Neurology prof explains why there’s so much variability in recovery from…

Dan Han, PsyD, associate professor of neurology, neurosurgery, and physical medicine and rehabilitation at the UK College of Medicine, spoke recently at the inaugural Horse Industry Safety Summit, in Lexington, UK, about traumatic brain injuries and rehabilitation following TBI. The education is useful for equestrian athletes and combat sports aficionados alike. And in fact, the former suffer a higher rate of TBI than do fighters

Dr. Han was asked why there is so high a degree of variability in recovery from TBI.

I’m often asked why someone is able to bounce back from a comatose state and be Olympic-ready and why some recoveries are much slower, said Dr. Han, as transcribed by Karin Pekarchik for The Horse. For example, William Fox-Pitt [who competed for Great Britain in the Olympics 10 months after a serious head injury] and Jonty Evans [an Irish Olympian who was in a coma for six weeks following a head trauma and had to learn to walk and talk again] had very different recovery times. I have to explain that the injury mechanisms are very different.

One side gets hit, and the brain squishes into the other side. Microscopic tears occur during the injury. The analogy I use is worn fiber. For instance, imagine you see someone wearing a suit. The suit could look fine from a distance, but if the fiber is worn or even torn, you would only see that wear, which is really injury, when you are close up. The integrity of the fiber is affected. That’s brain injury.

There are 1.7 million documented TBIs each year, and TBI is a contributing factor in 30% if all injury-related deaths in U.S. Health professionals have not always helped athletes understand TBI. It is estimated that up to three million TBIs go undocumented each year. Doctors have to correctly recognize the injury and treat it appropriately.

TBI affects kids very differently than adults. With kids, injury occurs during development and interrupts the development. Also, females have higher odds of poor outcomes than males.

Most concussions resolve in 24 or 48 hours, although they can last for two weeks for kids. Post-concussive disorder can last weeks, months, even years. TBI can affect memory and attention deficits. It can affect day-to-day function. Headaches are common; smell and taste loss can occur. The neurologic gauge in the brain for mood and emotional state can get out of whack after the trauma of concussion. TBI is related to quality of life and depression rates, because it interferes with enjoying experiences in life. There is a cumulative psychological toll associated with TBI.

The good news, Han continued, is that recovery can still happen over three years post-injury. There is a ‘Goldilocks’ zone between rest and keeping brain from atrophying. Not doing anything is detrimental to recovery. Using physical therapy, occupational therapy, and speech therapy can help with functional recovery. Other parts of the brain take up the slack, but if you are still symptomatic at one year, that might be your new baseline.

Karin Pekarchik, senior extension associate for distance learning within UK’s Biosystems and Agricultural Engineering Department, served on the planning committee for the Horse Industry Safety Summit.

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