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Information About Brain Injury

What is Traumatic Brain Injury or a Head Injury?

    A brain injury is a traumatic insult to the brain.  This insult may be caused in a variety of ways, including motor vehicle accidents, falls, a blow to the head, chemical exposure, loss of oxygen to the brain (eg. near-drowning), brain tumor, substance abuse, or an infection.  One leading cause of brain injury is stroke, which are also referred to as "brain attacks".

     Although brain injury is not always visible, it may cause physical, intellectual, emotional, social and vocational changes.  These changes affect not only the present but future status of an individual.  Indeed, it frequently means that the person, as you know him or her, may never be quite the same again.

     We often refer to this population as the “walking wounded” because, although no visible damage is noted, the psychological and intellectual consequences of TBI can be devastating to that person and to those who love him or her.

     This first category is known as a closed head injury.  Its cause is often a rapid acceleration/deceleration (whereby the brain is whipped back and forth in quick motion that occurs in motor vehicle accidents.  This pull and tug places extreme stress on the brain stem - the part that connects the larger part of the brain with the spinal cord and the rest of the body.

     A large number of functions are packed tightly in the brain stem, i.e. controls of consciousness, breathing, heart beat, eye movements, pupil reactions, swallowing and facial movements.  Furthermore, all sensations going to the brain, as well as signals from the brain to the muscles, must pass through the brain stem.  The stress of rapid deceleration pulls apart nerve fibres and causes damage to the activated system of neurofibres which send out these important messages to all parts of the body.

     The second category of TBI is usually referred to as “open head injury.”  This is a visible assault and may be the result of an accident, gun shot wound or a variety of other outside factors.  TBI also may occur following cardiac arrest, stroke or accident, such as drowning and many other causes due to anoxia  (Loss of oxygen to the brain).

What are the symptoms of Traumatic Brain Injury?

    Symptoms can vary greatly and are unique, depending on the extent and location of the brain injury.  Physical disabilities, impaired learning ability and personality changes are common.

1. Physical Impairments - Speech, vision, hearing and other sensory impairments, headaches, lack of coordination, spasticity of muscles, paralysis of one or both sides and seizure disorders.

2. Cognitive Impairments - Memory deficits - short and long term concentration, slowness of thinking, attention, perception, communication, reading and writing skills, planning, sequencing and judgement.

3. Psycho-Social-Behavioral Emotional Impairments - Fatigue, mood swings, denial, self-centredness, anxiety, depression, lowered self-esteem, sexual dysfunction, restlessness, lack of motivation, inability to self-monitor, difficulty with emotional control, inability to cope, agitation, excessive laughing or crying and difficulty in relating to others.

When do we know how serious the brain injury is?

    Usually it is difficult to predict the outcome of TBI during the first hours, days or weeks.  In fact, the outcome may remain unknown for many months or years.  It is very difficult when a physician says that we just have to wait and see, but often this is the most accurate answer.  
    
     During this time, the family or loved ones of the patient need to become advocates for the patient to make certain that he is receiving the best possible care (including the current advances in treatment and rehabilitation for traumatic brain injury) so that the patient can reach his maximum potential.

     When a person is in a coma for a long time and has severe disabilities, this is referred to as severe brain injury.  The longer coma lasts, the greater the disability is likely to be.  For patients with moderate brain injury surviving six hours or less of coma, over half will be able to return to school, jobs and independent living within a year after injury, although many will have some residual cognitive (thinking and reasoning) problems.

     The process of recovery often takes much longer than family and friends expect and they find it frustrating when professionals cannot give a definite prognosis.  “The Silent Epidemic” is a term frequently used to describe TBI as this injury often is not visible and the person may look fine.

What About Minor Traumatic Brain Injury?

    Unconsciousness lasting only a few moments (concussion) may not result in brain damage or long term disability, even though an individual may be confused for several hours or days. With minor TBI, a person may have any one of several of the previous symptoms or impairments with less frequency or severity than the person with more serious head injury.

     Those with minor TBI often suffer greatly when this is not diagnosed by professionals or is not understood by their family and community. Because there is no concrete basis for their symptoms, these people often do not receive appropriate treatment or rehabilitation.

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