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Brain Injury Page
Brain Injury (BI) is an insult to the brain that produces an
altered state of consciousness that results in impairment of cognitive
abilities, physical functioning and emotional and behavioral functioning that is
either temporary or permanent. It is not congenital or degenerative in nature
but caused by external forces.
There are three basic types:
Open Brain Injuries are a visible injury at a focal point in the brain that
causes specific problems depending on the area injured. An example of this would
be a gunshot wound that affected the speech area of the brain.
Closed Brain Injuries are from rapid acceleration and deceleration of the
brain bouncing off the skull. This is typical in motor vehicle accidents.
Acquired Brain Injury in 1997, the definition was broadened to include
an injury that occurs after birth such as stroke, Carbon Monoxide Poisoning,
infectious diseases, airway obstructions, seizure disorders and toxic exposure.
Statistics
- Brain Injury accounted for 34% of all injury deaths in the US in 1992.
- 2 million injuries occur each year.
- 3 hundred and 73 thousand are hospitalized and 99 thousand sustain moderate
to sever injuries resulting in lifelong disabilities.
- In a 1990-1993 study males ages 15-24 years and person over 75 years of age
have the highest incidence rate secondary to transportation related incidents
respectively.
- Transportation related incidents continue to be the leading cause of BI at 47 %.
- Falls account for 20-30 % and are the second leading cause.
- Interpersonal Violence is a distant third.
- Sports and Recreation are another cause of BI.
- It is important to note that over 50 % of persons who sustain a BI were intoxicated
at the time of the injury.
- Estimated costs of BI in the US are 48.3 billion annually.
Primary Injuries and Secondary Injuries
Primary injuries occur at the time of the incident. The skull is hard and
inflexible and the brain is soft like Jello. When the brain is slammed back and
forth inside the skull it is compressed and stretched. If the injury is sever
the axons are stretched until the are torn and the neurons died.
Another injury that can occur is when the brain is slammed against the bones of the skull
causing bruising and bleeding, which results in neuron death. This bruising can
occur at the site of the blow (coup) to the head and also directly opposite. (counter coup)
Lastly skull fractures can place pressure on delicate areas of the brain causing injury.
Secondary injuries include brain swelling that lead to neuron death by squeezing the
cells or disrupting the flow of blood and oxygen to the brain. A lack of oxygen to the brain
destroys brain cells.
Bleeding in the brain causes inter-cranial pressure damaging tissues and destroying neurons.
Loss of blood volume further compromises healthy tissues.
Seizures are another common secondary injury.
Pre injury factors - Usually people who are injured in during youth and early
adulthood fare better than those whose injuries occur later in life. If the person’s general health is
good then they usually fare better than a person who has poor or compromising health. The prior
history of brain injury also impacts recovery rate.
Injury factors - The severity of the injury. Is it mild moderate or sever. Also what are
the complicated medical factors such as multi system trauma, hemorrhages, seizures, coma length,
location of injury and prolonged oxygen depravation and access to acute care. The sooner care is
given the better the results.
Post injury factors - Continuum of care are important factors in a smooth transition
from Rehabilitation to IL. Psychosocial issues are important to consider. If the person is self-motivated
and has support of family friends and others they usually achieve a more positive outcome.
Functional Impact of BI
Changes in thinking after BI may include:
Lack of awareness of ones deficits, confusion about time and place, inability to recall or store
recent information, difficulty paying attention inability to learn new information, difficulty with planning
and organizing information, decision making difficulty with changes and lack of initiation.
Cognitive impairments often impact the skills needed to do normal daily activities.
Memory problems are considered to be the most enduring and disabling consequence of BI.
Memories from the past and present can be affected.
Executive functioning refers to the ability to plan, initiate, direct and monitor ones activities.
A person may not respond to the environment as we might expect. An example would be a person
who encounters problems on the job and may react by yelling rather than seeing the problem or not
being able to see solutions.
Speech and Language can be either receptive (ability to understand others or expressive
(ability to express self to others) or problems with articulation. A person can be hard to understand
due to slurring of words, halting speech or a monotone voice with no emotions.
Behavioral changes are described by survivors and family as another challenging area. Common
behavioral changes are wide emotional swings, angry outbursts, decreased frustration tolerance,
increased impulsively, self-injurious behaviors, unwanted sexual behaviors. Immature and self centeredness.
It is also important to recognize behaviors that appear to be non-problematic such as withdrawing,
lack of interest and not wanting to engage in meaningful activities as areas needing to be addressed.
A person with a BI does not experience the same attitude and emotions as he or she once did.
Coming soon are personal stories from survivors of brain injury.
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