Glenn Higgins hopped on his bike, waved to his wife and pedalled up the street to the local high school. It was a sunny morning in late August, and he wanted to make the most of the weather to log some laps on the asphalt track, away from the traffic and dogs that sometimes disrupted his rides.
"For whatever reason, I left without my helmet," says Glenn. It was the first time he'd done so in 23 years.
Glenn was cruising around the track at 40 km/h when without warning the bike's chain seized. The bike flipped and drove him headfirst into the ground. He blacked out.
He awoke to a woman standing over him asking if he needed help. He told her he was fine, but the blood pouring down his face said otherwise. She telephoned 911 and Glenn's wife. Later, hospital X-rays and CT scans showed that Glenn had a broken shoulder, two fractured vertebrae, skull fractures and brain bleeds.
An ambulance rushed Glenn to Sunnybrook's Tory Regional Trama Centre. "It was a desperate situation. I had a basal skull fracture and all I could think about was 'that's what killed Dale Earnhardt Sr. at the Daytona 500 NASCAR race'," says Glenn.
After five days in Sunnybrook's Critical Care Unit, Glenn returned home for a two-month-long recuperation that included physiotherapy for his shoulder and rest for his brain. He was often forgetful, at a loss for words, had trouble concentrating and difficulty sleeping. Glenn had suffered a moderate traumatic brain injury (TBI). As part of his treatment, he started making regular visits to Sunnybrook's Traumatic Brain Injury Clinic.
Brain injuries such as concussion have grabbed headlines recently with the prolonged sidelining of hockey player Sidney Crosby and the lawsuit launched by former football players against the National Football League. The clinic has been in operation at Sunnybrook since 1999, filling a gap in the care of mild to moderate TBIs. It receives referrals from within the hospital, but also from community doctors and general practitioners. "The aim is really to try to sort out what the major treatable problems are at the outset and, by treating those, determine what other areas may dampen down on their own, or require additional intervention," says Dr. Scott McCullagh, a neuropsychiatrist and the clinic's director.
When the head hits a surface—like asphalt or a car dashboard—and suddenly stops moving, the brain continues its trajectory and smashes into the skull. The action can squeeze, tear and stretch tissue, blood vessels and nerves. Using a variety of measures, doctors grade the brain injury as mild, moderate or severe. Physical, emotional and cognitive symptoms, including headaches, dizziness, difficulty sleeping, unhappiness and irritability, and trouble with concentration and forgetfulness, are common among those with mild and moderate TBI.
The vast majority of people with mild TBI recover within three months of the incident. But for roughly 10 to 15 per cent, the symptoms can persist. "Five years later they might still have headaches and be depressed—and they may have lost their job and their lives might have fallen apart," says Dr. McCullagh. Instead of taking a wait-and-see approach, the clinic aims to assess individuals within three months of the injury and offer early intervention. Often treating one symptom, such as mood or sleep disturbance, will improve others such as concentration. The outcome after a moderate TBI is more variable, but the same principles apply.
Two months after Glenn was thrown from his bike, the TBI clinic's medical team tested his concentration, word recall, pattern recognition, and ability to complete a logic puzzle. He drew clock faces, 3D cubes and took a smell test. He and his wife were provided with support and reassurance over time, as well as education about strategies for coping and gradually resuming his activities.
Glenn's injuries include damage to the areas of his brain that govern his sense of smell and taste. A year on, he still has partial hearing loss in his left ear and his sense of smell remains "wonky." Chocolate and Irish whiskey are among the big losses, he says. "I can't detect the complex flavours any longer."
The TBI clinic has a strong clinical research mandate. Among their research questions: What factors influence recovery from a TBI? The clinic has tracked more than 2,200 patients through their treatment, including hundreds of variables for each, to help doctors chart recovery. The team is also studying post-traumatic stress disorder among TBI clinic patients, and the links between TBI, mood and cognition. Dr. McCullagh is also a member of the Ontario Neurotrauma Foundation, and a senior contributor to a comprehensive set of guidelines that offer the best evidence on the assessment and treatment of mild brain injuries and persistent symptoms.
Despite his ordeal, Glenn is remarkably upbeat. "I know it will take some time, but the nerves will knit themselves together again. One day I'll bite into a really good piece of chocolate and the taste that I remember will click and I will be done," he says. "I'll call the clinic so they can say, 'This is how long recovery can take'." Dr. McCullagh says he looks forward to that call.