After brain injury, a silent struggle to start over

The long road for Kim Valentini began when she woke up in a hospital in Virginia after an accident in which the Ford Bronco she’d been driving flipped over four times at high speed.

Valentini’s first memory after that accident is of her family crowded around her hospital bed and someone telling her she’d been in a coma for 17 days. She remembers asking for some Excedrin to quiet the throbbing in her head.

When she was released from the hospital, Valentini needed to move back in with her parents in Edison, N.J., so she could learn to walk and talk again.

Every sentence a struggle
The speech problems were especially distressing for Valentini, who’d been at the top of her class in high school and college. Every sentence was a struggle as common words eluded her.  Often she’d blurt out a word that was close somehow in meaning to the one she was searching for — “bowl” instead of “pot,” for example. Even today the right word is often hard to come by. “My mom and dad joke that I speak in ‘Kimmerbonics,’” Valentini says with an easy smile.

Elusive words weren’t the only issue. If multiple conversations were going on at the dinner table, Valentini found she couldn’t focus on one. The longer the chatter went on, the more anxious and agitated Valentini would get.  “It all sounded so loud in my head,” she remembers. “I’d be like, ‘Please just stop!’”

Valentini’s odd collection of symptoms are typical of those experienced by TBI sufferers, says Dr. Douglas H. Smith, director of the Center for Brain Injury and Repair and a professor of neurosurgery at the University of Pennsylvania in Philadelphia. The disparate symptoms stem from the diffuse nature of the damage that occurs in a TBI: Although the front sections of the brain are often affected, nerve cells connecting many other areas of the brain sustain injury.

David Friedman / MSNBC.com Kim Valentini relies on calendar entries and notes to herself to get by in her daily life.

Experts suspect that much of the damage in a TBI happens when the brain’s soft, delicate tissue slams up against the hard, corrugated interior walls of the skull. Making matters worse, nerve fibers can stretch and then rip during the sudden accelerations or decelerations that occur in a car accident or a fall. Tiny tears in nerve fibers can lead to cell death days after the original brain injury. And cells that don’t die may never work right again.

Retraining the brain
Therapy for TBI focuses on teaching patients strategies to cope with their more permanent deficits and getting the brain to rewire as much as possible.

Sometimes brain cells can be coaxed into doing jobs they weren’t originally designed to do, says Dr. Mel Glenn, director of outpatient and community brain injury rehabilitation at Spaulding Rehabilitation Hospital and an associate professor at Harvard Medical School in Boston.

Just as an amputee can learn to walk in a different way using a prosthesis, a TBI sufferer can learn by practicing certain mental exercises to overcome some of the deficits caused by the injury.

The new circuits may not work as efficiently as the old ones, but sometimes they work well enough, says Cicerone of the JFK Johnson Rehabilitation Institute.

'You're not the same person'
During the first two years after her accident, Valentini made impressive progress. She was convinced she could get “the old Kim” back. And, she says, “I was working really hard because my goal was to become independent so I could be my fiancé’s wife.”

But after two years, her fiancé told her he couldn’t wait for the old Kim. “He said, ‘I still love you, but you’re not the same person I got engaged to,’” Valentini says. She suspects her fiancé was also frightened by the responsibility. “I was very fragile,” she recalls.

That loss was almost too much. Suddenly therapy seemed like a chore, Valentini remembers. The goal that had been driving her was gone.

Glenn isn’t surprised by Valentini’s experience. “Marriages often fall apart,” he adds. “Spouses will say, ‘This isn’t the same person I married.’ Sometimes they’ll stick it out. But it’s not infrequent for someone to say, ‘I’ve got to move on with my own life.’”

And it’s not just spouses, Glenn says, adding, “I’d say it’s extremely common for them to lose friends left and right and to be cut off from their social networks.”

Generally it’s the families like Valentini’s who stick it out, Glenn says.

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