Traumatic Brain Injury

All three of these alarming scenarios could cause traumatic brain injury (TBI). Brain injury is the most common cause of death or disability to people under the age of 40; there are over 2 million head injuries each year. Car accidents are one of the leading causes of brain injury; strokes are also responsible for many. But as illustrated above, any accident which involves the head can result in TBI. The brain is damaged when it knocks against the inside of the skull (as in a car accident), suffers a lack of oxygen (as in a stroke), or is pierced (as by a bullet). 

Brain injuries can be extremely difficult to diagnose because the symptoms and effects can vary widely depending on the individual and the nature of the accident. Often family members, advocates, and survivors themselves do not link changes in behavior and abilities with a head injury. The wide range of symptoms include: Cognitive Deficits, Perceptual Deficits, Speech Deficits, Language Deficits: Social Difficulties, Regulatory Disturbances, Personality Changes, and Traumatic Epilepsy.1 

Often the person suffering the symptoms is the poorest equipped to evaluate his or her condition, and the lack of obvious physical evidence and reliable treatment options can delay diagnosis, frustrating both the survivor and caregivers, who are unable to account for the often extreme and debilitating changes. 

The difficulty in identifying TBI can also significantly impact Social Security disability claims. Hugh Mossman warns: "In many cases, physicians will not spend much time diagnosing organic brain syndrome since it is generally agreed that there is little effective treatment for this problem, regardless of its cause. Many patients are not told that they are suffering from organic brain damage. It is not uncommon for claimants who have this problem to fail to mention it in the Social Security application."2 

Not surprisingly, the problems identifying TBI as the source of disability extend to Social Security's evaluations. According to Mossman, "In many cases, it will be difficult to establish that a claimant meets the listing criteria for organic brain damage or other mental impairments as a result of brain injury. In such cases, the question of disability will probably be decided under an analysis of the claimant's residual functional capacity under Step 5 of the sequential evaluation process....Mental abilities for understanding, remembering, carrying out instructions, and working with others will be considered in assessing residual functional capacity.  Nonexertional limitations do not involve strength demands and include such restrictions as: 

1) difficulty functioning because you are nervous, anxious, or depressed; 
2) difficulty maintaining attention or concentrating; 
3) difficulty understanding or remembering detailed instructions; 
4) difficulty in seeing or hearing; 
5) difficulty tolerating some physical features of certain work settings or 
6) difficulty performing manipulative or postural functions of some work such as reaching, handling, stooping, climbing, crawling or crouching." 

Traumatic Brain Injury is an insidious and extremely debilitating condition which affects many people every year. While there are no fail-safe cures, recognizing the symptoms of TBI is the first step in dealing with its impact. 

1 Excerpted from Family Caregiver Alliance, Fact Sheet: Head Injury. 425 Bush Street, Suite 500, San Francisco, CA 94108. (800) 445-8106. 
2 Hugh Mossman, Esq. Head Injury Workshop. NOSSCR, October 2-5, 1996.

What's Out There?

Family Caregiver Alliance 
(800)445-8106 

FCA, located in San Francisco, offers information, education, and services for families and professionals who care for adults with cognitive disorders including TBI. They have an excellent resource database which they can search for your individual needs. 

Marin Brain Injury Network 
(415)456-4101 

MBIN, in cooperation with College of Marin, sponsors three support groups for survivors of TBI. The groups provide information, emotional support, and social skills rehabilitation. The groups are facilitated by a neuropsychologist and are open to brain-injured adults, 18 to 60 years of age. 

Brain Injury Support Group 
(510)841-4776 

This support group gathers in Oakland twice every month to meet other survivors and share experiences. 

Acquired Brain Injury Program 
(415)561-1005 

This free program, run by the City College of San Francisco, is designed as a "transitional education" program for those individuals making the transition from rehabilitation into the community. 

Programs and Services for Students with Disabilities 
(510)436-2582 

DSPS, at the College of Alameda, offers four special programs for TBI survivors: the Adapted Computer Learning Center, Vocational Living Skills, WorkAbility III and Learning Skills.