Dr. Dan Engle, board-certified in adult psychology and neurology, and who completed psychiatric fellowships in child, adolescent and forensic psychiatry, has written an indispensable guide to recovering from traumatic brain injury (TBI), “The Concussion Repair Manual: A Practical Guide to Recovering From Traumatic Brain Injuries.”

TBI is incredibly pervasive. An estimated 80 to 90 percent of people have had some form of TBI. Military personnel and athletes such as football players and boxers tend to be at particularly high risk, but TBI can happen to anyone, for a range of reasons. Engle has had personal experience with it, which is what motivated him to pursue this discipline of medicine and write a book about it. 

“I went to college to play soccer … Boxers … who get slugged in the face — that’s about 20 pounds of pressure to their brain. Soccer players, if you go in for a full volley or a full header, take 70 pounds of pressure to the brain … I had a series of concussions that led up to me choosing medical school,” he says. 

“Two weeks before medical school, I broke my neck. That was a big entry point in a recalibration of my direction … I started [medical school] in a Halo Device, where they screw it into your skull and you’re walking around fixated. For the first three months of med school, I was in this Halo. It was the first thing that finally slowed me down. It helped me self-reflect. It helped me realize that I was driving at a level of intensity in my life that I didn’t really enjoy. 

I ended up having much more fun in med school and residency than I did in high school and college, just because I wasn’t so intense with everything. It oriented me from ER and surgical medicine into neurology and psychiatry. [My focus] was … the neuroreparative aspects of brain injury and spinal cord injury, as well as the more humanistic side of understanding people, the stories of what make us who we are and the mindset of healing, and how very [important] that is to recovery.”

TBIs Are Incredibly Pervasive, Yet Many Fail to Get Proper Rehabilitation 

A common myth is that unless you’ve suffered complete loss of consciousness, you didn’t have a concussion or significant head injury, but this simply isn’t true, Engle says. Generally speaking, a concussion is a mild TBI, and will score higher on assessment using the Glasgow Coma Scale (a scoring system that grades your level of consciousness after a TBI). More severe TBIs that are moderate or severe will respectively score lower. 

An estimated 4 million to 6 million people are on disability due to chronic severe conditions resulting from their TBI, but many more have undocumented TBIs — be it from a car accident, slip and fall incident or simply hitting your head on a cabinet. Most of these injuries are mild and heal on their own, but even mild TBI can have lingering effects that can become chronic unless you address them. 

“Most people, if they just hit their head on the door or cabinet, it’s not going to be enough to have a significant neurological sequela moving forward, but sometimes, it will. Oftentimes, the thing that happens in the home that will have negative long-term impacts is a fall. 

If you slip on a rug or slip going down the stairs, there’s a significant momentum that jostles the brain inside the skull to what’s called a coup contrecoup injury, or back-and-forth kind of injury. That’s going to be noticeable,” he says.

Telltale Signs of TBI

Oftentimes the injury doesn’t seem severe enough to have caused TBI, which is why telltale signs are often overlooked — things like poor concentration, mood changes or changes in your ability to focus and follow through on mental tasks. Word recall may also suffer. Emotional dysregulation, irritability, foggy thinking and sleep problems are also common effects. 

Whenever you experience an injury to your head, regardless of how severe it appears to be, pay careful attention to any psychological changes that might occur over the coming week or two. Signs such as those just mentioned are indications that your nervous system is on high alert due to an inflammatory cascade, which presents itself as psychological and cognitive downstream effects.

“The old adage, ‘Go home and rest. It’ll be OK,’ has some merit,” Engle says. “But when I had my concussions — the last of which was after I broke my neck … — I knew something was off because I had problems with attention, focus, concentration, memory, sleep, kind of like the classic post-concussive syndrome … 

This was 20 years ago. We didn’t really have appreciable technologies and therapeutics to heal it. I put myself in the lab. It was not fine for me that things were going to continue to be subpar. I wanted to try everything out … The things that worked for me or had worked significantly for friends, family and clients are the things that I ended up putting in the manual … 

Some people will experience hypersomnolence, particularly in the acute concussion phase, because the system needs to go into a quiet mode, convalesce and rest … So, get into a low stimulation environment. Being away from electronic stimulation, stressful work, stressful engagements at home; being able to really bring the energy home or rest the nervous system [is important].”

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