The Story of Jake

One day, 15-year-old Jake was outside riding his electric skateboard. Suddenly, he had a fall and, unfortunately, he was not wearing a helmet. A neighbor found him lying in the road and called 911. At the hospital, when his mom asked if he knew where he was, Jake said that he was at Disney World. When he realized he was in the hospital, he had no memory of why he was there or what happened to him. He had a headache, was tired, had problems balancing, and was sensitive to light. He also got angry and confused easily. Doctors confirmed that Jake had experienced a traumatic brain injury (TBI). Jake faced many challenges after his TBI, but his story has a happy ending. After a long recovery, he was able to succeed in school and even got a spot on his school’s varsity baseball team.

What is a Traumatic Brain Injury?

A TBI is an injury to the head caused by a blow, bump, or jolt. TBIs can be mild, moderate, or severe. Mild TBIs are the most common form and include concussions. Mild TBIs are serious but usually not life threatening. They can, however, still impact parts of a person’s daily life. Moderate and severe TBIs are much more serious and can be life threatening. For those who survive, many parts of their daily lives may be impacted. Lots of people get TBIs every year, and common causes in children include participating in sports, getting in a car accident, or bumping their head on an object.

The brain controls many thought processes and behaviors. Because TBIs affect the brain, they can impact many parts of one’s daily life. The effects of a TBI depend on how severe the injury was and the symptoms that the individual experiences. A child’s development, behavior, emotions, and health can be impacted by a TBI. Additionally, after a TBI, people may struggle with various brain processes. Examples include problems remembering information, struggles with scheduling homework, difficulties paying attention to parents and teachers, or trouble processing a play the coach suggests to the team. This article discusses how a specific type of memory, called working memory (WM), can be affected after a TBI.

Working Memory After a Traumatic Brain Injury

WM is a form of memory in which the brain holds on to small bits of information for a short time so that you can think about it or act on it in some way. Think of WM like a mental sticky note. A good example of WM is doing mental math. If you are given the problem (2 + 6) ÷ (1 + 3) to do in your head, you likely begin by adding 2 and 6 together to get 8. Next, you may add 1 and 3 together to get 4. Your WM temporarily stores 8 and 4 until you are ready to use them again, to divide 8 by 4 to get 2. WM can also be used for visual information. For example, think of the layout of your bedroom. Now imagine rearranging the furniture or getting a new chair. Where would you put everything? Your WM holds on to the mental image of your bedroom while you imagine how you could move items in it. These are some of the many ways WM can be used (If you would like to see other examples of tasks that can strengthen WM skills, check out this site).

WM is often impacted after a TBI. One group of scientists found that children who had a TBI also had problems with WM [1]. In the year after suffering a TBI, the children’s WMs were impaired regardless of each child’s age or how severe their injury was. One year after the TBI, however, children with mild or moderate TBIs showed improvements in WM. Unfortunately, children with severe TBIs continued to have WM problems even 2 years after the injury. In older children with severe TBIs, difficulties with WM were worse when there was damage to the brain’s frontal lobe (Figure 1). This study shows that many important factors can influence WM after a TBI, including age at the time of the TBI, time since injury, how severe the TBI was, and the part of the brain that was damaged. However, other research has not seen WM problems in children after TBIs [2]. Therefore, not everyone who gets a TBI has problems with WM.

WM problems can impact various areas of one’s daily life. WM is especially important for doing well in school and is related to both reading scores and success in math [3]. Children with TBIs might struggle to do the math problem we mentioned earlier. Because WM is involved in so many complex thought processes used during school, suffering from a TBI makes school-related tasks harder. After a mild TBI, such as a concussion, students are encouraged to stay home for several days. This gives them a chance to get over some of the shorter-lived symptoms, such as headache and sensitivity to light. However, once students return to school, they often still have problems with many brain processes, including WM.

Can Working Memory be Restored After Traumatic Brain Injury?

You may be wondering if WM can be repaired after a TBI. Researchers are developing methods to help. These methods are called interventions, and they include activities or mental workouts that help to restore brain functions. After a person gets a TBI, they may participate in an intervention in which they perform activities and trainings to improve WM. Some activities can be done on a computer and others involve physical tasks.

Let us explore one activity that might be used during an intervention to improve WM. First, the person sits down at a computer and sees sixteen gray squares on the screen (Figure 2A). Next, one at a time, some of the squares reveal a number (Figure 2B). Then, the numbers disappear so only the 16 gray squares are left on the screen (Figure 2C). The person doing the task must then click on the squares that had numbers appear in them, in numerical order (e.g., click on the square that showed “1” first, then the square that showed “2”). This example is from an intervention called the Cogmed intervention [4, 5]. Many other interventions are being researched, including Perception Attention THerapy (PATH) [6] and Ready Set! Let’s Train! [7]. Although current interventions are promising, much more research needs to be done to find interventions that lead to lasting improvements in WM after a TBI.

It is important to remember that people respond differently to interventions. Also, even if a person improves at intervention tasks, it does not mean their WM automatically improves. Getting better at a task the more you do it is called the practice effect. This is like practicing only your favorite song on the piano—you might get good at playing that one song, but playing one specific song well does not mean you are a great piano player yet!

Take-Home Message

TBIs can be very serious and can impact daily life. After a TBI, individuals might have problems with WM. WM is important for many aspects of daily life, including school. The severity of the injury, time since the injury, person’s age, and the part of the brain that was damaged can all impact WM after a TBI. Although researchers have developed some interventions to help repair WM in individuals who have suffered TBIs, there is still a lot of research to be done. If you ever think you might have injured your brain, it is important to talk with your parents and to go to the doctor to receive proper care.

Glossary

Traumatic Brain Injury: ↑ Injuries to the brain from a jolt, bump, or blow to the head.

Concussion: ↑ A type of mild TBI that affects brain activity after a hit to the head.

Working Memory: ↑ A form of memory that holds on to and manipulates information for a short amount of time.

Frontal Lobe: ↑ The front-most part of the brain, which is involved in many complex brain functions including working memory.

Interventions: ↑ Activities, therapies, and mental workouts used to restore certain brain functions in individuals with TBI, including working memory.

Practice Effect: ↑ Getting better at a cognitive test due to repeating the task.

Conflict of Interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

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