Every injury is different. Every person is different. The consequences are different too! There are so many invisible consequences that we cannot be complete in one poster:

We list the invisible consequences so that people can link complaints more quickly to brain injury.
We want to prevent people from recognizing the complaints only gradually, through trial and error. 
Unfortunately, many doctors have too little knowledge of the chronic phase of brain injury and therefore too little knowledge about the invisible consequences.

We therefore advocate additional training for doctors!

For the person with the injury, it can be difficult to understand their own invisible consequences. It can take a while (sometimes years) before someone knows that something is caused by the brain injury, then finds appropriate help and can talk about it with the environment.

Too few care providers recognize the symptoms of brain injury or link them to a previous injury suffered in childhood, for example.

It can also take a long time for people around you to understand that a change in thinking, behavior, emotion, senses, not being able to tolerate sound, light or a warm summer day, can be a result of brain damage.
This can lead to misunderstanding and frustration for both the environment and the person with brain injury.

It is also possible that the complaints only become visible when people start participating more intensively in society again. At that point, it may become apparent that certain things are no longer possible.
Unfortunately, the environment of the person with brain damage does not always notice the great impact of all the invisible consequences.

Too often, only what is physically going well (again) is considered. This can give both the person with brain damage, but certainly also the partner/caregiver a feeling of ignorance of how tough life really is.
The reverse is also true... not everyone sees the invisible consequences in themselves. Then it is a challenge to let invisible consequences get through to someone. That does not always work.

Make invisible consequences discussable!

All links below lead to pages with more in-depth explanations

Sensory effects

These are effects that affect sight, hearing, touch, temperature, taste and smell.

• Visual consequences of brain injury: problems with seeing, for example double vision, not seeing clearly or one eye reacting faster than the other
• CVI - cerebral visual disorders: including intermittently sharp vision and not registering everything you see
• Hemianopia: visual field loss
• Sensory dysfunctions (smell, taste, seeing, hearing)
• Changes in taste and smell. This can cause the patient to eat much less.
• Auditory processing disorder
• Hearing too much/too loudly: hyperacusis and sound overstimulation
• Tinnitus (ringing in the ears)
• Disorders in temperature: the patient can no longer tell the difference between warm(er) and cold(er). Body temperature can no longer be regulated properly or there is heat intolerance
• Disorders in sense of touch (gnostic sensibility) experiencing pain in a place that should not be painful or no longer feeling pain
• Neglect (hemispatial neglect) not perceiving (body) parts, not being aware of, for example, the left side of the body.
• Agnosia: difficulty recognizing faces or recognizing objects or sounds
• Prosopagnosia: not recognizing faces
• Overstimulation of the senses
• Sudden deafness

Problems with communication
Communication problems can manifest themselves in many different ways. For example, some people have problems with speaking and formulating words, while others experience problems with understanding language. Cognitive problems such as delayed information processing can also cause problems with communication. For example, it can be difficult to follow someone who talks very quickly.

• Aphasia dysarthria and speech apraxia (difficulty speaking, understanding, comprehending, taking language literally, speech and articulation disorders)
  
  • Receptive aphasia
  • Expressive aphasia
  • Dysarthria; difficulty articulating
  • Speech apraxia: difficulty speaking purposefully
    
• Taking language literally
• Communication problems, having a conversation can sometimes be so difficult
  
• Pragmatic language disorder
• Word finding problems and word confusion
• Foreign Accent Syndrome
• Being easily distracted or not being able to remember what someone else is saying. Jumping from one topic to another in a conversation. Wandering with thoughts or reacting associatively. One association after another comes to mind
  
• Listening can be taxing
• Fatigue being too tired to absorb information
  
• Difficulty in a busy environment
• Not noticing differences in intonation and emotion or not being able to show emotion
• Deafness due to brain damage

Cognitive consequences
By cognition we mean processes that are necessary to be able to think. Cognition consists of many different functions.

Examples are: remembering information, attention and concentration, planning and organization. We need cognitive functions in almost everything we do in our daily lives.

• Memory problems
• Attention and concentration
• Executive functions that are disturbed: for example planning, working memory, regulating emotions, maintaining attention, difficulty solving problems, reduced task initiation (difficulty starting a day or specific task) with a small instruction this often works.
  
• Disharmonious profile (difference between verbal abilities and executive functions (difficulty with overview and planning), intelligence is higher in one area than in another,
• Sometimes reduced intelligence, or reduced intelligence in sub-areas
  
• Time perception disorder: altered sense of time, not being able to estimate time well or no longer knowing what time of day it is
  
• Delayed information processing
• Reduced reaction speed, reduced timing and speed of skills
  
• Perseveration, not being able to stop a thought, action, movement, talking about work or hobby, or being stuck in a certain emotion
  
• Not being able to quickly switch from one subject or action to another,  for example, in the event of an unexpected phone call, not being able to switch from one's own thoughts to the caller's subject. Many people with injuries therefore do not like being called unexpectedly.
  
• Problems with orientation
• Reduced or no insight into illness (Anosognosia)
• Difficulty with generalizing; not being able to apply what has been learned in a different situation.
• Being overwhelmed by / overstimulated by thinking tasks and other cognitive tasks / reduced resilience. abundance of information etc.
• Reduced stress resistance
• Reduced ability or inability to sense one's own boundaries
  and not being able to indicate these (well) to others
  
• Brain fog, foggy thinking

Emotional and behavioral changes

Emotional and behavioral changes can on the one hand be a direct result of the brain injury. On the other hand, emotional consequences can also arise from the traumatic impact of the brain injury. The emotional impact of experiencing limitations as a result of the brain injury can also contribute to changes in emotions.
The realization of what has been lost, the realization that you can no longer do everything or almost nothing at all, can cause feelings of grief. Read more on the next page about coping with grief due to brain injury.

