Acquired brain injury is an injury to the brain that is not hereditary, present at birth, or degenerative. Causes include traumatic brain injury; anoxic/hypoxic injury (e.g. heart attack, carbon monoxide poisoning), intracranial surgery, seizure disorders and toxic exposure (e.g. substance abuse, ingestion or inhalation of volatile agents).
Traumatic brain injury with or without skull fracture is an insult to the brain caused by an external physical force that may produce a diminished or altered state of consciousness.
Brain injury may result in an impairment of cognitive abilities (e.g. perception, memory, or judgment), physical, behavioral or emotional functioning. A brain injury may be either temporary or permanent and may cause either partial or total functional impairment.
Mild brain injury, also known as concussion is an injury that may leave the person feeling dazed or cause a brief loss of consciousness. A concussion is a brain injury.
Mild brain injury can lead to "post-concussion syndrome" that can include headaches, dizziness, mild mental slowing, and fatigue. For some people, symptoms may last only a few months; for others, problems may persist indefinitely.
Adopted by the Brain Injury Association Board of Directors, March 14, 1997.
Brain Injury Characteristics:
Just as each individual is unique, so is each brain injury. Physical disabilities, impaired learning and personality changes are common. Frequently reported problems include:
Speech, Hearing, Paralysis, Headaches, Vision, Seizure Disorder, Muscle Spasticity, Reduced Endurance.
Concentration, Attention, Perceptions, Planning, Communication, Writing Skills, Short Term Memory, Long Term Memory, Judgment, sequencing, Reading Skills, Orientation.
Behavioral / Emotional Changes:
Fatigue, Anxiety, Low Self-Esteem, Restlessness, Agitation, Mood Swings, Excessive Emotions, Depression, Sexual Dysfunction, Lack of Motivation, Inability to Cope, Self-Centeredness.
Whatever the cause, a brain injury can, according to the Brain Injury Association of America, result in “an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning.” Cognitive consequences can include memory loss, slowed ability to process information, trouble concentrating, organizational problems, poor judgment, difficulty initiating activities, among others. Physical consequences can include seizures, muscle spasticity, fatigue, headaches, balance problems, among others. Emotional/behavioral consequences can include depression, mood swings, anxiety, impulsivity, agitation, among others.
Brain injury affects not only the individual, but the family, close friends, coworkers and other social networks of the individual as well. Roles and relationships change; the financial ramifications may be extensive.
Things the Family Should be Mindful of….
Reinforce the behaviors you would like to see increase.
When safety is not an issue, ignore the behavior you would like to decrease.
Model the behaviors you would like to see the individual display.
Avoid situations that provoke behaviors you are trying to reduce.
Structure the environment and setting.
Use cues for positive behaviors.
Schedule regular rest periods.
Redirect the person rather than challenging them.
Provide 2 choices to the person that are acceptable to you regardless of what is chosen.
Seek professional help sooner than later.
Glossary of Brain Injury Terms
The following list of brain injury-related terms have been identified by the Brain Injury Team at the Rehabilitation Institute of Chicago:
Agitation Uncontrolled restlessness, upset or excitement in response to internal or external factors
Arousal The change from a state of sleep to one of being awake
Aspiration: Food or liquid going into the lungs instead of the stomach
Attention: The ability to focus on a given activity
Awareness: Understanding the problems resulting from a brain injury
Cognition: Thinking or mental activity
Confabulation: Making something up that is not true (Note: the individual may believe it to be true
Distractibility: Inability to hold attention on an activity
Dysarthria: Speech that does not sound normal or is hard to understand due to a weakness of the muscles of the lips, mouth or tongue
Dysphagia: Difficulty with chewing or swallowing food or liquid
Impulsiveness: Doing or saying something too quickly, often leading to errors and difficulties
Initiation: The ability to begin an activity
Judgment: The ability to know the dangers of certain activities and to make correct decisions
Memory: Remembering and learning new things. This includes remembering what you do; remembering what others say; and remembering what you see or read.
Organization: The ability to arrange thoughts and make them sound sensible and orderly
Orientation: A sense of what is going on around you. This includes knowing the day, date, month and year; knowing things about yourself; knowing where you are and how to get around; and knowing what happened to you.
Perseveration: Inability to turn the attention from one thought to another
Pragmatics: Behaviors related to communication, such as eye contact, gestures and facial expressions
Problem solving: The ability to recognize when there is a problem and decide the best ways to correct it
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Brain Injury Tests and Procedures
The following list of brain injury-related procedures/tests have been identified by the Brain Injury Team at the Rehabilitation Institute of Chicago:
Blood Flow / Doppler
Ultrasound test used to detect clots (deep venous thrombosis) in blood vessels of the legs. Safe and painless.
