Brain Injury Patient Questionnaire

Personal symptom discovery is key for the brain injury patient, according to Gail L. Denton in her book Brainlash.  Denton created a questionnaire, posted below, to assist patients in recognizing their symptoms in order to accurately address the problems that arise from the injury.  While reading over the questions, try to determine if the problem is post or pre injury.  If the symptom or issue emerged following the injury, then rate each problem on the following scale: Never, Occasionally, Sometimes, Frequently, or Always.

Pain

1.  Do you have more headaches since your injury?  Is the pain in the temples or forehead?
2. Do you have pain in the back of your head?  Does it move forward?
3.  Do you tire more easily, either mentally or physically?  Does the fatigue worsen with pressured thinking or emotional situations?
4.  Are your neck and shoulders beginning to hurt?  Tingling down your arms?  Overall aching feeling?  Overall pain upon waking in the morning?
5.  Are you overly sensitive to light, sound, motion, or intense environments?  Do you have blurred vision?  Does it get worse with fatigue?

Memory

1.  Do you lose or misplace items?
2.  Do you forget what people tell you?  Or what you have said to others?
3.  Do you forget where you parked your car?  Or your current driving destination?
4. Do you forget what you've read?  Or the last TV or radio topic?
5.  Are you having difficulty remembering life details from the past?

Attention and Concentration

1.  Are you having trouble concentrating?  Holding a thought?
2. Do you have difficulty concentrating in noisy or strongly lit environments?
3.  Do you have difficulty concentrating on more than one topic or task at a time?
4. Do you have difficulty focusing your attention while reading or watching TV?
5.  Are you having difficulty staying focused when you are driving?
6.  Do you have difficulty making decisions?  Or remembering what you decided?
7.  Do you drift off in conversation, unable to recall what has been said?
8.  Are you easily distracted?  When interrupted, do you struggle to find your place again or return to your task?
9.  Is it stressful to read and answer this questionnaire?
10.  Have you become impulsive, making decisions or remarks without thinking them through?

Language and Communication

1.  Do you have difficulty following a conversation?
2. Do you have difficulty thinking of the exact word or words you want to use?
3.  Do you have problems expressing yourself in writing?
4.  Is it difficult conversing with others or staying in a conversation?
5. Are you struggling to spell words?  Do you reverse the letters?
6.  Are you pronouncing words correctly?

Visual Perception

1.  Do you have increased sensitivity to light, sound, shopping, party, or large meeting environments?
2.  Do objects seem closer or farther away than they actually are?
3.  When reading, do printed letters appear to change their shape or position on the page?  Are you experiencing eye strain or headaches while reading?
4.  Do you have difficulty focusing your eyes on objects?
5.  Do you feel dizzy or nauseous?  Are you bumping into objects more than usual?
6.  Do your eyes struggle to track written text or follow moving objects?

Executive Function

1.  Do you have difficulty following through with planning for work or leisure activities?  Do you accurately gauge the time a task will take?
2.  Do you have problems setting goals and priorities and keeping to your plan?
3.  Do you have difficulty starting new tasks?  Do you struggle to get in the mood to begin?
4.  Do you have difficulty changing from one task to another?
6.  Are you able to anticipate the consequences of your actions?
7.  Are you checking and rechecking your work?  Does the slightest disruption in your routine derail you?
8.  Are you unintentionally repeating yourself in conversation?

Emotional Function

1.  Have you noticed frequent mood swings or emotional outbursts?
2.  Do you have difficulty handling your anger?
3.  Do you feel depressed?  Are you fearful?  Have you lost hope?
4.  Do you have feelings of anxiety, jumpiness, or nervousness?
5.  Do family and friends comment on changes in your behavior?
6.  Do you have trouble sleeping or a poor appetite?
7.  Have you become gullible?  Easily distracted or unintentionally naive?
9.  Are you easily startled, agitated, or irritated?

Finances and Measurements

1.  Do you have difficulty easily performing simple addition and subtraction?
2.  Can you easily make change at the store?
3.  Do you struggle to balance your checkbook as accurately as before?
4. Do you remember to open your mail, sort it, and pay your bills on time?
5.  Can you follow a recipe easily, or comprehend and follow instructions to assemble or operate something?

Safety

1.  Do you forget to turn off the iron, stove, or other household appliances?
2.  Do you forget to lock the doors to your home?
3.  Do you forget important appointments?
4.  Has your tolerance for alcohol, caffeine, or drugs decreased?

Brain Function Impairment

Brain function impairment is a major symptoms of traumatic brain injury and can be classified according to the site of the injury.

