Hidden Injuries: Brain Health, Prevention, and Inspiring Strength
Shir Smith is a survivor.
She was born premature and had a lack of oxygen to the brain. She suffered repeated domestic violence and sexual assaults throughout her life. The pain was clear, but Smith (below) didn’t realize until much later that she had suffered invisible harm along the way.
“I came to understand that all my life I’d been experiencing the symptoms and side effects of multiple brain injuries,” Smith said. “I didn’t have any idea until an injury prevention educator came to our place of work.”
That realization brought new clarity and spurred a lifelong commitment to helping others better understand their brains and how past injuries can have current impact. Smith’s lived experiences — which include her own struggles with alcohol and methamphetamines — have given her a nuanced perspective about brain injury, its impact, and how to move forward.
“I’ve always been passionate about helping the underdog that just didn't feel they could tell their story and be believed,” Smith said. “I like to find what works for each individual and help them become comfortable in their own skin.”
Today, Smith works at the Brain Injury Association of Nebraska (BIA-NE) alongside Executive Director Peggy Reisher (below), who has seen incredible progress at the state level because of indispensable CDC funding, some of which dates back a decade or more.
“The CDC injury prevention funds we get from our state have allowed us to create system change with just a little bit of seed money,” Reisher said. "We provide brain injury training to a range of community and government providers who work with high-risk populations, including justice-involved individuals, domestic violence survivors, and those experiencing homelessness. As a result, these programs are now better equipped to help people understand and prevent brain injuries, while also identifying and supporting individuals who have been injured."
Smith, for one, has seen the impact up close.
“I realized pretty quickly that I wanted to help with screenings so we can get the data to show we're overlooking a major problem,” Smith said. “Now, we can see the problem in real life and in the numbers. This allows us to educate more people about injury prevention, as well as how to best manage symptoms and advocate for their needs.”
During her time working in jail settings, Shir also noticed an interesting phenomenon. Women who were survivors of domestic and sexual abuse began to refer their abusers — including exes and family members.
“I realized I needed to screen everybody, and have an open door for anybody that has ever had any kind of injury to their brain,” Smith said. “I have seen people change the dynamics in their life — learning to thrive and understanding they don’t have to settle, like they have been told by so many.”
Reisher’s work, and Smith’s experiences, have shown that brain injuries can occur as early as infancy, causing a lifetime of challenges. “Brain injury is often invisible and can result in lasting cognitive, emotional, and behavioral challenges that are easily misunderstood,” Reisher said. “Symptoms such as forgetfulness, emotional outbursts, or disorganization may be misinterpreted as noncompliance or poor motivation rather than signs of brain injury. Many may not even realize they’ve had a brain injury which is why it is important to educate our community as a key prevention step.”
Using additional CDC Injury Center funds, BIA-NE created a video in 2014 called Forever Shaken, which tells the story of four children in Nebraska that, as babies, were shaken and suffered head trauma. It highlights the impact of that trauma and presents key prevention strategies to keep babies safe. The video continues to be a central component of statewide education, and BIA-NE has received messages from people in other states and countries that have also used the video in their trainings.
“It is used here in Nebraska as part of the education and training that all daycare providers get, and schools are also using it,” Reisher said. “We also updated it this year with funds from injury prevention. So this little investment is teaching people in Nebraska and all around the globe. It's going to live well beyond us.”
So what do the recent funding and policy changes at the federal level mean for individuals working on these issues within local communities? Reisher said, from a systems perspective, it could make people believe there's less value in the idea of prevention. Her experience shows the exact opposite.
“Education is prevention,” Reisher emphasized. “With brain injury, we know that if you've had one, there's a greater likelihood of having another if you don't manage it. It's a cumulative effect, so we teach what to do to prevent it from happening again.”
BIA-NE also uses extensive free resources from the CDC, including materials focused on concussion awareness information for youth sports, such as the Heads Up program.
“If that's no longer being funded at the same level, this work will lose momentum because there's not going to be new information,” Reisher said. “And, at the state level, we don't necessarily have the bandwidth to do that type of research on our own without the CDC. When I think of it being gone forever, it just makes me very sad, because it's been an incredible resource for so many of us across the country.”
Smith agrees.
”The impact will be very detrimental,” she said. “I feel like they're headed in the wrong direction. But, I will continue to spread the word. I'm passionate about what I believe when it comes to brain injury. I feel like it should be top of the list, because it's our brain, for heaven's sake.”
Shir Smith is a Resource Facilitator with the Brain Injury Association of Nebraska
Peggy Reisher is the Executive Director of the Brain Injury Association of Nebraska