Test to find heterotopic ossification (excess bone growth); involves injection of medicine followed by images obtained by a special camera. Radiation exposure is the same as a spinal x-ray.
Computerized x-ray provides images of the brain; sometimes used for suspected hydrocephalus.
Records electrical activity of the brain; can help predict risk for seizures. Safe and painless; requires a medical adhesive that may cause discomfort when removed from the hair.
EMG / NCV (Electromyogram & Nerve Conduction Studies)
Records electrical activity of muscles and nerves; used to predict risk for seizures. Safe and painless; requires an adhesive that can cause discomfort when removed from the hair.
Assesses ability of nerves to send information from the body to the brain; used to measure visual, hearing and sensory function, most often in minimally responsive patients unable to have a regular physical exam.
Gastric Tube Insertion
Provides nutrition and fluids through a tube; either surgically inserted in the stomach or inserted into the nose and throat and then down into the stomach.
Intrathecal Baclofen Trial
Surgical procedure (done by a neurosurgeon and therapist) delivers medication into the spaces around the spinal cord; sometimes used to treat spasticity.
Provides detailed brain images using magnetic energy, and not the radiation used in regular x-rays.
Nerve Block / Botulinum Toxin Injections
Used to treat spasticity by blocking nerve-to-muscle pathway and allowing the muscle to relax. Injections can be mildly uncomfortable.
Surgical procedure places a drain from ventricles of brain into abdomen to remove excess fluid in hydroencephalus. Patients are watched closely for signs of infection.
Video Swallow Assessment
X-ray measures swallowing ability. A physician and speech pathologist monitor swallowing of different substances to ensure that food is not aspirated (goes into the lungs rather than the stomach).
Internal images to view fractures in bones and look at lungs for possible pneumonia. Painless, but involves a small amount of radiation.
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Author: Brain Injury Team – Rehabilitation Institute of Chicago
The brain is the control center for the body. It manages many things such as breathing, moving and vision. The brain also controls thinking, emotions and behavior. An injury to the brain can affect almost any function of the body and can sometimes affect personality.
Each area of the brain involves different functions (see illustration), but sometimes there is overlap so that more than one location controls a function. Every brain injury is different so no two people will have identical symptoms. One person may have problems with memory and concentration while another may have weakness or paralysis of muscles. Almost any mix of symptoms or impairments can occur.
Areas of the brain
• The left side (hemisphere) controls the right side of the body and vice–versa. An injury to the right side of the brain can cause weakness or paralysis on the left side of the body.
• The ability to use language is generally controlled by the left hemisphere; damage to this area will cause difficulty with understanding or speaking.
• The back of the brain controls vision.
• The right side of the brain controls spatial skills.
• The brain stem controls basic body functions (breathing, blood pressure and swallowing).
• The front of the brain controls motivation, emotion and behavior.
• The bony skull covers the brain and helps protect it from injury.
Only a limited space for the brain exists in the skull, however. If the brain swells after traumatic brain injury, it can get compressed and damaged.
• Ventricles are hollow spaces within the brain that are filled with cerebrospinal fluid. In brain injury, the drainage system of these ventricles can get damaged. This results in a build up of fluid known as hydrocephalus.
• Traumatic brain injury often affects many parts of the brain rather than just a single region. Thus, the effects of a brain injury may not always be clearly defined but will depend on the location and the amount of damage to particular brain parts.
Symptoms of Traumatic Brain Injury
• muscle weakness or paralysis
• loss of coordination
• problems with vision or smell
• slurred speech
• difficulty swallowing,
• spasticity (severely increased muscle tone)
Cognitive (thinking) impairments
• poor memory
• lack of concentration
• slowed thinking
• inability to plan ahead
• problems with perception
Emotional and behavioral issues
• lack of awareness of problems
• poor judgment
• low motivation
• poor emotional control
Types of Non–Traumatic Brain Injury
Many different situations can cause damage to the brain. Traumatic brain injury is the most common type, but non–traumatic injury includes:
• Anoxic injury – The brain does not receive adequate oxygen, most commonly after cardiac arrest, when there is little or no blood flow to the brain. Most common results are problems with memory and muscle coordination.
• Toxic or metabolic injury – Occurs after exposure to unsafe substances, such as lead, or a harmful buildup of the body's own chemicals, as in kidney failure.
• Encephalitis – Occurs when there is an infection of the brain, most often due to a virus.
Although the consequences of non–traumatic brain injury are often similar to those seen with a traumatic brain injury, there are important differences. Discuss these differences with your health care team.
Penetrating and Non–Penetrating Brain Injuries
Traumatic brain injury occurs as a result of any strong force to the head. Penetrating and non–penetrating injuries are the two main types.
