How the Human Brain Responds to Trauma
BY CHARLES SPENCER
Suddenly the brain is big news.
News articles analyze brain injuries to Rep. Gabrielle Giffords and ABC’s Bob Woodruff. And concussions—formerly an annoyance athletes routinely ignored once their heads cleared enough for them to get back in the game—are being taken more seriously.
That’s good news to Bryan Fantie, a professor of psychology at American University and director of the Human Neuropsychology Laboratory. Fantie is also the founding director of AU’s behavioral neuroscience doctoral program.
Male, Female Brains Differ
Fantie is encouraged by reports that Giffords, who was shot in the head during a political event in Tucson, Arizona, is talking and positive. But her luckiest break in terms of prognosis may be her gender.
“We’ve known for years that a woman who has an equivalent amount of brain damage to a man would be more likely to recover with fewer problems because of the organization of her brain,” Fantie said. “She would show less aphasia, so her language problems would be less than the man’s. If she had motor problems, they would be less than the man’s. So women recover in general from equivalent brain damage better than men.”
The reason: For the typical right-handed male, the language center for the brain lies in the left hemisphere. Women, though, generally have language centers in both sides of the brain. So their prognosis for recovery is better. And because they are less likely to, say, address a midlife crisis by cranking up a shiny new Harley, women also suffer far fewer severe brain injuries than men.
TBI Affects Millions
In the United States, 1.7 million children and adults annually sustain traumatic brain injury (TBI) and another 795,000 suffer a brain injury from a non-traumatic cause, according to the Centers for Disease Control and Prevention. More than 3.1 million U.S. children and adults have a lifelong disability caused by TBI. And an additional 6.4 million have a disability related to stroke.
Those kind of numbers concern researchers like Fantie, who first entered the field of brain injury research with extensive laboratory and clinical training in Canada. Fantie came to the United States for a postdoctoral fellowship at the National Rehabilitation Hospital in Washington, D.C., and later worked as a research neuropsychologist at the National Institute of Mental Health’s Laboratory of Psychology and Psychopathology, which became the Section on Clinical and Experimental Neuropsychology.
Survivors Are Changed
So cases such as Bob Woodruff’s, the ABC newsman who sustained severe head wounds when an improvised explosive device detonated near him in Iraq, are in some ways quite familiar to him. Woodruff’s wife, Lee Woodruff, has written about her husband’s impressive recovery from the explosion: “Regardless of how miraculous a recovery may be, no one is the exact same person afterward,” she wrote. “While I’m thrilled when people say, ‘You’d never know Bob had been injured,’ he can tell you how he’s changed and what he does to compensate.”
It’s a result Fantie knows all too well. A head-injury patient is treated, checks out on memory tests, recovers speech, and is declared cured. Three months later, the patient’s spouse is back in the office asking, “Who is this person?” The supposedly cured patient can function normally in the workaday world, but there have been subtle changes that close family members immediately notice. Fantie used to call the phenomenon The Invasion of the Body Snatchers.
What Change Looks Like
These patients’ personal lives often experience other strains as well. People with head injuries are much more likely to divorce and subsequently to have trouble sustaining relationships than average.
Complicating this is the problem that people with brain injuries sometimes don’t show emotion the way they used to, which can be unsettling to family members.
“When I looked at him he had that kind of look, that flattened affect,” Fantie said of seeing Woodruff in a TV interview. “That’s not to say he’s feeling flattened affect. People with Parkinson’s [show this characteristic]. They can be feeling emotions quite deeply but they don’t show it. That’s part of the problem with emotion research. People have confounded the subjective experience of emotion. What you’re feeling is not necessarily what you look like you’re feeling.”
Even so, Fantie is optimistic in Woodruff’s case.
Social Network Is Key
“The best predictor of outcome, of prognosis, is your social network regardless of the severity of your injury,” he said.
Why that’s true he doesn’t know. It’s a subject he and an AU colleague want to study.
Last week, another category of brain injury made the news when bills to improve football helmet safety were being debated. Helmet safety standards, overseen by a volunteer trade association composed of doctors and sporting goods industry reps, have remained essentially unchanged since 1973, according to a report.
At least 1.6 million sports-and-recreation-related concussions occur annually in the United States, notes the Brain Injury Association. The five leading sports activities that lead to concussions for victims from 5 to 18 years old are bicycling, football, basketball, playground activities, and soccer.
Microscopic changes in the brain can add up to big problems, which is why apparently less-severe but repeated trauma can spell trouble.
“If you look at adolescent-to-high-school-age kids, do you know what group has the most head injuries and what sport? And do you think it’s girls or boys?” Fantie asks, springing an impromptu quiz on mild-to-moderate head injuries.
“It’s girls. And the sport?”
The guess would have been football, but that’s out.
“It’s equestrian, it’s riding horses. The girls fall off and hit their heads and they wear those funny little helmets that are very pretty but they don’t do very much good when you fall and hit your head on the ground. Especially a little girl falling off a huge horse.”
Recovery Is Unpredictable
Which gets to what has fascinated Fantie about brain-injury research from the beginning: the sheer complexity of the problems and the unpredictability of recovery. He has seen people with horrendous wounds—bullets passing all the way through their skulls, others thrown through windshields in auto accidents and lapsing into comas—and somehow these people not only survived but went on to live exceptional lives.
“You can have people who lose consciousness and their brains are totally fine,” he said. “And then you can have people who never lose consciousness and their brains are totally messed up.”
There is no perfect predictor of outcome. And that’s what makes it interesting.