Abstract
Traumatic brain injury (TBI), including concussion, is the commonest neurological condition in high-income countries and is the second commonest condition next to migraines. Although most of these injuries are unintentional, substance abuse and age-related physiological factors have been implicated as causal factors of fall-related TBIs. Our study used qualitative methods and a life course perspective to examine whether life events and psychosocial antecedents, such as early adverse childhood experiences, play a role in the occurrence of non-intentional fall-related TBI. In-depth interviews were conducted with 27 patients who sustained a TBI due to unintentional falls. Transcripts were qualitatively analyzed to explore factors related to their prior life experiences that may have been related to the reasons that led to their falls. The results reveal that childhood family conflict and peer-influenced risky behaviors may have contributed to poorer mental and physical health in adulthood, which in turn contributed to injuries. Respondents whose behaviors did not play a direct role in their injury event were labeled “Stumblers.” These patients' falls were seen as being related to unfortunate unique environmental and situational factors and could colloquially be described as “accidental falls.” We also identified a distinct group of patients who had a cumulative life experience starting in early childhood that contributed to a pattern of riskier behaviors, ultimately culminating in a fall-related TBI. The second group of patients were labeled “Tumblers” as they chose to participate in risky activities, regardless of whether they considered them to be risky, which ultimately led to the fall-related TBI. This group was identified by a purposeful volitional state that sought out the “opportunity for accidental fall.” Childhood family conflict and peer-influenced risky behaviors were important precursors to mental and physical health states in this group.
Highlights
Traumatic brain injury (TBI), including concussion, is a serious global public health problem
Two pathways to fall-related TBI were identified: 1) the traditional Stumbler Pathway associated with physical and psychological vulnerabilities and situational factors, and 2) a novel Tumbler Pathway reflecting longer-term family and peer influences and dispositional factors related to active risk-taking
Tumblers played an important role in the precipitation of their own injury. This is not to imply blame, but rather to acknowledge that their life course trajectories were negatively altered by early family and peer influences, leading to increased involvement in substance abuse and risky activities, which may have contributed to their injury event
Summary
Traumatic brain injury (TBI), including concussion, is a serious global public health problem. The incidence of TBI has been increasing worldwide,[1,2,3] with an estimated 10 million cases annually.[3] In Canada, TBI is the second most prevalent neurological condition.[4]. Many of those who sustain TBI experience lifelong physical, cognitive, behavioral, and/or psychosocial impairments as well as economic burdens associated with their injuries.[5,6]. Causes of TBI can be classified as unintentional and intentional, with the commonest cause, falls,[7].
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