After brain injury, a silent struggle to start over

EDISON, N.J. - Without the calendar taped to the refrigerator in her parents’ kitchen, Kim Valentini wouldn’t know where her dad was. It’s not that he travels far or even that he’s hard to reach. It’s because she can’t remember from hour to hour — sometimes minute to minute — where he’s told her he’ll be.

Before she started inscribing his answers on the kitchen calendar, the 36-year-old New Jersey woman would find herself calling as many as seven times in a single afternoon to ask the same question: “Where are you, Daddy?”

Eleven years after a devastating car wreck, Valentini still lives with a brain injury that’s left her short-term memory spotty while whole sections of her long-term memory seem to have been erased.

She remembers she once worked as a contract administrator, but she can’t recall exactly what she did in her job. She remembers she used to like to ski and to dance, but she can’t recall why she liked to do either. She remembers an “old Kim” who was successful and confident, with a foolproof memory and a quick mind — but she can’t recall how to be that person now. She remembers that there was a car accident, but can’t recall the details of the night when, she says, “the old Kim died.”

Valentini's car crash contributed to some sobering statistics. More than 5.3 million people in the United States are living with long-term disabilities because of traumatic brain injury, or TBI, according to the Centers for Disease Control and Prevention. Each year at least 1.4 million Americans suffer a TBI — more than are struck by heart attacks.

'Silent epidemic'
Experts call it “the silent epidemic,” in part because the official numbers most likely underestimate the size of the problem. A TBI can do significant damage without leaving any visible signs, so the initial injury is often dismissed as just a bump on the head.

“There are countless ‘walking wounded’ who look just fine on the outside, but who aren’t the same on the inside,” says Jonathan Lifshitz, an assistant professor at the Spinal Cord and Brain Injury Research Center at the University of Kentucky Chandler Medical Center.

What's made TBI more visible is its emergence as the signature wound of the Iraq war. Advances in body armor and emergency medical care have allowed thousands of U.S. soldiers to survive bomb blasts that have devastated their brains. And now, ABC News anchor Bob Woodruff has brought TBI into America's living rooms with the story of his own brain injury suffered in a roadside explosion while he was reporting in Iraq last year. 

But most cases of traumatic brain injury, like Valentini's, happen far from the war zone. More than 40 percent of TBIs are the result of traffic accidents —  the most common cause of this type of injury.

Ironically, advances in protective equipment — seatbelts, airbags, helmets — may have led to increases in TBIs over the past decade or so, Lifshitz says. That’s because people who once would have died from injuries in an accident now live, but with badly wounded brains.

Brain damage is forever
Right now no one fully understands what happens when brain injuries like Valentini’s occur. But experts note that serious damage can result even if there are no visible indications of injury to the head, or even signs on a brain scan.

David Friedman / MSNBC.com Keith Cicerone of the JFK Johnson Rehabilitation Institute likens traumatic brain injury to the loss of a limb.

And a TBI can result in changes to mental processing that are profound, profuse and permanent. Thinking can be slowed, attention dulled, memory muddled and judgment impaired, says Keith Cicerone, director of neuropsychology at the JFK Johnson Rehabilitation Institute in Edison, N.J.

Therapy can help people cope with the changes, but it doesn’t repair the damage. Brain damage is forever, Cicerone says, likening TBI to the loss of a limb.

“If you lose a leg, you wouldn’t expect it to regrow,” he explains. “It’s a long road going from the injury to learning to live a fulfilling life, but with limitations.

“We’re not looking to make you who you were. We’re trying to teach you to live with the person you’ve become — who you are now.”

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