“Brain injury” is a term with both a literal meaning and societally-held connotation. Literally, it’s an injury to the brain. But generally speaking, it connotes the idea of skull damage, such as a bullet penetrating the brain or a car fracturing the skull, and loss of consciousness or coma. Despite media coverage of sports-related concussions, we still equate outward signs with inward intensity of injury.
That’s why I titled my 2012 and 2017 memoirs Concussion Is Brain Injury — and why this blog is called that: to make it known that concussion causes brain injury, concussion is brain injury, and concussion can cause untold catastrophe to one’s cognitive, physical, emotional, psychological, and spiritual selves.
Despite football in the U.S. and hockey in Canada raising the profile of how concussion damages players’ brains, concussion is still seen as a go-home-and-rest kind of condition. Yet the kinetic energy that’s transferred from a moving object — a body, a fist, a car, a hockey puck or a football helmet — to the target’s body and head also gets transferred to the brain.
Kinetic energy is the amount of energy that a body stores up inside itself from motion. The greater the motion, or velocity of an object, the greater the kinetic energy, and the greater the resulting concussive force on the brain when its kinetic energy, or the kinetic energy transferred to it, is suddenly stopped. When objects such as a seatbelt, the ground, or hockey rink boards stop the body, they also stop the skull, but the brain keeps moving slightly longer within its cushion of cerebrospinal fluid until it hits the rough inside of the skull. A car moving at speed will have more kinetic energy to transfer into the stationary car it hits and its occupants than a fist on a jaw. Yet both will transfer their kinetic energy to the brain, and in both cases, the rough inside skull will stop the brain’s motion, perhaps tearing neurons and blood vessels or shearing them. But since we cannot see this process happening, cannot see the brain shredded, bruised, or bleeding, concussion remains seen as a minor issue.
How much less, then, is domestic violence’s impact on victims’ brains considered brain injury? On October 19, 2022, Statistics Canada released its latest report on family (domestic) violence, which stated:
“There were 127,082 victims of police-reported family violence (violence committed by spouses, parents, children, siblings and extended family members) in 2021, a rate of 336 victims per 100,000 population. This marked the fifth consecutive year of increase. Women and girls represented two-thirds (69%) of family violence victims. The rate of family violence was more than two times higher for women and girls than for men and boys (457 victims versus 212 per 100,000 population).”
Taking just those numbers, that’s a staggering number of Canadians who’ve experienced violence. In 2019, Statistics Canada also surveyed self-reported intimate partner and spousal violence. Their questions included:
Has your current or former spouse or partner done any of the following?:
- Threatened to hit you with their fist or anything else that could have hurt you
- Thrown anything at you that could have hurt you
- Pushed, grabbed or shoved you in a way that could have hurt you
- Slapped you
- Kicked you, bit you or hit you with their fist
- Hit you with something that could have hurt you
- Beaten you
- Choked you
All of these situations can include potential for brain damage. Emergency staff may see the bruising, but without a qEEG, they won’t see the concussive forces' effects on the brain. Support staff may see violent outbursts or a person shut down, the outward signs of brain trauma, but ascribe them to something else. From Emergency Medicine News on this subject:
“Your patient presents to the ED with a broken wrist. She says she tripped and landed on it. You take a history, conduct a physical examination, and prepare to send her for x-rays, but she seems agitated and a little confused and doesn't answer your questions directly. She squints at the bright lights of the ED and complains of a headache. Is this woman intoxicated or on drugs?”
Catherine Fortier, an assistant professor of psychiatry at Harvard and the deputy director of the VA Translational Research Center for TBI and Stress Disorders (TRACTS), was quoted in Emergency Medicine News' December 2022 Special Report on "The Often-Missed Result of Intimate Partner Violence" as saying that 94% of women experience blows to the head, neck, or face. Each of these can cause a concussion. Just like an ankle that is sprained over and over becomes weak and doesn’t heal fully anymore, repeated over time, blows will build up damage and weaken the brain’s function.
Confusion, agitation, avoidance, and appearing shut down suddenly look different when we shift our perspective from assuming drunk or depressed to potential brain damage. Unfortunately, advice on how to make such an assessment remains in the realm of asking questions. We wouldn’t assess heart damage through questions alone. Isn’t it time that we include qEEG and evoke potentials testing as part of emergency medicine’s standard diagnostic tools for anyone who’s experienced kinetic forces to the head, whether from a car crash or domestic violence? We don’t hesitate to use ECG to diagnose heart trouble, so why do we not even think about using qEEG, a similarly non-invasive, objective test for the brain?
Copyright ©2022 Shireen Anne Jeejeebhoy
Shaw, Gina. (Dec 2022). Special Report. The Often-Missed Result of Intimate Partner Violence. Emergency Medicine News 44(12):p 1,20-21, December 2022. | DOI: 10.1097/01.EEM.0000904600.57776.b2