 8, 2014 Westborough, MA  F1 race car driver Michael Schumacher was released from a rehabilitation hospital in Geneva, Switzerland and is now home recovering from the catastrophic brain injury he sustained in December 2013.  He is conscious but does not speak or move about.  He requires 24 hour medical care and is living is a special suite adapted in his home that allows him to continue to receive the best care possible while being in his familiar setting surrounded by family and friends.  The cost of his care exceeds $ 100,000 per month.

This is the sad example of the devastating impact of traumatic brain injury on both individuals and their families.  And the costs associated with its care.  Thousands of Formula 1 racing fans visit the Facebook page of Michael Schumacher monthly to hopefully learn of his recovery.  Only this week was it published that Schumacher is unlikely to ever drive again.

“TBI is a preventable affliction and prevention starts with awareness and learned caution about the possible impact of taking risks and pushing the envelope of one’s ability” according to Michael Sefton, Ph.D. Director of Neuropsychology at Whittier Rehabilitation Hospital in Massachusetts.  Schumacher’s injuries are likely going to result in permanent brain damage making it unlikely that he will live independently.  At a cost of over 1 million dollars annually even the more affluent patient will need help paying for the costs associated with the catastrophic disability caused by trauma to the brain.

Behavior change and growing awareness after TBI

WESTBOROUGH, MA March 4, 2014 The recovery from TBI is a long and arduous one often taking years.  Family members experience the up and down emotions like no other form of illness save the treatment for cancer. Recovery will take years in many cases such as that of Michael Schumacher. No one is immune from the impact of traumatic brain injury.  Early this winter race care drive Michael Schumacher became critically injured in  a ski accident while he and his son were on the slopes in France.  

As of today Schumacher is still hospitalized and he remains in an unconscious state.  He is fighting to regain his functioning and is only beginning his journey.  Schumacher has a long way to come and sadly, may yet succumb to his severe brain injury from a host of possible causes like infection, post traumatic seizure, autonomic storming, and even recurrent swelling.  Or he may dwell in a persistent near-conscious state forever.  No one can say for certain but the longer he remains in an unconscious state the less likely it is that he will regain full function.  It is likely that he will never drive again and that Michael Schumacher will never be the same.  If he is able to regain consciousness his re-entry into the world will be tenuous.

Awareness of deficits after brain injury

Traumatic brain injury is a social contagion.  It affects patients and their families immeasurably by altering the normal trajectory of development.  Since Michael Schumacher’s accident thousands of unnamed people have become injured – even killed around the world because of traumatic brain injury.  These nameless people must slowly regain their awareness as they slowly emerge from the injury’s grip.  This is a slow and grevious process amplified by a tendency to under estimate the injuries with which they clearly struggle.  “This lack of awareness becomes the disconnect between family and survivor” according to Michael Sefton, Ph.D.  Deficits in awareness has a direct impact of success of recovery from rehabilitation brain injury according to an article by Dirette and Plaisier in 2007.  They describe awareness as an accurate or not accurate appraisal of one’s cognitive capacity and “accurately recognize problems caused by their injuries” (2007).  The conflict that grows can marginalize the survivor and leave him at risk for social problems like drug and alcohol abuse.  Arguably, one’s awareness of his deficits comes as a process of grief, anger, and finally acceptance – especially when one’s personal self appraisal differs greatly from that of supportive family members, according to Sefton.

Meanwhile, George Prigatano, Ph.D. has a marvelous chapter on the stages of awareness including 2 concepts highlighting emergent and anticipatory awareness. Ostensibly, these describe differing levels of insight and self-monitoring often marred by the impact of brain injury.

Dirette, D.K. & Plaisier, B.R. Brain  Injury. (2007) 21, (11), 1131-1136

Prigitano, G. Acta Neurochir Suppl. 2005;93:39-42