Injury to the left side of the brain may result in the following symptoms:

• Sequencing difficulties
• Impaired logic
• Extreme reactions such as anxiety or depression
• Decreased control over right-sided muscle movements
• Difficulties remembering what was spoken
• Difficulties expressing language or speaking to others
• Difficulties with receptive language or understanding language when others are speaking

Injury to the right side of the brain may result in the following symptoms:

• Difficulties with comprehending the "big picture"
• Decreased control over lef-sided muscle movements
• Difficulties recalling what one has seen
• Decreased awareness of impaired abilities
• Difficulties adapting to one's visual field and space
• Altered creativity or interpretation of music

Injury across the brain may result in the following symptoms:

• Increased confusion
• Delayed thinking
• Decrease in attention and concentration
• Increased fatigue
• Impaired cognitive ability

Brain Injury Diagnostic Test Descriptions

A brain injury patient will often receive numerous diagnostic test to help determine the level of damage that has occurred.  Below the most common diagnostic tests are identified and explained to help make the diagnostic period easier to understand.

Angiogram - This test looks at the blood vessels in the brain.

CT/CAT Scan (Computerized Axial Tomography - The CT scan is typically the first diagnostic test a brain injury patient will receive and is, by definition, a specific type of x-ray, designed to measure the brain's density, that generates an image of the brain.

X-Ray - The X-Ray is used to determine if bones, particularly the skull, are broken or fractured.

Magnetic Resonance Imaging (MRI) - The MRI produces a detailed image of the brain and other internal organs using radio waves and a strong magnetic field.

Electrocardiogram (EKG) - The EKG is used to look at the heart's function and electrical activity.

Neuroimaging - These tests, including the SPECT (single photon emission computerized tomography), the PET (position emission tomography), and the MRI, visually show the brain's activity during various tasks.

Electroencephalogram (EEG) - Used to detect the presence of seizures or decreased brain activity, the EEG measures the brain's electrical activity that is produced by nerve cell activity.

Brain Anatomy Overview

The brain is one of the most complex structures in the human body and, therefore, when the brain is injured  many strange and serious symptoms may occur.  By looking at basic brain anatomy and the functions that each area of the brain control, the symptoms resulting from the brain injury may be explained and understood.  Although an injury may have occurred in a specific area, most brain injuries impact multiple areas of the brain.  The main regions of the brain are the cerebellum, the brain stem, and the cerebrum.

Cerebellum: The cerebellum is located in the hindbrain and controls coordination, voluntary movement and balance.  If injured, the cerebellum may produce symptoms including tremors, involuntary eye movements, poor muscle coordination (also known as ataxia), slurred speech, vertigo, and the inability to make quick movements or to grab objects.  Injury to this area of the brain makes basic tasks very difficult such as walking, eating or talking.

Brainstem: The brainstem connects the brain to the spinal cord and controls necessary survival functions such as heart rate, blood pressure, breathing, digestion, attention, concentration and the ability to be awake and alert.  The brain's twelve cranial nerves are based in the brain stem and run throughout the brain.  Any possible injury to the brainstem must be treated by a doctor immediately to reduce risk of coma, long term symptoms, or even death.  Less severe symptoms resulting from a brainstem injury include insomnia, vertigo, balance and movement problems, perception difficulties, dysphaia, or difficulty breathing.

Frontal Lobe: The frontal lobe is located in the front section of the brain and controls thought processes such as organization, planning, problem solving, selective attention, flexible thinking, mood changes, sequencing, focusing, language expression (also known as Broca's Aphasia when injured) and even personality (located in the prefrontal cortex to be specific).

Occipital Lobe: The occipital lobe is located at the back of the head and is responsible for processing visual information.  Damage to this area most commonly results in visual disturbances such as hallucinations, reading and writing difficulties, and a difficulty with identifying colors, words, movements and objects.

Parietal Lobes: The parietal lobes, also home to the primary sensory cortex, are located in close to the back and top of the skull and control functions such as sensation and the judgement of various sensations.  Damage to the right parietal lobe results in poor navigational skills and the ability to recognize locations and damage to the left parietal lobe results in a diminished ability to comprehend spoken and written languages.

Temporal Lobes: The temporal lobes are located on each side of the brain near the ears and control functions such as the absorption of new information, short-term memory, verbal memory or visual memory.  Damage to these lobes may result in symptoms that include prosopagnosia (or the inability to recognize faces), short-term memory loss, increased aggression, long-term memory loss and a difficulty with categorization and identification.

Welcome to the Traumatic Brain Injury Recovery Blog!

As a traumatic brain injury researcher, survivor, and college intern, I recognize the struggles that TBI patients face when searching for the right treatment and path to recovery.  This search for the right doctor, treatment, medication, and information adds unnecessary stress and exhaustion to the life of a brain injury patient and this blog has been created to ease that stress.

This blog includes information about alternative and conventional treatment options, patient resources such as support groups and additional information, TBI news, and suggestions from your fellow TBI survivors.

In my opinion, I believe the most frustrating aspect of a brain injury is that this condition is invisible to all others.  The memory loss, pain, difficulty with concentration, and all other symptoms are not visible to the world like a broken arm.  The many symptoms transform simple daily tasks into overwhelming burdens, but this reality is only visible to those suffering from brain injury.  This challenge will, however, diminish with time and with the help of treatments that can be used to combat these symptoms.  The symptoms are not permanent, so maintain optimism and strength.

I hope this blog will help to point you in the direction of recovery and can assist you in your search for an effective treatment.