• Aggression
• Apathy (reduction of initiative / emotional flattening)
  
• Anger
• Irritability (irritation / anger outbursts / aggression)
  
• Mood changes (depression / gloom)
  
• Disinhibited behavior
• More impulsive behavior, this can be caused by a frontal syndrome
  or injury to the cerebellum, it occurs with multiple injuries
  
• Libido change
• Risk-seeking behavior
• Decrease in decorum, no longer feeling whether something is appropriate to say see also:
  
• Boundless behavior
• Compulsive laughter / crying, PBA
• Tears that flow quickly
• Increase in emotional sensitivity, easier emotional
• Milder character traits than before the injury, friendlier
  
• More gentle
  
• More honest
  
• Decrease in empathy
• Changed sense of humor or taking language literally
  
• Difficulty putting things into perspective

• Susceptible to addictions
  
• Disturbed awareness of illness / insight into illness / reduced ability to see what is really no longer possible (Anosognosia)
• Egocentricity in all degrees, more focused on yourself
  
• Changes in personality
• Post-traumatic stress disorder (PTSD)
• Perseveration, not being able to stop an action, thought, etc.
  
• Reduced stress resistance
• Changed intimacy / sexuality
  
• Changed relationships
  
• Changed friendships

General invisible effects

Sometimes the effects that are experienced are very general. They cannot be precisely categorized. These effects can indirectly influence many of the above-mentioned specific functions and thus have a great impact on someone's daily life. A good observer can, however, observe these effects.

• Fatigue
• Overstimulation (can be both sensory and cognitive in nature (not always visible))
  
• Pain and pain syndromes
• Not feeling pain
  
• Headache
• Ringing in the ears/tinnitus
• CSAS and sleep disorders (CSAS is sleep apnea caused by brain damage, can occur without snoring)
  
• Dyspraxia a milder form of apraxia (not being able to perform daily activities) (Not always visible or noticeable)
  
• Swallowing disorder
  
• Balance disorder (not always visible) including vertigo
  
• Balance problems (not always visible)
  
• Hormonal changes (not always visible)
  
• Epilepsy (not always visible)
  
• Dysautonomia, problems with blood pressure and/or heart rate
  
• No longer feeling hungry or thirsty/ or feeling too hungry and thirsty
• Loss of strength, either on one side or in one part of the body

Finally: Not one brain injury is the same as another!

The consequences are different for everyone. Some have one complaint, others several. The expression of it can vary greatly over time. There is often a combination of injury and remaining skills, remaining knowledge and understanding (intelligence), thinking ability (cognition), behavior and personality.
There are so many gradations in brain injury that you can never compare.
Sometimes it is mourning for what is no longer possible, and sometimes it is good to realize what you can still do. Contact with peers can sometimes help to realize the latter.

When there is no wheelchair in sight

Too often the invisible consequences of brain injury are wrongly interpreted as psychiatric complaints.

It is very clear that this causes a lot of damage and makes people with these complaints feel they have no protection.
Let it be clear: we do not want to diminish the needs of people with psychological problems. We advocate for further training in the consequences of brain injury for those care providers who have to make a diagnosis or a life-changing decision.

If the MRI doesn't show anything...
Many brain injury survivors who do not have any external disability are faced with prejudices from those around them, even from doctors and insurance companies. They have survived the brain injury but do not receive any support to cope with the enormous limitations.

Some skeptics refuse to believe that brain injury exists unless there is solid medical evidence.
Focal brain injury, that is, not spread throughout the brain but in one or a few places, usually leaves scars that are clearly visible on MRI or CT scans, if larger than 0.5 millimeters.
However, cellular or axonal injury that is smaller than 0.5 millimeters cannot be made visible with most MRI scans. The brain has a limited capacity to heal itself. In some cases, after years or even months after the injury, the evidence can no longer be shown on a scan. The cognitive deficits may still be present in that case.

There is also diffuse brain injury, which means brain injury where damage occurs at a microscopic level spread throughout the brain. This type of injury does not show up on scans.

It can have a huge impact.
Therefore, read our page about what a brain scan can and cannot show. We have created a special page about when people don't believe you.

Nothing to see...invisible disabilities...lifelong impact

It is precisely the invisible, hidden disabilities that make life hard.

Brain injury patients who have no visible signs and who appear 'healthy' can be chronically overtaxed by their environment and become overloaded as a result. Chronic fatigue to exhaustion can be one such consequence.

The remark; "If only there were something to see, even a leg in a cast is taken into account", is often heard. It is difficult for others to imagine what consequences a 'mistake in the control room' can have when it is not visible from the outside.

Moreover, someone with a brain injury often cannot estimate how far the influence of the injury reaches. Let alone explaining it properly to others.

Brain injury and aggression

Aggression in brain injury patients is a problem that poses major problems for all those involved.
Contrary to popular belief, it is rarely a symptom that directly results from the brain injury. It usually involves behavior that has an insightful background in the brain, the person and the situation of the patient.
The better we understand this, the more effectively we can act.
There are different forms of aggression and they can be treated and explained based on their origin.

Subsequently, we will look at how drug-induced influence on neurotransmitter systems and the creation of an adequate environment for the patient can make aggression unnecessary.
Because that is the ultimate message: aggression is difficult to treat but can be prevented. An effective approach requires close cooperation between the patient, caregivers, doctors and other healthcare providers, based on a shared insight into the origin of aggression.
Together, they can create the conditions that make this behavior an unnecessary survival strategy for the patient.
We have a page about aggression caused by brain injury.