Penetrating, also known as open head injury, occurs whenever an object goes through the skull and damages the brain underneath. The most frequent causes of penetrating head injury are gunshot wounds. This type of injury usually damages specific parts of the brain and spares others. People may have fewer impairments after this type of injury than they do after non–penetrating injury.
Non–penetrating or closed head injuries occur when the skull is not significantly damaged, but the brain inside is. Examples are injuries from automobile collisions or from being struck in the head with a hard object. The impact whips the brain back and forth inside the skull. This causes twisting and tearing of delicate brain tissue, as well as bruises (contusions) where the brain knocks against the skull. Arteries and veins can be stretched and torn, causing leakage of fluid, or even bleeding. The damage in closed head injury is rarely confined to a single area. Most often, it affects large parts of the brain – especially those that control being awake and aware.
Secondary Brain Injury
Although much damage is caused by the initial impact (primary injury), additional factors can cause more problems. These are called secondary injury. Most of the care that a person receives in the hospital after a brain injury is meant to minimize the effects of secondary injury since the primary injury (the impact) has already happened.
A major cause of secondary injury is increased intracranial pressure, usually caused by swelling of the brain. Since the brain has no room to expand, it gets pressed up against the skull. This pressure causes damage to the brain tissue. In addition, the pressure can cut off blood flow to the brain, causing further damage. A number of things can help minimize brain swelling including medicines, hyperventilation on a ventilator or even surgery to open the skull and relieve some of the pressure.
Another main cause of secondary injury is bleeding in or around the brain. During the acute hospitalization, doctors watch for developing blood clots (hematomas) that can cause damage to the brain tissue directly and cause build up of dangerous amounts of pressure within the skull. This can also affect drainage in the brain and cause fluid to build up (hydrocephalus). Sometimes hematomas need to be drained surgically.
Other medical problems, which are common after trauma, can aggravate a brain injury. Low blood pressure or low blood oxygen due to breathing difficulty can cause further damage to the already–injured brain. Infections, blood abnormalities and seizures can also affect brain function.
Damage to the brain is caused by many factors in addition to the original trauma. Brain injury represents all these different factors together.
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Author: Brain Injury Team – Rehabilitation Institute of Chicago
Many medical issues may arise during hospitalization for a brain injury. Below are some of the most common complications. Please check with your health care team for additional information.
Fever and Infection
Infections are very common after a brain injury. Usually the first sign of infection is a fever. Typical locations of infections are the lungs (pneumonia) and bladder. That is tests are often needed when patients have a fever, to determine the cause. A urinalysis and culture, and an x–ray of the chest are usually done. Once the infection has been located, antibiotics are used for treatment.
Conditions other than infections can also cause fevers, such as blood clots and heterotopic bone. Sometimes the fever can be a result of the brain injury itself and an infection. This happens when the part of the brain that controls body temperature is damaged.
Blood Clots (Deep Venous Thrombosis / DVT)
DVT refers to blood clots in the legs. These clots are very common in people with brain injuries; they occur in approximately 40 percent of patients. Clots can break off from the blood vessels of the leg and travel to the lungs where they can cause severe damage or even death. For this reason, patients are monitored closely for signs of DVT. In addition, medicines (such as an injection of a blood thinner) are used to reduce the risk of DVT.
If a blood clot is suspected, the physician may order a Doppler or blood flow test. If a clot in the lung is suspected, a spiral CT scan may be ordered. In either case, blood thinning medication is used for treatment.
The risk of seizures depends on the type of injury. In people with a closed head injury, about five percent will develop seizures. In those with a penetrating injury, the percentage can approach 50 percent. A seizure occurs when a part of the brain becomes active on its own. Symptoms of the seizure depend on which area of the brain is involved. If the area of the brain that controls movement of the arm is affected, the seizure would consist of twitching or shaking of that arm. Not all seizures involve movement. Instead, they can cause an abnormal sensation in the body or changes in mental function. Usually, however, seizure in people with brain injuries can cause a loss of consciousness and shaking of the whole body.
Anti-seizure (anti-convulsant or anti–epileptic) medicines are sometimes used to help prevent seizures. The decision to use these medications is based on the risk of having a seizure and the side effects of the medication. When the risk of developing seizures is low, the physician may decide not to start a medicine, unless the patient actually has a seizure. Sometimes, results of a test known as an EEG test may be used to help make the decision.
If a patient has already had one or more seizures, especially that occurred 24 hours after the injury, anti-epileptic medicines are used, usually for six months to one year, at which time the need for them will be reassessed.
This is a build up of fluid in the hollow spaces of the brain known as ventricles. The extra fluid can squeeze the rest of the brain and cause symptoms. Symptoms are not very specific, however. Often, the first signs may be a subtle change in level of arousal or a slowing of recovery. Of course, many other factors can cause these changes.
