It was easy to pick the veterans and military personnel. They were up early, pushing weights in the hotel gym or using sticks to help them walk. What was equally obvious, however, was their keen awareness that an incapacitating injury is about much more than a limp or missing limb.
Recent advances mean the brain is no longer a black box into which can only be interpreted using outmoded Freudian ideas like the id (emotions), super-ego (social awareness), and ego (the conscious self). The old models are rapidly being discarded as we shift to a new comprehension of the specific physical properties of the brain.
We’re still, nevertheless, at the very early stages of this cognitive revelation, as was obvious walking around the stands of people hawking products to conference-goers.
The big problem with a closed-head injury is, of course, that you can’t see what’s wrong. Magnetic Resonance Imagery can provide a hint of where the problem might lie, however this is (normally) only very general in nature and we don’t (yet) have a full detailed map of how the brain actually works.
This hasn’t dissuaded a veritable bank of companies from pushing their wares; pretending technical answers are available that can chart exactly where the physiological problem lies and then use that to predict particular treatments and outcomes.
Some are better than others and all are careful not to claim too much, although that rarely dissuades (wealthy) parents and partners who are desperate to go anything they can for a person they once loved. .
This can lead to the depressing situation detailed by one professor who progressed through a series of drug trials given to comatose or non-responsive patients. Very often, just after it had first been administered, new drugs would prompt physical reactions – eyes opening and hands that could grip.
Families would be ecstatic, finally believing their loved one might recover, Then, often quickly and within a matter of days, the patient would regress to their previous state, all gains washed away.
There are still no answers for people in this situation. The chances of any recovery – certainly to what we consider the intrinsic and critical elements of humanity – seem almost too remote to even consider.
Nonetheless our belief that we will, eventually, find a technical answer perpetuates the cycle of despair as we search new drug after new drug in the desperate hope we may find a cure.
Others at the conference – including a very strong Australian delegation, particularly from the Monash-Epworth Research Centre – focused on other rehabilitation strategies, giving me a new word in the process.
Alexithymia refers to the way we process our emotions, a concept which is central for many with head injuries.
Socialisation is about dealing with others; the way we use external cues to get on with others. Here too treatment is changing dramatically. The idea that animates the NDIS is that everybody should be able to live the best life possible. That requires communicating desires and understanding needs.
When a TBI occurs, such as when the helmet suddenly stops moving and the brain smashes into the skull at however many kilometres an hour, connections that have taken decades to develop are suddenly severed.
They can be re-built, but that takes time and attention. Teaching simple strategies, such as pausing to notice other peoples feelings, understanding your instinctive emotional response to a situation, and allowing individuals to feel able to create different responses can significantly empower people and assist with successful reintegration into society.
Simply equipping people with a TBI so they recognise they can choose different options to respond can open the door to reintegration.
That’s why the US military is throwing so much effort and money at this issue. Great efforts are being made to gather data and information – even dating back to the first Gulf War – to allow this to inform the development of new rehabilitation strategies. Most are equally appropriate for civilians as well.
This is an area where the frontier of knowledge is changing year by year. If we want to keep up government will need to commit more resources to research.
Nic Stuart is a Canberra writer.