She was not wearing a helmet at the time of the accident. (Quinn, 2009) However, while it is true that sometimes there are no immediately obvious signs of a severe brain injury, at other times there are.

Severe Traumatic Brain Injury

The symptoms of a severe traumatic brain injury (which can result in permanent neurological damage) include a number of cognitive problems including inability to concentrate, problems with memory, problems in focusing and paying attention, ability to process new information at a normal rate, a high level of confusion, and perseveration, which is the action of doing something over and over again because an individual has forgotten that he or she has already done it. Other symptoms of severe traumatic brain injury can include problems with vision and hearing as well as a reduction in the ability to smell, paralysis, loss of control of bladder and bowels, sleep disorders, menstrual irregularity, inability to regulate body temperature, and a range of level of pain.

Individuals who have suffered a severe traumatic brain injury may also have a number of problems with language along with "executive functioning." Executive functioning is key to a range of important activities: This level of cognitive functioning allows for most of the goal-oriented behavior that individuals pursue:

Executive functions are necessary for goal-directed behavior. They include the ability to initiate and stop actions, to monitor and change behavior as needed, and to plan future behavior when faced with novel tasks and situations. Executive functions allow us to anticipate outcomes and adapt to changing situations. The ability to form concepts and think abstractly are often considered components of executive function. (Barry, n.d.)

It should be immediately clear how harmful the effects in terms of an individual's overall functioning any diminishment in a person's executive functioning skills would be. Barry notes that "Executive functions are important for successful adaptation and performance in real-life situations. They allow people to initiate and complete tasks and to persevere in the face of challenges."

Ironically -- or most tragically -- a high level of executive functioning is needed to adapt to changing and novel circumstances, the very type of environment that is present when an individual is adapting to the consequences of a serious injury.

Because the environment can be unpredictable, executive functions are vital to human ability to recognize the significance of unexpected situations and to make alternative plans quickly when unusual events arise and interfere with normal routines. In this way, executive function contributes to success in work and school and allows people to manage the stresses of daily life. Executive functions also enable people to inhibit inappropriate behaviors. People with poor executive functions often have problems interacting with other people since they may say or do things that are bizarre or offensive to others.... When executive functions are impaired, however, these urges may not be suppressed. Executive functions are thus an important component of the ability to fit in socially. (Barry, n.d.)

Neuroplasticity

Much of the ability of an individual with traumatic brain injury to heal from their injuries arises from the quality of the human brain to be neuroplastic. This idea is a relatively new one at least to the extent that it is now used. Only a few decades ago, scientists believed that only the very young human brain (and possibly even only the prenatal human brain) could repait itself. Now, however, scientists believe that the ability of the brain to repair itself andmake new connections extends throughout the human life.

More technically, neuroplasticity refers to the ability of the brain to compensate for injury by forming new neural connections throughout an individual's lifetime. These new neural connections can adjust their activities to respond to new demands made on the individual, thus restoring the ability of an individual with traumatic brain injury to respond to the complexity of the real world. Neuroplasticity works through the process of axonal sprouting, in which axons extend their reach into new spaces.

Neuroplasticity can occur within a single hemisphere if the brain is not too badly damaged to heal itself on a single side. It can also occur in a cross-hemispherical fashion, in which new neurons are formed on one side to compensate for injury on the other side. Levin (2003) summarized the importance of this type of regrowth:

The evidence to date indicates that the traditional view of enhanced reorganization of function after early focal brain lesions might apply to early focal brain lesions, but does not conform with studies of early severe...

In contrast to early focal vascular lesions, young age confers no advantage in the outcome of severe diffuse brain injury. Disruption of myelination could potentially alter connectivity, a suggestion which could be confirmed through diffusion tensor imaging (DTI). Initial reports of DTI in TBI patients support the possibility that this technique can demonstrate alterations in white matter connections which are not seen on conventional magnetic resonance imaging (MRI) and might change over time or with interventions. Preliminary functional MRI studies of TBI patients indicate alterations in the pattern of brain activation, suggesting recruitment of more extensive cortical regions to perform tasks which stress computational resources. Functional MRI, coupled with DTI and possibly other imaging modalities holds the promise of elucidating mechanisms of neuroplasticity and repair following TBI p. 665).
In other words, the brain regenerates nerve cells differently in an adult than in an infant. Though the reason for this differential is not yet well-known, determining the reason holds potential for increasing the ability of researchers to use natural neuroplasticity to help individuals heal from brain disease or damage.

Treatment for Traumatic Brain Injury

The above summary of the potential consequences of traumatic brain injury should make it clear that both the short-term and long-term consequences of such an injury can be devastating. To limit the effects of traumatic brain injury, the injured person should receive a range of treatments. These include a number of purely medical interventions that occur immediately after the injury (such as stabilizing an individual's head and neck and transporting him or her to a hospital) to repairing skull fractures. Less immediate but still essential follow-up care may include physical therapy and speech therapy. These can both be extremely helpful. Neurological interventions may also be helpful.

Although all of the above forms of treatment and therapy can be extremely helpful. However, many individuals who have suffered a traumatic brain injury also need additional forms of therapy and support to help them regain the social (and related workplace) skills that they lost as a result of the accident. Unfortunately, this type of support is often neglected or simply not available to individuals with traumatic brain injury.

This is in large part a function of the ways in which the American medical system works as a whole: While our system of healthcare is generally quite good at supplying people with the care that they need in an urgent situation (for example, if a person with traumatic brain injury were to have bone fragments embedded in his or her skull, there are numerous skilled surgeons who could remove these fragments just after the injury occurred. But our healthcare system -- or rather, our health-delivery system as it is currently constructed -- does a less competent job in delivering long-term sub-acute care. Unfortunately for those people with traumatic brain injuries, this is often precisely the kind of care that they need to regain their ability to functionally in interpersonal relationships and at work.

The problems that individuals with traumatic brain injury face in receiving adjunctive services is made worse for many if they cannot return to work. Since the majority of Americans receive health insurance through their jobs, they may well be left with a very minimum of healthcare options. The bare-bones plans that they may be able to afford will often offer care only for acute situations. While this is a far-from-ideal situation for the recovering individual, there are ways in which friends and family members can help the patient to recover even in the absence of professional support. Again, this is not ideal, but it is sometimes the only option.

I should emphasize that I am not dismissing the importance of family and friends in helping individuals with traumatic brain injury recover. There are several important reasons, in fact, why people who are emotionally close to an injured person can be especially effective in helping that person heal. The first of these is that family members (and other intimates) have a level of emotional connection to the individual and thus loyalty to him or her and desire to see him or her healed that cannot be matched by even the most well-meaning professionals.

The second reason that people close to the injured person may be especially helpful in the healing process is that people with traumatic brain injury are often very suggestible: Family members can use this fact to make continual suggestions throughout the day and over the often long course of healing that will be most helpful in restoring social and employment skills.

Moreover -- and…