Brain Injury Association of Montana

Brain Injury Association of Montana

About Brain Injury

Results of Brain Injury
Types of Brain Injury
Types of Traumatic Brain Injury (TBI)
Symptoms of Brain Injury
Severity of TBI
Types of Impairments Caused by TBI
Recovering from TBI

Results of Brain Injury

Brain injury may result in physical, intellectual, emotional, social and vocational difficulties. These problems may affect the present and future life and the personality of the individual with the brain injury. Frequently, this means that the person may not be quite the same after the brain injury.

Brain injury is unpredictable in its consequences. The most important things to remember are:

A person with a brain injury is a person first.
No two brain injuries are exactly the same.
The effects of brain injury depend on such factors as cause, location and severity.

When a brain injury occurs, the functions of the neurons, nerve tracts, or sections of the brain can be affected. If the neurons and nerve tracts are affected, they can be unable or have difficulty carrying the messages that tell the brain what to do. This can change the way a person thinks, acts, feels, and moves the body. Brain injury can also change the complex internal functions of the body, such as regulating body temperature, blood pressure, bowel and/or bladder control. These changes can be temporary or permanent. They may cause impairment or a complete inability to perform a function.

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Types of Brain Injury

There are two types of brain injury, acquired brain injury (ABI) and traumatic brain injury (TBI).

Acquired brain injury (ABI) takes place at the cellular level within the brain, but is not hereditary, congenital, degenerative or induced by birth trauma. Acquired brain injury can affect cells throughout the entire brain instead of just in specific areas as with traumatic brain injury.

Traumatic brain injury (TBI) is an insult to the brain, not of a degenerative or congenital nature but caused by an external physical force, that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning. These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial maladjustment.

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Types of Traumatic Brain Injury (TBI)

There are two basic types of traumatic brain injury, closed head injury and open head injury. An open head injury is caused by a bullet or other penetrating object. Closed head injury is the more common of the two. It is usually caused by a rapid movement of the head during which the brain in whipped back and forth, bouncing off the inside of the skull. Closed head injuries often occur as a result of motor vehicle crashes or falls. The stress of this rapid movement pulls apart and stretches nerve fibers or axons, breaking connections between different parts of the brain. It can also cause brain "contusions" (bruises), especially in the frontal parts of the brain which help control behavior and emotions. In most cases, there may be a rupture of blood vessels causing a blood clot, or hematoma that may grow and push on the brain or around it, raising the pressure inside the head.

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Symptoms of Brain Injury

IMPORTANT NOTICE - This information is not intended to be a substitute for medical advice or examination. A person with a suspected brain injury should contact a physician immediately, go to the emergency room, or call 911 in the case of an emergency.

Symptoms of a brain injury can include, but are not limited to:

Spinal fluid (thin water-looking liquid) coming out of the ears or nose.
Loss of consciousness; however, loss of consciousness may not occur in some concussion case.
Dilated (the black center of the eye is large and does not get smaller in light) or unequal size of pupil.
Vision changes (blurred vision or seeing double, not able to tolerate bright light, loss of eye movement, blindness).
Dizziness or balance problems.
Muscle movement disorders.
Respiratory failure (not breathing).
Coma (not alert and unable to respond to others) or semi-comatose state.
Paralysis, difficulty moving body parts, weakness, poor coordination.
Slow pulse.
Slow breathing rate, with an increase in blood pressure.
Vomiting.
Lethargy (sluggish, sleepy, gets tired easily).
Headache.
Confusion.
Ringing in the ears or changes in the ability to hear.
Difficulty with thinking skills (difficulty "thinking straight", memory problems, poor judgement, poor attention span, slowed thought processing).
Severe behavior problems (psychosis, depression, restlessness, combativeness, hostility).
Inappropriate emotional responses (irritability, easily frustrated, inappropriate crying or laughing.
Difficulty speaking, slurred speech, difficulty swallowing.
Body numbness or tingling.
Loss of bowel control or bladder control.

