brain injuries

What is a Brain Injury?
Brain Injury refers to any injury to the brain resulting in significant impairment of attention, cognition, language, memory, behaviour, motor skills and/ or neurological dysfunction. The injury constitutes a substantial handicap to the individual and is permanent in most cases.

What is Acquired Brain Injury?
Acquired brain injury (ABI) occurs when a sudden, external, physical assault damages the brain. It is a broad term that describes a vast array of injuries that occur to the brain. The damage can be confined to one area of the brain or occurs in more than one area of the brain. The severity of a brain injury can range from a mild concussion to a severe injury that results in coma or even death. Acquired brain injuries are often referred to as traumatic brain injuries although ABI can also be caused by a non-traumatic cause such as a tumor (growth), aneurysm (swelling in a blood vessel in the brain), anoxia (lack of oxygen) or infection.

What causes Acquired Brain Injury?
Brain injury may occur in one of two ways:

• closed brain injury
  Closed brain injuries occur when there is a non-penetrating injury to the brain with no break in the skull. A closed brain injury is caused by a rapid forward or backward movement and shaking of the brain inside the bony skull that results in bruising and tearing of brain tissue and blood vessels. Closed brain injuries are usually caused by car accidents and falls. Shaking a baby can also result in this type of injury (called shaken baby syndrome).
• penetrating brain injury
  Penetrating, or open head injuries occur when there is a break in the skull, such as when a bullet pierces the brain.

There are many causes of head injury in children and adults. The most common injuries are from motor vehicle accidents (where the person is either riding in the car or is struck as a pedestrian or (motor)cyclist), from violence, from falls, or as a result of shaking a child (as seen in cases of child abuse). Brain injuries can also be caused by infections or tumors in the brain, when the brain does not receive enough oxygen (anoxia) or as a result of a ‘brain’ attack      (aneurysm)

What are the Possible Results of Brain Injury?
Some brain injuries are mild, with symptoms disappearing over time with proper attention. Others are more severe and may result in permanent disability. The long-term or permanent results of brain injury may require post-injury and possibly life-long rehabilitation.

Possible effects of brain injury are:

• cognitive problems such as confusion; memory problems and memory loss (amnesia); shortened attention span; difficulties with problem solving; inability to handle more than one- or two-step commands at the same time; inability to understand abstract concepts; problems with judgment; loss of sense of time and space; decreased awareness of self and others; coma.
• motor problems such as poor coordination; poor balance; problems with swallowing; easily fatigued; delays in initiation of movement; spasticity (tightening and shortening of the muscles); shaking (tremors); inability to plan movements; paralysis or weakness.
• sensory problems such as changes in hearing, vision, taste, smell, and touch; loss of feeling or heightened sensation of body parts; difficulty positioning limbs in relation to the body; problems with eye-sight(e.g. double vision, blurry vision, or limited range of vision)
• communication problems such as slow, hesitant speech and decreased vocabulary; difficulty forming sentences that make sense; problems identifying objects and their function; difficulty speaking and understanding speech (aphasia); difficulty choosing the right words to say (apraxia); problems with reading, writing, and ability to work with numbers
• social difficulties such as difficulties in making and keeping friends; difficulties understanding and responding to the nuances of social interaction
• personality changes such as irritability; anxiety and depression; lack of interest & feelings (apathy); emotional lability; decreased motivation; disinhibition, including temper flare-ups, aggression, cursing, lowered frustration tolerance, and inappropriate sexual behaviour

Can the Brain Heal after being Injured?
Most studies suggest that once brain cells are destroyed or damaged, for the most part, they do not regenerate. However, recovery after brain injury can take place, as, in some cases, other areas of the brain compensate for the injured tissue, or the brain learns to reroute information and function around the damaged areas. The exact amount of recovery is not predictable at the time of injury and may be unknown for months or even years. Each brain injury and rate of recovery is unique. Recovery from a severe brain injury often involves a prolonged or life-long process of treatment and rehabilitation.

The Brain Injury Rehabilitation Program
Rehabilitation of the patient with a brain injury begins during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun. The success of rehabilitation depends on many variables, such as the nature and severity of the brain injury; the type and degree of any resulting impairments and disabilities; overall health of the patient; and family support.

The goal of brain injury rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life on a  physical, emotional, and social level. The rehabilitation will focus on maximizing the patient's capabilities at home and in the community. Positive reinforcement helps recovery by improving self-esteem and promoting independence.

Most rehabilitation programs work on many different skills such as:

• Self-care: Feeding, grooming, bathing, dressing, toileting, sexual functioning, diet & nutrition, and medications
• Mobility: Walking, transfers, and driving a wheelchair
• Communication: Speech, writing, and alternative methods of communication
• Cognition: Memory, concentration, judgment, problem solving, and organizational skills

Apart from revalidating the above-mentioned skills, most programs also incorporate the following components:

• Psycho- Education: Patient and family education and training about brain injury, safety issues, home care needs, and adaptive techniques
• Psychological testing and counselling: To identify problems and solutions with thinking, behavioural, and emotional issues
• Pain management: Medications and alternative methods of managing pain
• Family support: Assistance with adaptation to lifestyle changes, financial concerns, and discharge planning