This is a part of the Hot Topic podcast series from the Model Systems Knowledge Translation Center on Changes in Memory After TBI. Dr. David Arciniegas discusses It's Not Just The Injury That Matters But The Brain That Is Injured.

People have a lot of frustration and distress as a result of their memory problems after TBI. At least one source of that frustration and distress is the constant comparison of how they're doing to how they think they ought to be doing. One of the important points for us to help people with brain injuries and their families understand is that each of their stories will be unique.

People do have very different experiences of memory problems after injury one to the next. Some of that has to do with the fact that no injury is the same, even though the details may sound very similar. The specifics of the way each brain responds to injury, the forces that are applied to it, make every injury unique.

As the great British neurologist Sir Charles Symonds said in the 1930s, however, "It's not just the injury that matters, but the brain that is injured." So we're not all built the same. Some of us have greater resilience, some more vulnerability – for a whole variety of reasons that affect the way the injury disrupts or doesn't disrupt the systems that serve memory. For some of us, the – including for reasons of genetics, the injury, once applied, has a much bigger effect than you might expect, whereas for others those same genetics help the brain heal a little more effectively.

In the late period of – after injury, we see those differences play out with some people having had a very severe injury and recovering well and some people having had what sounds like a less-severe injury but actually not doing nearly as well as the other. It's a – it's a really interesting area of brain injury research right now, trying to figure out all of those things that either help us heal effectively – to be resilient – or that make us more vulnerable to having problems after injury. We don't know all the details yet, but I think even as, again, our forefathers in this field knew, these are important things for us to be considering and to make – and to make sure that we teach the people who have injuries that it is a different story for each of us.

Our expectations have to be about you and where you're going, not about some ideal of how you should do, because it's going to be different for everybody.

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