Often someone with a brain injury has no outward physical signs of injury, and may have trouble convincing others that they do have a disability.

“My insurance company says I am better and don’t need any more rehabilitation”.

“Mum and dad say it’s all in my head, that I’m making all this up”.

“The boss thinks I look fine and should be able to handle the huge workloads again”.

Brain injury is often called the invisible disability because a person may outwardly appear to be unaffected, particularly if the cause was a brain tumour, near drowning, mild stroke or drugs. Even when the injury is caused by trauma such as a motor vehicle accident, the scars may heal so well that the person appears to be fully recovered.

Unfortunately even a so-called ‘mild’ brain injury can leave a person facing cognitive deficits in memory, concentration, motivation, fatigue, stress, depression and reduced self-awareness. People who acquire a brain injury often find that family, employers and friends have trouble accepting there can still be problems when there is no physical evidence.
Family members often have the most trouble understanding the invisible nature of acquired brain injury. With effort, the effects of a mild to moderate brain injury can often be hidden or compensated for so that most people will not detect any problems. But families get to see beyond the ‘public face’ due to the amount of time they spend together.

After the brain injury the family is frequently confronted with a ‘new’ personality—a family member who may be negative, unmotivated, unable to carry tasks through to completion, constantly forgetting things, unable to take others’ needs into account and prone to depression or angry outbursts.
Before the brain injury, the person usually had some degree of control over these areas and how they chose to act and speak. Now they have lost these abilities and may only regain some control through compensatory strategies, if at all.

HOW TO CONVINCE OTHERS

How do you convince sceptical family or friends that you do have a brain injury? Trying to discuss the issue is often difficult. Family members are often resentful if they have been coping with some of the more unpleasant sides of a brain injury, such as anger or self centredness. Discussions can break down into recriminations and the brain injury can be seen as a weak excuse for inappropriate behaviour.
Families often come to an understanding of acquired brain injury through simply reading about it. Previously their ideas may have been based on what they had seen in movies—a person is knocked briefly unconscious, forgets who they are, their memory is restored by another bump to the head, then they are fine again.
There is a wealth of medical research and information showing that even in cases where people were not unconscious, they may face lifelong difficulties with short-term memory, emotional instability and a wide range of other effects – a far cry from the instant recovery portrayed by Hollywood.

ONGOING PHYSICAL ISSUES

Unfortunately, individuals with a brain injury are often left with much more than life-long cognitive effects such as susceptibility to stress, inability to work, memory problems and extreme fatigue. Traumatic brain injury often leaves lasting effects in terms of musculoskeletal problems, migraines, auditory and visual disabilities or neuroendocrine disorders. Insurance companies and generic rehabilitation services are often unaware of the frequently ongoing nature of deficits from traumatic brain injury and that a ‘return to normal health’ does not occur in the majority of cases. In some cases individuals need to take legal action to obtain the rehabilitation and support that their insurance guarantees.

There is a public perception that legal compensation payouts are often very large; but such multi-million dollar awards take into account that the person will need cognitive and physical therapy or support for the rest of their lives.

WHAT ABOUT THE ULTIMATE SCEPTICS?

Some people may refuse to believe a brain injury exists unless there is firm medical proof. Usually a moderate to severe brain injury leaves scarring that will clearly show on MRI or CAT scans. The brain does have a limited ability to heal itself; and in milder cases, a scan conducted years or even months after the injury may no longer show evidence, although the cognitive deficits remain.
There is also diffuse brain injury, where the damage occurs at a microscopic level throughout the brain, and will not show on scans despite the huge impact it can have.

In these latter cases a neuropsychological assessment is used to identify a brain injury, its effects and the strategies needed for rehabilitation. Testing includes a variety of different methods for evaluating areas such as attention span, memory, language, new learning, spatial perception, problem solving, social judgment, motor abilities and sensory awareness.
These tests can be quite expensive. Universities offering programmes in neuropsychology often provide evaluations at low cost or on a sliding scale as part of their student training.

It is no wonder that brain injury survivors get discouraged when others won’t accept that they have this disability, and the survivors have to face criticism instead of support.