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Severity of TBI

Mild brain injury, also know as a concussion, is experienced with at least one of the following:

Any period of loss of consciousness.
Any loss of memory of events immediately preceding and/or following the injury.
Any alteration in mental state at the time of the injury.
Focal neurological deficit(s) that may or may not be transient.

Although people with mild brain injury often do not even go to a hospital, a relatively subtle amount of reversible damage occurs, even after a mild concussion. A mild brain injury can be followed by "post-concussion syndrome" that can include temporary headaches, dizziness, mild mental slowing and fatigue.

The most important element in the management of mild brain injury is recognizing that the symptoms are real and can be treated. In fact, symptoms of mild brain injury almost always improve within six months. Another important element of mild brain injury is the proper management of resulting fatigue, with a gradual return to normal activities and/or work over time.

The most common symptoms of mild brain injury are:

Physical (headache, dizziness, nausea, sleep problems, fatigue).
Cognitive (decreased attention span, concentration, mental speed and short-term memory).
Behavioral (irritability, emotional liability, depression, anxiety).

Moderate brain injury can be identified and documented easily, but distinctions between moderate to severe brain injury are less clear-cut. Generally, a moderate brain injury is one that results in a loss of consciousness lasting only a few minutes to a few hours, followed by days or weeks of confusion.

Persons sustaining a moderate brain injury usually have physical, cognitive and/or behavioral impairments which can last for many months and even become permanent. These impairments are similar to those experienced by individuals with severe brain injury, but occur to a lesser extent. With treatment, however, individuals with moderate brain injuries generally are able to make a complete recovery or successfully learn to compensate for their deficits.

Severe brain injury almost always results in prolonged unconsciousness or coma lasting days, weeks and even months after the injury. Coma is a state of unconsciousness from which the individual cannot be awakened, in which the individual responds minimally or not at all to stimuli and initiates no voluntary activities.

Persons in coma appear to be asleep, but cannot be awakened and there is no meaningful response to stimulation. Such persons often have brain contusions, hematomas or damage to the nerve fibers or axons, and some may have sustained anoxia, or lack of oxygen to the brain. Although persons who sustain a severe brain injury can make significant improvements in the first year after the injury and continue to improve at a much slower rate for many years, these individuals often will be left with permanent physical, cognitive or behavioral impairments.

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Types of Impairments Caused by TBI

Physical impairments can include: speech, balance, vision, hearing and other sensory impairments; headaches; lack of coordination; spasticity of muscles (paralysis of one or both sides); seizure disorders and problems with sleep.

Cognitive impairments can include: short- and long-term memory deficits, slowness of thinking and difficulty maintaining attention and concentration, as well as impairments of; perception; communication; reading and writing skills; reasoning; problem solving; planning; sequencing and judgement.

Psycho-social, behavioral and emotional impairments can include; fatigue; mood swings; denial; self-centeredness; anxiety; depression; lowered self esteem; sexual dysfunction; restlessness; lack of motivation; inability to self-monitor; difficulty with emotional control and anger management; inability to cope; agitation; excessive laughing or crying and difficulty in relating to others. (Attention to behavioral disorders is particularly important after a brain injury, because they are often misunderstood and misdiagnosed.)

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Recovering from TBI

The good news is that the human brain has a remarkable capacity to naturally compensate for injury. The principle task for individuals with a brain injury, their families and caregivers is to stimulate this natural recovery and compensation and guide it in the proper directions through rehabilitation and education. The ultimate goal is to maximize recovery for each individual. The fact that a person with a brain injury may be left with a particular impairment does not mean that this also must be a disability for which they cannot compensate or which will prevent them from leading a productive and fulfilling life.

The field of brain injury rehabilitation has expanded greatly over the past few decades. Almost all individuals with brain injury would benefit from some level of specialized rehabilitation, especially in community-based programs. The various types of available services include acute and post-acute rehabilitation; behavior modification; transitional living; independent living; home a personal assistant care; and educational/vocational programs. The exact type and intensity of brain injury rehabilitation that is best for each individual depends on many factors. TBI rehabilitation is a new field and there is still much to learn. It is up to each person, their family and physician to determine what program is best suited to individual needs and aggressively pursue those options.

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