Brain Injury (Traumatic)
By: Family Caregiver Alliance
Traumatic brain injury, also known as brain injury or head injury, is an injury that results in damage to the brain. Brain injury may occur in one of two ways:
A closed-brain injury occurs when the moving head is stopped rapidly, as when hitting a windshield, or when it is hit by a blunt object, causing the brain to smash into the hard bony surface inside the skull. Closed brain injury may also occur without direct external trauma to the head if the brain undergoes a rapid forward or backward movement, such as when a person experiences whiplash, or when babies are shaken.
A penetrating brain injury occurs when a fast moving object such as a bullet pierces the skull.
Both closed and penetrating brain injuries may result in both localized and diffuse damage to the brain.
Each year, an estimated two million people sustain a brain injury. About 500,000 brain injuries each year are severe enough to require hospitalization. Brain injury is most common among males between the ages of 15-24, but can strike at any age. Many brain injuries are mild, and symptoms usually disappear over time with proper attention. Others are more severe and may result in permanent disability.
Cognitive deficits include shortened attention span, short-term memory problems, problem solving or judgment deficits, and the inability to understand abstract concepts. Loss of sense of time and space, as well as decreased awareness of self and others, can occur. There may also be an inability to accept more than one- or two-step commands simultaneously.
Motor deficits include paralysis, poor balance, lower endurance, reduction in the ability to plan motor movements, delays in initiation, tremors, swallowing problems, and poor coordination.
Perceptual deficits mean possible changes in hearing, vision, taste, smell and touch, loss of sensation of body parts, left or right side of body neglect. The individual may have difficulty understanding where limbs are in relation to the body.
Speech deficits most commonly include speech that is not clear as a result of poor control of the speech muscles (lips, tongue, teeth, etc.) and poor breathing patterns.
Language deficits can mean difficulty expressing thoughts and understanding others. This may include problems identifying objects and their function as well as problems with reading, writing, and ability to work with numbers. Problems with pragmatic language, decreased vocabulary and word substitution may occur. Speech therapy may be necessary to work with language problems.
Social difficulties may be apparent, such as impaired social capacity resulting in self-centered behavior in which both empathy and self-critical attitudes are greatly diminished. Brain injury can result in difficulties in making and keeping friends, as well as understanding and responding to the nuances of social interaction.
Regulatory disturbances include fatigue and/or changes in sleep patterns, dizziness or headache. There may be loss of bowel and bladder control.
Personality changes may be subtle or pronounced. Changes include apathy and decreased motivation, emotional lability, irritability, or depression. Disinhibition also may result in temper flare-ups, aggression, cursing, lowered frustration tolerance, and inappropriate sexual behavior.
Epilepsy occurs in 2 percent to 5 percent of all people who sustain brain injury, but it is much more common with severe or penetrating injuries. While most seizures occur immediately after the injury or within the first year, it is also possible for epilepsy to surface years later.
Epilepsy includes both major or generalized seizures and minor or partial seizures.
Generalized seizures, also called grand mal, are the most dramatic type of seizure. The person falls unconscious to the ground. His or her body stiffens, then jerks convulsively. The mouth, eyes, legs and arms move. Urinary incontinence is common. After several minutes, the jerking movements slow and the seizure ends. The person will likely be drowsy afterwards and may not remember the seizure.
Partial seizures, also known as "focal," may be simple (during which the person is conscious but temporarily loses control of movements or senses, such as the uncontrollable jerking of an arm or leg), or complex (during which the person appears to be in a trance and may have isolated movements, such as lip smacking or picking at their clothes). About 75 percent of seizures are partial, although many of these seizures may eventually generalize.
The extent of an individual's enduring problems after a brain injury depend on many factors. Prompt and proper diagnosis and treatment can help minimize some consequences of brain injury. However, it is usually difficult to predict the outcome of a traumatic brain injury in the first hours, days, or weeks. In fact, the outcome may remain unknown for many months or years.
Rehabilitation of the individual with a brain injury begins immediately. The initial life-saving treatment may be provided by an EMT, emergency physician, neurosurgeon or neurologist. As the person improves, a team of specialists may be used to evaluate and treat the problems that result. This team may include experts in rehabilitation medicine (physiatrists), psychiatry, nursing, neuropsychology, social work, nutrition, special education, occupational, physical, speech and language therapies, cognitive retraining, pastoral support, activity therapy, and vocational rehabilitation. The individual and his/her family are the most important members of the team, and should be included in the rehabilitation and treatment to the greatest extent possible.
There are a variety of treatment programs along the continuum of care, including: acute rehabilitation, long-term rehabilitation, coma treatment centers, late rehabilitation, extended intensive rehabilitation, transitional living programs, behavior management programs, life-long residential, day treatment programs, independent living programs, and traumatic brain injury programs within community colleges.
© Family Caregiver Alliance