Uncovering insightful information through real life TBI survivor stories.
Posted Dec 30, 2020
Diane Roberts Stoler PhD
Quiet Explosions: Healing the Brain, an award-winning documentary written, directed, and produced by Jerri Sher, uncovers the severe depression and post-traumatic stress disorder (PTSD) of traumatic brain injury (TBI) survivors. Quiet Explosions offers hope and insight into treatment options rarely offered and not widely recognized.
I have both professional and personal experience in the areas of brain injury and brain rehabilitation. Over my 35 years in practice as a neuropsychologist, forensic psychologist, board certified health psychologist, and board certified sports psychologist, I have worked with many professional sports figures and performing artists, along with wounded warriors from combat for both TBI and PTSD. I am also a brain injury survivor. I’ve undergone brain surgery from a stroke and have suffered five concussions. The most recent concussion resulted from an automobile accident in October 2020.
What I am getting at is that I have a deep understanding of brain injury and I found Quiet Explosions timely, brilliant, and inspiring. As you can imagine, I have seen a number of movies or documentaries on the subjects of PTSD and TBI. None have come close to the quality and insight brought to life with actual stories by survivors.
Evaluating and Diagnosing Brain Injury
Although concussion (mTBI) and TBI awareness have increased over the years, it seems the current protocol for evaluating is still somewhat lacking. More often than not, a CT scan and an MRI are the only diagnostics to take place in evaluating a brain injury. While these methods are important to look for a brain bleed as that can be life-threatening, these structural methods won’t show microscopic damage that can account for various and ongoing symptoms.
After the Boston Marathon bomb explosion, I wrote about the impact of a blast injury and how anyone within a quarter-mile radius of the blast likely suffered a concussion. Yet the majority of people were not treated for a concussion (mTBI), but for their physical wounds and for PTSD, and likely only with psychotherapy or medication. Not until this documentary has anyone shown the definitive connection between a brain injury and PTSD. Quiet Explosions also emphasizes the importance of getting the right structural assessments done, as well as functional assessments of the brain for proper diagnosis. This is a very important point and I am so glad this was brought to light in this documentary.
Understanding Brain Tissue and Brain Scanning
Most brain scans focus on “grey matter,” the physical brain structure that does much of the information processing, whereas the “white matter” acts as a communication highway, electrically taking messages to different regions of the human body or mind.
Grey Matter Diagnostic Scans
• CT (Computerized Tomography) scan is the standard of care following a concussion and is one of the lowest-resolution scans of grey matter. It is commonly used because it is relatively cheap and widely available. A CT scan uses many layers of X-rays to show the structure of the brain, detecting obvious brain injury as well as large tumors or hemorrhages. It can miss small issues, so if a doctor wants greater detail and resolution they may decide to have a better scan.
• MRI (Magnetic Resonance Imaging) scan is the next level of detail. The science behind this scan is complex, but essentially it generates a strong magnetic field around the brain and can distinguish different tissue types by how they respond to the field. The MRI measures the same grey matter that the CT scan does, giving doctors an image of the structure of the brain with a bit better detail.
• SWI (Susceptibility Weighted Imaging) is an MRI sequence that is particularly sensitive to compounds that distort the local magnetic field making it helpful in detecting blood products, hemorrhage, and iron storage.
All three of these structural imaging methods provide beneficial information on the “grey matter” of the brain, but they do not look at possible damage to “white matter.” The white matter system can be damaged by any kind of brain injury, but will not appear within a CT, MRI or SWI scan, because those scans are for detecting grey matter.
White Matter Diagnostic Scan
• DTI (Diffusion Tensor Imaging) is an accommodated MRI that observes neuron pathways, the white matter superhighways. With this type of image, doctors can begin to identify areas where the brain’s communication superhighway has been damaged. A DTI is an important part of evaluating and diagnosing a brain injury, yet it is very unlikely to be ordered by a doctor or asked for by the patient since it is not widely known.
In addition to structural methods of evaluating the brain, it extremely important to have functional assessments completed as well. These include neuropsychological assessments, and Quantitative EEG (QEEG) or a Brain SPECT (single-photon emission computed tomography). SPECT is a state-of-the-art brain mapping tool that provides information on areas of the brain that work well, areas of the brain that work too hard, and areas of the brain that may not be functioning well.
The Importance of Proper Evaluation and Treatment
It is a rare person who knows or would ask for a DTI scan, let alone functional assessments. This is why I was thrilled to see how Jerri Sher highlights the SPECT and how it is used to evaluate and treat TBI and PTSD in her documentary. In addition, this documentary highlights various methods of treatment including Hyperbaric Oxygen Therapy (HBOT) and Dr. Gordon’s hormonal therapy, which he pioneered for treating PTSD. While it was enlightening to see Quiet Explosions cover many effective treatments typically not mentioned or offered by most doctors, I wish neurofeedbackwas covered as well. Neurofeedback has been around for over 30 years and is used effectively to treat PTSD, TBI, and PCS (post-concussion syndrome).
Source: Dr. Diane Brain Health
Without proper treatment, ongoing symptoms can lead to depression and suicide, as discussed in Quiet Explosions. I personally was shocked in my own training to discover that twice the amount of soldiers who died in combat in the Vietnam war and were affected by Agent Orange, died of suicide and homicide. It is hard to fathom that twice the amount lost their life to suicide or homicide than in combat.
Quiet Explosions does an excellent job of helping viewers gain a better understanding of the connection between TBI and PTSD and offers hope in an otherwise dark and silent epidemic. Traumatic brain injury (TBI) impacts 2 million people per year from all walks of life. You do not have to be a military veteran or professional athlete to experience its devasting effects. If you or a loved one have been suffered a fall, have been in an accident, or plays sports — or to anyone looking for a better understanding of traumatic brain injury (TBI) and treatment options, I highly recommend this enlightening documentary.
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