A resilient mind promotes healing.
Patients who have enjoyed full health before a mild traumatic brain injury stand an excellent chance of making a complete recovery. A study conducted at Tampere University Hospital in Finland shows that only about one per cent of otherwise healthy patients suffer from long-term symptoms after a mild brain injury. The researchers still hope to discover why the symptoms are prolonged for this small group of patients.
The study, directed by Professor Juha Öhman, gathered a sample of 3,023 patients who had been admitted to Tampere University Hospital as emergency patients after a head trauma. The study followed up these patients, who were aged 18–60 years old and had no significant chronic diseases.
A control group consisted of patients with ankle injuries who also underwent magnetic resonance imaging (MRI) of their brains similarly to the brain trauma patients.
Both groups also participated in a neuropsychological examination at the start of the study. Their recovery has been followed up annually for up to five years after the injury.
“The most obvious finding was that patients recover well from a mild brain injury – practically to full health if the patient had no previous illnesses,” says Docent Teemu Luoto.
“For example, a physically active man in his forties who has neither regular medication nor previously diagnosed illnesses will typically do well after the trauma. Such patients can recover their previous health within weeks or months and go back to work and normal life.”
According to international statistics, up to 20 per cent of patients with mild traumatic brain injury can suffer symptoms for a very long time, even for years. However, in Öhman and Luoto’s study, prolonged symptoms were only suffered by about one per cent of the patients. The difference is explained by the prior good health of the patients included in the data in Tampere.
“Large international studies include all sorts of patients – those who have several different diseases and a lot of elderly people. It is the burden of the other illnesses prior to the mild brain trauma that causes several long term symptoms,” Luoto says.
In Finland, there are about 15,000 brain injuries annually, with 10–20 per cent of the cases being moderate or severe.
Most mild traumatic brain injuries in Finland are caused by minor ground-level falls. Unfortunately, this type of accident often happens under the influence of alcohol.
“In our study, sixty per cent of the patients’ traumas were caused by ground-level falls,” Öhman says.
“This is quite rare in international data. Internationally, the most significant causes of mild brain injuries include traffic accidents, for example.”
In the MRI scans, there were no significant differences in the white matter of the brain between the patients with ankle injuries and the patients with brain traumas. In addition, the scans of latter patients did not reveal any changes caused by the trauma that related to recovery from the injury.
Neuropsychological testing was used in order to determine what symptoms and cognitive changes the patients had, and different indicators were used to describe the patients’ post-traumatic functional ability and quality of life.
Researchers all over the world are looking for a physiological reason why some patients recover from mild traumatic brain injuries better than others. Among other things, new brain scanning methods are expected to aid in this research.
Other factors have been found to affect the patient’s prognosis.
“Patients who can adapt to setbacks, who have resilient personalities, recover better from the injury,” Luoto says.
How people encounter and deal with setbacks is also evident in recovery, as is their propensity to feel anxiety. For example, patients who were visibly anxious and stressed about their injuries in the emergency room suffered from the symptoms longer than those who had a more relaxed attitude.
Text: Pirjo Achté
Photograph: Jonne Renvall