The Rewiring, Part 2: Intro to TBI

Imagine walking up a hill one morning and coming down a different person. That’s what happened to me a couple of years ago when I fainted and hit my head. I acquired a Traumatic Brain Injury (TBI) that affected my senses, equilibrium, emotions, and cognition.

MRI of Diane’s brain, sagittal view.

If you had been in my shoes the morning I fell, you would have brought your dura with you. It’s a liquid-filled sac that surrounds your brain and spinal cord. It maintains an elevated pressure that helps insulate your brain during a fall. Unfortunately for you on this day, your dura wouldn’t be enough.

Imagine your head hitting the deck. Your skull cracks and your sinus gets fractured. But most importantly, your brain suffers a violent jolt: a sudden deceleration from 12 miles per hour to zero. Shock waves ring through the intricate gelatinous structure as it bounces around inside your skull. Millions of tiny fiber-like structures compress, twist, and shear. The damage doesn’t even end there. Your brain immediately responds by swelling, bleeding, and heating up. For weeks afterward, these changes continue to tear at the very substance of your thoughts.

MRI of Diane’s brain, transverse view.

The next thing you know, you’re waking up, face-down on the sidewalk. In the coming days you will find yourself living with a distorted sense of time and a loss of your olfactory neurons. Your emotions will swing uncontrollably from a subterranean landscape of disbelief and doubt to thrilling silver-lined clouds of hope. Random visual illusions will crowd your vision, sometimes amusing and sometimes disturbing. The injured brain can do some really strange things to its inhabitant.

For you, everything has changed. But to those around you, your injury will be invisible. Along with the challenge of recovering from your TBI will be the challenge of trying to communicate about it from your altered inner world.

If this seems like an experience you’d prefer to skip, I would agree with you. Unfortunately, it is not uncommon. It’s likely that you know someone who has had a TBI. The U.S. Department of Health and Human Services estimates that TBIs are involved in over 1.4 million U.S. emergency-room visits annually, far outstripping the number of traffic fatalities. That equates to about 1 in 200 people per year. The number is probably much higher. People like me, who didn’t go to the emergency room, are not included in that statistic.

MRI of Diane’s brain, coronal view.

Luckily, like a torn muscle, the moderately-injured brain can largely recover through rest and exercise. Very soon, your grey matter will begin to rebuild itself. Your mind palace would become a construction zone. Roadblocks will go up, sequestering damaged streets and highways. Crews will look for ways around, rerouting traffic along new footpaths. The paths will become rutted, worn, and eventually paved. This process is called neuroplasticity. The neuroplastic brain can change the mind, which in turn can alter the structure of the brain. Neural damage can’t be undone, but recovery can be profound. For me, neuroplasticity was everything. It gave me hope.

The Exploratorium’s research-and-development environment was a supportive atmosphere for my recovery. With the encouragement of family, friends, and colleagues, I began to see my injury for its phenomenological properties, and came to define my recovery as an investigation. Like an exhibit prototype, my recovering brain became something curious to observe and nurture. Writing this series with Paul helped me gain needed perspective, while I struggled to record my progress.

Please join us as we try to form new connections among the stories and episodes of my brain’s redevelopment.

Go to The Rewiring, Part 3.