BINSA Information on Brain Injury Acquired Brain Injury (ABI) There are a number of ways an individual can suffer an acquired brain injury (ABI)
Figure one - ABI causes Significant causes of ABI • Traumatic Brain Injury (TBI) Traumatic Brain Injury (TBI) is damage to the brain caused by physical forces to the head and brain. This might be a blow to the head, or the head being forced to move rapidly backwards and forwards as occurs in a high speed crash. Motor vehicle crashes, falls, assaults, sport accidents, gunshot wounds or violent shaking (particularly of a young child) all can result in injury to the brain. Page 1 of 6
BINSA Information on Brain Injury
The brain may be torn, stretched, penetrated, bruised or become swollen. Oxygen may not get through to the brain cells and there may be bleeding. The effects can be temporary or permanent, and range from mild to severe. Anyone concussed for any period of time may have some brain damage. For some people, the effect is permanent.
Figure two – TBI Other ABI causes The brain can also be damaged as a result of a stroke, alcohol or drug abuse, poisoning, infection, disease, near drowning, a sporting or work accident. Brain damage is sometimes caused by AIDS, Parkinson’s, Multiple Sclerosis and Alzheimer’s. The term Acquired Brain Injury (ABI) including TBI, is used to describe all types of brain injury, which occur after birth. ABI and TBI are not the same as intellectual disability. People with brain injuries usually retain their intellectual abilities but have difficulty controlling, coordinating and communicating their thoughts and actions. People with an ABI can make significant recovery, but their needs are different from people with intellectual disability.
Page 2 of 6
BINSA Information on Brain Injury
How Does the Brain Work? The brain is a soft, jelly-like mass. It is inside a rigid skull and is suspended and cushioned by the spinal fluid which circulates around it. It is made up of billions of nerve cells and messages are transmitted by a combination of electrical and chemical activity to control and coordinate everything we do. There are a number of parts and different parts control different functions. For example: Left and Right Cerebral Hemispheres
Figure three – How does the brain work The largest part, the cerebrum, is divided into two hemispheres joined in the centre. The left hemisphere controls speech and language, and the right controls visual information, drawing and musical appreciation. Each hemisphere enables us to feel and move the opposite side of the body. Perhaps the most important function is the integration of information from different sources, and subsequent decision making. The outcome of a brain injury will be different for each person, depending on how much damage has occurred and which part of the brain has been damaged. For example, damage to the frontal lobes may lead to difficulty in controlling emotions, while damage to the temporal lobes is likely to result in difficulty remembering new things. Damage to the parietal lobes may affect a person’s ability to tell left from right.
Page 3 of 6
BINSA Information on Brain Injury
‘The Two Kinds of Traumatic Brain Injury
Figure four – 2 kinds of brain injury There are two kinds of Traumatic Brain Injury. Closed Head Injury occurs when the head is struck. Movement of the brain is rapidly accelerated then stopped violently but the skull or membrane linings are not broken or penetrated. Damage is caused by bruising, tearing, twisting, and also hitting the inside of the skull. Open Head Injury occurs when the skull or membrane linings are exposed or penetrated. Brain swelling and bleeding can cause further damage to other parts of the body and this can result in a loss of blood and oxygen to the brain. In both types, the brain may be torn, stretched, penetrated or bruised. Apart from direct injury to brain cells by trauma or infection, brain cells are damaged by lack of oxygen. Coma In this state the person is unconscious and does not at first open his/her eyes or respond to things happening around them. This stage can last for minutes, hours, weeks or months. A few people stay in prolonged coma or emerge but remain unresponsive. Post Traumatic Amnesia (PTA) The period from injury to recovery of the ability to acquire and retain new information is known as Post Traumatic Amnesia (PTA). It includes the period of coma and a period of disorientation during which the person may remember things which happened before the accident, but not what happened a few hours or even minutes ago. They are confused about the day, time and where they are. They may be afraid, physically and verbally aggressive or exhibit sexually aggressive behaviour. They may even hallucinate, have delusions or wander. This behaviour is all due to the brain injury. Page 4 of 6
BINSA Information on Brain Injury
Too much stimulation at this time can compound the person’s confusion and distress. Length of PTA is frequently used as a guide to the severity of brain injury. In general, if this stage lasts for more than one week, ongoing cognitive problems may be expected. Chances of Recovery The outcome of TBI is difficult to predict in the early stages. It often takes time before there is enough information to assess how much recovery can be expected. Recovery is usually rapid at first, with improvements occurring as swelling and bruising in the brain subside. Improvements continue as damaged cells heal, although brain cells do not regenerate. In some cases other cells take over the job. Generally, the slower the rate of the initial improvement, the greater the chance of permanent disability. Of each 1,000 people who survive a severe brain injury: • about 2/3 of them will experience good recovery but may have some ongoing cognitive or behavioural problems • about 1/4 will have a moderate disability • about 10% will have a severe disability • about 1% will be in a permanent coma-like or persistently unresponsive state. Acute Stage This is the period of intense medical treatment immediately after the injury when the main concern is the person’s survival and medical stability. Rehabilitation Intensive therapy is designed to help the natural process of recovery and reduce the likelihood of long-term disability. There is an emphasis on helping the person to regain previous skills and overcome ongoing problems. Intensive rehabilitation may continue for many months. Community Re-entry This stage involves helping the person focus on every day living in work, study and leisure. It may involve finding ways to adapt or compensate for long-term problems and disabilities. This may take a long time.
Page 5 of 6
BINSA Information on Mild Traumatic Brain Injury
How Effective Is Therapy? For some individuals, therapies are so effective that the person can return to a happy, full life. It is important for them and their family to be optimistic, but also realistic about recovery. It is wise for families to trust their own instincts, and express their views about what is possible to the team of specialists working with the individual. Some families think that health professionals are too pessimistic. They can occasionally be proved wrong, especially when a suitable rehabilitation therapy or community support program is found. Long-term Implications ABI is often called the ‘hidden disability’ because its long-term problems are usually in the areas of thinking and behaviour. As a consequence, the difficulties that people with brain injury face may be ignored or misunderstood. Sometimes friends and family misguidedly see them as lazy or hard to get along with. There is generally very little understanding and knowledge in the community about brain injury. The long-term effects of an ABI are hard to predict and will be different for each person. Most will experience increased mental and physical fatigue, and will be process information more slowly. There are five areas in which people with an ABI may experience long-term changes
Figure five - 5 kinds of long term changes • medical difficulties • changes in physical and sensory abilities • changes in behaviour and personality • communication difficulties • cognitive difficulties (the ability to remember, plan, concentrate or solve problems). The extent of some of these changes may only become fully apparent after the person has been living at home for a while.
Page 6 of 6