The consequences of an injury to the brain are wide ranging. First and foremost, a traumatic brain injury can be fatal. If the individual survives the brain injury, the damage that may have occurred to the brain is often life changing.
Some individuals may be unable to breathe on their own; they may require intervention to assist them with eating due to their inability to swallow. Some individuals may have speech difficulties or mobility difficulties. Others may have memory or concentration problems, preventing them returning to the work that they did prior to their injury.
The effects of a brain injury are so diverse that it is important that the right specialists are involved from the beginning, to ensure that the right tests are carried out and the right questions asked to identify what difficulties a person is experiencing as a result of their brain injury and to put in place a programme of rehabilitation at an early stage in order to assist that person in their recovery. Studies carried out in China have shown that early, intensive intervention can speed up a person’s recovery following a brain injury. Indeed, whilst it is likely that a person will continue to progress for up to two years following a traumatic brain injury, the most significant progress is usually seen within the first six months following injury.
In the immediate aftermath of a brain injury, the medical practitioners will, quite rightly, be concerned with saving that person’s life. That is ensuring that the person survives their injury and any subsequent surgery, can breathe on their own and that any physical damage to the brain is minimised as far as is possible.
The medical practitioners may also look at what therapies are needed in order to put in place a plan for an individual’s recovery and to assist them in learning to cope with life post injury. This may include speech and language therapy, physiotherapy, occupational therapy among others. Medical practitioners may also refer an individual to a talking therapy, such as CBT, to deal with any cognitive or psychological difficulties a person may experience.
There does however seem to be a gap in the treatment immediately available following a brain injury, in respect of dysfunction in the ability to taste or smell. Perhaps this is due to the fact that it does not affect the ability of someone to self care and is a more subtle difficulty then memory, concentration or personality changes. It can however drastically alter a person’s quality of life.
Damage to the senses
Following a brain injury, it is relatively common that an individual may have either a reduced sense of taste and smell, or have lost these senses all together. The total loss of the ability to smell is called anosmia, and this injury can be full (i.e. loss of the sense of smell) or partial (reduced sense of smell).
Our ability to smell originates in the olfactory nerves which sit at the base of the brain’s frontal lobes, behind the eyes and above the nose. A traumatic brain injury can cause damage to these nerves through a direct blow to that part of the head, through haemorrhage of the brain or stretching and/or shearing of the nerves. The severity of the anosmia has been found to increase with the severity of the brain injury.
Our ability to smell is directly linked with our ability to taste and so in circumstances where an individual is suffering from anosmia, it is likely that their ability to taste will also be affected. Often, individuals suffering from anosmia will only be able to taste salt, sour, sweetness and bitterness as these tastes are received by receptors in the tongue rather than in the brain.
This consequence of a brain injury is often overlooked by treating practitioners, as it does not impact upon a person’s very survival. Often, survivors of traumatic brain injury may not raise it with their treating practitioners as they may not be aware of it themselves to begin with. An altered sense of taste or smell is often a side effect of many medications and it can often take some time before the injured person is aware of it.
But the ramifications of this condition are significant. Imagine if you could never smell fresh flowers or chocolate or taste your favourite food again. I worked with a client previously who suffered from this condition and his mother’s greatest regret was that he would never get to smell what his first new born baby smelt like. That is something that may not come into your mind when injured in your early twenties, but is certainly a loss suffered as a result of his injury that cannot be quantified.
As well as losing the ability to experience new tastes and experiences, there are also real health risks associated with not being able to smell or taste. We rely on our sense of smell every day of our lives; to smell if something is burning, to smell if food has gone off, to smell if there is a gas leak. We often take the ability to smell for granted and it is only when we lose this ability that we realise what an impact it has on our daily lives.
This condition appears to be underestimated and trivialised by doctors. It is important that doctors are made aware that an individual is suffering from this condition. Once a doctor has been made aware of the condition, a test known as UPSIT can be carried out to identify the level of dysfunction. This test involves a series of scratch and sniff items to determine the level of traumatic loss of smell.
Whilst there is currently no fixed treatment for this condition, being aware of it is important. An individual can take steps to make their home safer, such as by installing smoke detectors or switching to electric rather than gas. It will also allow the person to make changes to their lifestyle in the way that they eat in order to continue to gain enjoyment out of eating.
I have worked with previous clients who have told me that they eat out less following their brain injury, as they don’t want to spend money on food they can’t taste. They will only eat dishes that they had tasted prior to the accident as they could ‘remember’ the taste of such food and did not see the point in trying new things. They put lots of salt on their food and sugar in their tea to enable them to get some taste out of what they are eating. This is of course very unhealthy and can cause associated health problems in the future. If someone is aware that this is a consequence of their brain injury, just like their mobility problems or their concentration difficulties, then they can take steps to adapt to their new post injury lifestyle. They can do this, by for example, eating spicier more flavoursome food. Trying out different textures or temperatures in order to continue to gain some pleasure from what they are eating.
In addition, in cases where the traumatic brain injury has been caused as a result of the negligence of a third party, such as in a road traffic accident, this is an injury caused by the accident and the affect of this injury on a person’s life should be compensated. If the doctors aren’t aware of the condition, and I as the solicitor conducting the litigation claim for compensation am not made aware of the condition, then I cannot include it any claim for compensation.
If you lost the ability to see, doctors would send you for lots of tests to ascertain the route of your blindness and look at ways of restoring or improving your sight. If you lost the ability to hear, doctors would investigate the cause of your hearing loss and look for aids or equipment to assist you. If you suffered from numbness or paralysis and could not touch or feel, a medical practitioner would take steps to identify the origin of your numbness so that treatment could be considered.
Why is it then that the senses of taste and smell are not treated with such high regard? They are often overlooked by medical practitioners and trivialised as they do not affect the survival of a person or their ability to live independently.
Anosmia affects around 30% of all those individuals suffering from a traumatic brain injury. The condition may improve over time, but in many cases it is permanent. Personally, I consider the loss of the ability to taste or smell to be hugely significant and should be considered immediately following injury to ensure that this can be factored into the early rehabilitation for a brain injured person. This condition can have a detrimental impact on a person’s psychological wellbeing which must be a priority following a brain injury when an individual is coming to terms with what treatment they must undertake in order to recover and what changes they must make to their lifestyle for those aspects of their injury that will not improve.
I consider therefore that the UPSIT test should be a mandatory test in hospitals dealing with survivors of brain injury, to ensure that the right experts can be involved from the beginning to ensure that any rehabilitation package deals with the whole injury suffered by a person, rather than those aspects of their injury deemed to be more important.