Terminology Lesson: Symptoms

I remember being acutely unaware of post traumatic brain injury symptoms during Jason’s few months. Literally months where I wasn’t clear on what I was looking at. Doctors and friends would often tell me that what I thought were symptoms were actually my unfulfilled dreams of being a controlling wife.

Okay, they never used those words, more like “Husbands are just like that”. Because getting married would obviously change my husband more than his traumatic brain injury.

So here’s my list of symptoms that I wish I knew then. This may not be a complete list, but just the symptoms that were more relevant to Jason’s injuries. They are not listed in any order specifically.

  • Headaches, pressure in his head
  • Dizziness
  • Choking on some foods -also diagnosed as dysphagia
  • Inattention – when stimulus overwhelmed him physical symptoms (such as the choking) would increase
  • Sequencing issues – trouble deciding what order to do tasks at work or while cooking dinner etc.
  • Initiation – failure to start tasks without being asked/ordered
  • Due to initiation and sequencing issues needing to stay on a strict schedule
  • Cognitive fatigue
  • Taking longer than pre TBI to complete tasks
  • Preservation -the repeating of one activity
  • Fixating on certain tasks or activity
  • Concentration issues
  • Self awareness impairments (which makes monitoring these symptoms the duty of the spouse or support person)
  • Emotionally labile – some breakdowns, crying, anger, especially when cognitive fatigue kicks in
  • Difficulty making decisions
  • Difficulty seeing the outcomes of his decisions
  • Lying
  • Time management issues
  • Memory loss
  • Mild aphasia. Aphasia has a variety of sub categories as listed by the National Aphasia Association http://www.aphasia.org/aphasia-definitions/
  • Difficulty with change of plans
  • Lateral thinking limitations
  • Interrupting during conversations

Terminology Lesson

Who the heck am I speaking with? (in alphabetical order)

Ear, Nose and Throat Doctor – If you have headaches that are similar to sinus aches or tinnitus you may be referred to an ENT doctor to assess if anything other than the brain injury is contributing.

Family physician – In Canada family physicians are governed by their provincial college such as the College of Physicians and Surgeons of Ontario (http://www.cpso.on.ca/About-Us). In our experience this will be the person that makes the majority of your referrals and fills out paperwork for insurance, lawyers etc. It is essential that you trust your family physician and that they have some understanding of the new research out about brain injuries. In another post I will discuss our experience with changing doctors in Ontario which may be necessary if your doctor is unwilling to work with you.

Neurologist – A doctor that specializes in neurological conditions but does not do surgical procedures. They can work with a wide variety of conditions such as dystonia, multiple sclerosis and brain injuries.Most often your family physician will need to refer you to a neurologist as they are not a front line healthcare professional.

Neuropsychologist– A psychologist that focuses on cognitive skills such as memory, planning, comprehension. From our understanding they should be involved in any situation where the TBI survivor wants to return to work as they will be able to give a full write up about cognitive difficulties.

Neuropsychometrist – Works closely with the neuropsychologist and administers the testing for cognitive skills.

Neuropsychiatrist – A psychiatrist with a specialty in behaviour and mood that can analyze their effects on the neurological conditions. Because they are doctors they are able to prescribe medications if they are warranted.

Neurosurgeon – This is a surgeon that specializes in surgery for the brain or spine. With regards to brain injuries they may be called into your case if you have areas of bleeding in the brain. In Jason’s case the neurosurgeon simply monitored his bleeds and provided a follow up. In other cases with more severe bleeds they would operate. Once the physical bleed is resolved it is common to be referred to another health professional.

Nurses – Nurses in a doctor’s office or hospital will often be responsible for your day to day care, checking symptoms and vitals. In some situation a nurse may be sent to visit you at home to change bandages, check symptoms or assist with any medical concerns. Home visits will often be organized by groups such as the Common Association for Community Care (http://www.cacc-acssc.com/)

Nurse Practitioner – Nurse practitioners are nurses that have done extended training to offer more in depth care to their patients. They are able to write some prescriptions as well as make referrals to physicians and specialists in Ontario. (http://npao.org/resources/find-a-nurse-practitioner/#.VYv_ZflViko)

Occupational Therapist- In Canada they are a federally registered health profession (https://www.caot.ca/) . Occupational therapists help return to your lifestyle – they can offer solutions to make your house safer (handrails, canes or braces etc), accommodations at work (modified work schedule recommendations, ergonomic assessment) and information on how to regain your life (sleep, exercise and balance guidance). Some specialize in cognitive skills which can be very helpful post traumatic brain injury.

Personal support worker (PSW) – These individuals may come into your home to assist with daily activities and your personal hygiene as well as to provide comfort and company post TBI. In Canada they are often found through organizations like CACC.

Physiatrist – Often described as a rehab doctor, physiatrists work at restoring function to those that are injured, In our experience the physiatrist did Jason’s rehab intake assessment and then coordinated his therapies and rehab experience.

Physiotherapist – Physiotherapists help individuals regain range of motion, balance and mobility. They can be seen without a referral and some specialize in vestibular physiotherapy which can be helpful post TBI. http://www.collegept.org/Home

Psychiatrist – Physicians that can diagnose and treat mental health conditions.

Psychologist – Professionals that deal with behaviour and coping skills but are not physicians and therefore cannot prescribe medications.

Radiologist – These are the people that read and interpret your CT and MRI results. They write the reports that get sent to your doctor.

Social worker – Often encountered in a rehab setting the social worker may help the family as a whole discuss the changes post TBI and learn how to cope. They may also assist with discharge plans and finding community referrals.

Speech and Language Pathologist -These individuals often work in rehab settings and assess those with traumatic brain injuries for language problems such as aphasia (loss of words) or speech problems with enunciation etc. They can also help with swallowing difficulties that may occur post TBI.