Women and Traumatic Brain Injury

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As we approach Action for Brain Injury Week (17 – 23 May 2021), Associate Solicitor Louise Gardner, looks at the impact of gender on brain injury and asks if there is an imbalance in the way women’s brain injuries are assessed and treated.

 A crucial part of my role is supporting people with life-changing injuries, particularly traumatic brain injuries (TBI). I understand the devastating impact of head injury. However, I was less familiar with US research, which has shown that being a woman, can make you more likely to get a brain injury and can impact the severity of your injury, recovery and prognosis.

Gender differences in brain injuries have only been the subject of research for the last 20 years. It begs the question of why this is the case, given how long we’ve understood concussion. Does it display historic sexism in medical research? Or a lack of knowledge that men and women’s central nervous systems are different? Or is it because high-profile sporting head injuries involve men?

I have read numerous articles and research published by PINK Concussions, a non-profit organisation focusing on education and medical care for females with concussions from sport, domestic violence, accidents, and military service. Its mission is to drive change and innovation by developing gender-specific, evidence-based strategies to identify, manage, and support women with brain injuries.

Brain differences in men and women

Men and women have slight variations in their brain axons, thought to impact the likelihood and extent of the injury. Traumatic brain injury causes damage to the axons; nerve cells within the brain that are vulnerable due to their fragile structure.

Male axons are often larger and have a more complex structure. Female axons are more delicate and prone to breakage of their microtubes which are stabilised by protein. These proteins can’t unfurl fast enough to keep up with the rapid stretching during a severe injury. Damage to the microtubes leads to degeneration and death of some of the axons. Female axons are more easily damaged, causing dysfunction rather than recovery.

During an injury, the brain moves within the skull. The sudden acceleration and deceleration forces cause the damage.  Research has found that a sturdier and stronger neck stabilises the brain within the head during sudden movements protecting the brain from damage. However, an average women’s neck diameter is 30% smaller than a man’s neck, which could increase the head’s potential acceleration by as much as 50%, causing more significant brain damage.

Another study has suggested females have a slightly faster metabolism than men, including greater blood flow to the head. If a blow to the head affects the blood supply containing glucose and oxygen, it could cause increased damage to brain structures.

Experts also think female hormones contribute to the extent of possible damage when comparing female and male injury, depending on the varying hormone levels during the menstrual cycle.

Research has shown that the differences in our physiology make it more likely to cause females injury. It has also demonstrated that symptoms, deficits and recovery can vary between the sexes.

Impact and recovery

The impact of a brain injury varies from person to person. But according to researchers, women are more likely to experience some deficits or disorders when compared to men:

  • Adolescent females are more likely to be diagnosed with an endocrine disorder after a head injury and at an earlier age than men.
  • Females who sustain a head injury are more likely to suffer long-term headaches, mental fatigue, mood disorders and concentration difficulties.
  • Concussion symptoms can take longer to resolve for women compared to men. A study of 266 adolescents with injuries found females took 76 days to recover, while men took 50 days.
  • Some female athletes with concussion, when tested, have shown to perform worse on tests of the vestibular ocular reflex. This process allows our eyes to fix on a target while the body moves.

PINK Concussions asks: what about the effects of psychosocial and societal gender roles on women’s recovery from head injury?

Could society’s historical approach of telling men to fight through pain affect the reporting of symptoms post-injury? Are women more honest about reporting TBI symptoms?

Could outdated and sexist views that women’s pain is psychological rather than physical play a part in how healthcare professionals treat them? Doctors may accept that a male brain injury patient complaining of headaches and low mood is suffering from head injury symptoms. But are women given the same consideration, or are they sometimes written off as hormonal or overly emotional?

Interestingly, studies in the US have found evidence that women are less likely to be prescribed pain killers in hospital and are prescribed sedatives instead.

So, are women’s post head injury pains being discounted? I hope they are not. But this does make me reflect on how women’s injuries are assessed, treated and what specific rehabilitation and support are available to address any gender imbalance.

Towards a greater understanding of women’s TBI

Research and greater awareness of gender differences in TBI are vital. It can prevent the increased risk of severe head injuries for women in contact sports, military exercises, and other situations where brain injury may occur.

As a solicitor, an awareness of these differences could help women who are making claims for compensation get the right support and treatment.

Early intervention via the Rehabilitation Code can help address the more common symptoms experienced by women. For example, arranging early endocrine testing to identify if the injury has caused a hormonal imbalance; arranging early access to talking therapies to address mood disorders and; understanding if the inner ear organs have been damaged.

The Code could also assist injured women by providing domestic support and childcare. Often women have no choice but to continue caring for children and looking after their homes. If recommended, support can help lessen responsibilities during the acute period of recovery and potentially beyond.

Medicolegal experts in neurological disciplines, (neurology, neuropsychology, neuropsychiatry, neuro-rehabilitation consultants, and audiovestibular experts) should be aware of gender differences and asked to advise the Court on the impact of those injuries on women’s daily activities, work and recreation.

Those impacts must be taken into account when applying the Judicial College (JC) Guidelines when assessing pain, suffering and loss of amenity (PSLA).  The 15th Edition of the JC Guidelines, Chapter 3, on Brain and Head Injuries, makes clear that classification of the injury, be that severe, moderate or mild, should refer, not to the clinical categorisation of the injury, but to the effects of the injury upon the Claimant.

Compensation should reflect the nature and severity of symptoms rather than any diagnostic label. With research showing the effects of TBI women can be more severe, medicolegal experts should be asked to address them and take them into account when quantifying the value of claims.

The Court should also be advised if the Claimant would benefit from additional therapies, rehabilitation, and vocational support. Any such recommendations should be costed within the Schedule of Loss.

Women’s injuries should never be investigated less thoroughly, or written off as psychological or emotional. We need to encourage women to advocate for themselves and fight for fair assessment and treatment of their injuries. If that injury is a result of someone else’s negligence, women should seek advice and support from a specialist solicitor who understands their injuries, and their impact.

Novum Law’s specialist brain injury solicitors can help you make a claim for serious personal injury compensation if you or a loved one has sustained a brain or head injury due to someone else’s negligence.

We offer no win no fee claims which means you can make a brain injury claim with no financial risk to you in the highly unlikely event your claim is unsuccessful. Call us today on Freephone 0800 884 0777 or email info@novumlaw.com.

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