A CT scan can help detect hydrocephalus and if so, a decision will be made in consultation with a neurosurgeon about the type of hydrocephalus and if it would improve with the placement of a shunt. Hydrocephalus is thought to occur in about five percent of people with brain injuries. The percentage is higher in those with severe brain injuries.
This is the formation of extra bone in the body, usually in the large joints such as the hip or the shoulder. It can cause pain, swelling, inflammation and tightening of the joint. No one knows for certain why people with brain injuries and other conditions are likely to develop heterotopic bone formation, however, it occurs in about 10 to 20 percent of people with brain injuries.
Diagnostic tests include x–rays, and bone scans. Treatment can include range of motion exercises, medicines or even surgery.
Fractures and Nerve Injuries
Because most people with brain injuries have been involved in trauma, for instance an automobile collision, they are likely to have other injuries as well. Approximately 30 percent of people with brain injuries have fractures and the same number have injuries to the nerves of the arms and legs. Sometimes these injuries are not discovered the rehabilitation phase of treatment for several reasons. During initial hospitalization, the focus is on life threatening conditions. More minor issues are not a priority. Also, many fractures and nerve injuries are extremely difficult to diagnose when someone is comatose or minimally conscious because the primary symptoms of these injuries are pain and difficulty moving. As a person becomes more alert, however, the team may order additional tests, such as x–rays or an EMG, (see Common Tests and Procedures) to diagnose the problem.
High Blood Pressure (Hypertension)
Fewer than 10 percent of people will have high blood pressure after a brain injury. This is usually because of damage to the part of the brain that controls blood pressure but your physician may run tests to eliminate other possible causes. Medicines to control blood pressure, called an anti–hypertensives, are sometimes used.
This is one of the most common problems faced by people with brain injuries. Certain muscles of the body are tight or hypertonic because they cannot fully relax. For instance, the elbow can be bent almost completely, so that the hand is almost to the shoulder. If one tried to straighten the elbow out, it would be extremely difficult because of the tightness. Spasticity prevents the person from using the body part and can be painful. Besides, even when the person would be unable to use the body part anyway, for instance, because it is paralyzed, the spasticity can interfere with the ability of another to provide care. For example, if the elbow is bent as described earlier, it may be impossible to dress or even clean the crook of the elbow.
Therapies play a crucial role in the treatment of spasticity. Medicines are also used to help relax the muscles. Other treatment options are nerve block, botulinum toxin injections and surgery.
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Brain Injury Fact Sheets
Who is The Brain Injury Association Of Illinois?
What is a Brain Injury?
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Website Links to Additional Material
Brain Injury Organizations and Websites
Brain Injury Association of America
Brain Injury Association of Illinois
Brain Injury Association of Illinois – Brain Injury Help Channel (Film Series)
Brain Injury Toolbox
Ask the TBI Doc
Illinois Brain & Spinal Cord Resource Center
Brain Injury Related Organizations and Websites
American Brain Tumor Association
American Stroke Association
Aneurysm and AVM Foundation
Be Smart. Be Well.
Brain Aneurysm Foundation
Brain Trauma Foundation
CDC – Centers for Disease Control and Prevention
Coma Recovery Association
National Aphasia Association
National Institutes of Health – Medline Plus
National Headache Foundation
National Institute of Neurological Disorders and Stroke
National Resource Center for TBI
The LIFE Center
Vestibular Disorders Association
Resources for the Individual and the Family
B Independent (Merchandise)
CEMM – Office of the Surgeon General
CNS – Help for Families
The TBI Guide (by Dr. Glen Johnson)
Understanding Brain Injury
Resources for the Family / Caregiver
Duke Medicine and Health
Family Caregiver Alliance
Resources for the Child / Young Adult Who has Sustained a Brain Injury
Brain Injury and the Child
A Family’s Perspective
MTV - True Life “I have a Traumatic Brain Injury”
Resources for the Elderly Individual Who Has Sustained a Brain Injury
Brain Injury and the Elderly
Brain Injury and the Military
BrainLine for Military
Defense & Veterans Brain Injury Center
Illinois Dept. of Veteran’s Affairs
The Journey Forward
Veterans Benefits Administration Benefits Fact Sheets http://www.vba.va.gov/benefit_facts/index.htm
Education and Return to School Resources
National Association of Special Education Teachers
Quick Find Online Clearinghouse
Return to School
Selecting a Brain Injury Rehabilitation Program
Brain Injury Association of America
National Disability Rights Network
Financial – Federal Benefits
Social Security Administration
Social Security Administration – Assistance completing SSDI application
Benefits Check Up
. . . . . . .
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