Week 1

If there is one lesson I should take away from this first week, it's that there's a constant flow of new information in the medical field. On my first day as a clinical observer, I sat in on what was essentially a book club for doctors. The medical personnel here at the clinic meet on a weekly basis to discuss current research and national medical journals, which allows them to provide the best, most up-to-date care for their patients. That's true dedication. 

In addition to these conferences, I've been shadowing Dr. Zieman and Dr. Cardenas, observing patients with a history of TBI and common treatments used for their injuries. Although the clinic receives patients from very disparate backgrounds, the doctors always ensure that their patients understand the basics about TBI. Therefore, I'll also start off by explaining exactly what the term means. 

A traumatic brain injury is the umbrella term for any damage to the brain caused by trauma that interferes with normal functions. This includes injuries that result from penetration of the skull (i.e. bullet wound), blunt force trauma to the head (i.e. fall), or other bodily impacts that provide enough force to shake the brain within the skull (i.e. car accident). It seems self-explanatory, but there is a more complex classification system in place used to diagnose different types of TBIs. This differentiation can be made based on the initial period of unconsciousness and the Glasgow Coma Scale. The Glasgow Coma Scale is a range from 3 (worst) to 15 (best) that measures patient response to a series of vision, verbal, and motor tests conducted after a TBI. 

The first type of TBI is a mild TBI (mTBI) or a concussion. These patients experience loss of consciousness for less than 30 minutes and have a Glasgow Coma Scale score between 13 and 15. Common symptoms that can occur both at the time of injury or much later include headaches, fatigue, short-term memory loss, visual impairment, inability to concentrate, dizziness, sensitivity to light, nausea, loss of smell or taste, irritability, confusion, sleep disturbances and increased risk of seizures (all humans have at least a 1% chance of having a seizure during their lifetime). Within mild TBIs there are two subsections: complicated and uncomplicated. A mild uncomplicated TBI means that there are no observable structural changes to the brain in a CT scan or MRI, while a mild complicated TBI indicates that bruising, bleeding or other abnormalities are visible on the brain. 

Mild Complicated TBI

The next type, a moderate TBI, involves loss of consciousness for anywhere between 30 minutes to 6 hours and a Glasgow Coma Scale score between 9 and 12. Meanwhile, a severe TBI involves loss of consciousness for more than 6 hours and a Glasgow Coma Scale score between 3 and 8. Symptoms of moderate to severe TBI include but are not limited to persistence of headaches, vomiting, seizures, dilation of pupils, numbness of digits, vision impairment, balance problems and dizziness, loss of hearing or ringing of ears, inability to wake from sleep, profound confusion, memory loss, lack of focus, speech difficulties, diminished sensory receptiveness, and irregular mood changes. Although paralysis, cerebrospinal fluid leakage, and coma can also result from a severe TBI, patients at the BNI Concussion and Brain Injury Center are already undergoing the recovery process so these symptoms are not as common at the clinic. 

Along with the mass of information I've learned about TBIs themselves, I've also witnessed different treatment methods. Patients who complain of headaches or dizziness are prescribed various seizure or pain medications. Over time, these medications or the dosages can change depending on the impact of the medicine on the patient. The doctors usually assess first-time patients by testing their vision, reflexes, hand-eye coordination, and balance. In one case that I observed, the doctor performed a maneuver on a patient complaining of dizziness to "reset" the inner ear crystals that help maintain balance. 

Additionally, the doctors typically work in conjunction with physical therapists, neuropsychologists, and occupational therapists to treat all physical and mental effects of a patient's injury. In relation to my research project, this can be a problem because outpatient therapy requires a follow-up meeting. Patients who are domestic violence survivors tend to be less likely to return for another doctor's evaluation so that their progress can be monitored. This is something I need to consider throughout my research to gain the most reliable statistical data (based only on patients that return for multiple evaluations).