All About Brain Injuries
For you, your family and your loved one, it may be helpful to learn about the areas of your loved one’s brain that have been damaged, and what can happen as a result. Although a great deal is known about brain function, there is still much more to be learned.
How the Brain Works
In healthy adults, the brain is composed of neurons (nerve cells), which are basically communication fibres. Neurons carry messages throughout the brain and body, and the brain uses these messages to perform various functions, like moving, breathing, thinking, speaking, sensing, emotion, and anything else our bodies can do.
The brain is protected by cerebrospinal fluid, three linings (meninges) and the skull.
The brain itself is divided into two halves that look alike, but differ in many functions. The halves are called the cerebral hemispheres (Fig. 1). These are further divided to create four separate areas called the frontal lobe, occipital lobe, parietal lobe, and temporal lobe.
For most people, the left half of the brain controls verbal functions including language, thought and memory involving words. The right half controls nonverbal functions. These include things like recognising the difference in visual patterns and designs, reading maps and enjoying music. The right hemisphere is also involved in expressing and understanding emotions.
Although each half of the brain has distinct functions, the two parts actually work closely together to control the activity of the body. The left side of the brain controls movement and sensation in the right side of the body and the right side of the brain controls movement and sensation in the left side. Thus, damage to the right side of the brain may cause movement problems or weakness on the body’s left side.
Specific parts of the brain control specific functions. The effect of a brain injury is partially determined by the location of the injury (Fig. 2).
How Does The Brain Get Hurt?
Even though the brain is well protected, it can still be injured in many different ways. Most injuries are a result of a stroke, bruising, bleeding, twisting, or tearing of brain tissue. Damage to the brain may occur at the time of injury or it may develop after the injury due to swelling or further bleeding. It’s possible to have more than one type of brain injury.
A break in the bone that surrounds the brain. These fractures often heal on their own. Surgery may be needed if there has been damage to the brain tissue below the fracture.
A mild injury or bruise to the brain which may cause a short loss of consciousness. It may cause headaches, nausea, vomiting, dizziness, and problems with memory and concentration. This injury doesn’t need surgery.
A French word that describes contusions that result after the brain bumps into the skull after an impact. A coup occurs when the head is hit and the brain bumps into the skull at the point of impact. A contrecoup occurs when the impact causes the brain to bump into the opposite side of the skull.
A blood clot that forms between the skull and the top lining of the brain (dura). This blood clot can cause rapid changes in the pressure inside the brain. Emergency surgery may be needed depending on the size of the clot.
A blood clot that forms between the dura and the brain tissue. If this bleeding occurs quickly it is called an Acute Subdural Hematoma. If it occurs slowly over several weeks, it is called a Chronic Subdural Hematoma. The clot may cause increased pressure and may need to be removed surgically.
A blood clot deep in the middle of the brain that is hard to remove. Pressure from this clot may cause damage to the brain. Surgery may be needed to relieve the pressure.
Diffuse Axonal Injury (DAI)
Damage to the pathways (axons) that connect the different areas of the brain. This occurs when there is twisting and turning of the brain tissue at the time of injury. The messages the brain sends are slowed or lost completely. Torn axons can’t be repaired so treatment is aimed at managing swelling in the brain.
Brain Damage That Develops After An Injury
Damage to the brain may occur immediately as a result of the injury, or it may develop as a result of swelling or bleeding that follows the injury.
A normal functioning brain inside the skull looks like this:
Changes can occur as a result of brain injury. The brain tissue may swell causing it to take up more room in the skull. This is called an oedema. When this occurs, the swollen brain tissue will push the other contents of the skull to the side.
There may be bruising called contusions or a collection of blood called a hematoma or clot. This may also push the other contents of the skull to one side.
The flow of cerebrospinal fluid may also become blocked. This will cause the open spaces (ventricles) to become enlarged. This is called a hydrocephalus.
Any of these changes can cause increased intracranial pressure. That’s when the skull may become overfilled with swollen brain tissue, blood, or cerebrospinal fluid after a brain injury. The skull is like a rigid box, and will not stretch like skin does to deal with these changes. The skull may become too full and increase the pressure on the brain tissue.
What Happens To Someone With A Brain Injury?
If your loved one sustains a sudden, traumatic brain injury, it can make you feel overwhelmed and can be frightening.
The days, weeks or months after a brain injury that your loved one is in a coma, will be difficult and stressful times for you and the family. There are so many questions and uncertainties about the future.
Your loved one who has recently had a significant brain injury will understandably be going through a lot, both physically and emotionally. Each injury is different and each person is different.
Your loved one might simply roll with the punches, or may be devastated. There may be times when they’re in denial, depressed and not motivated to try to recover. There may be other times when your loved one is so anxious to get better that they’ll put in a lot of effort to attain the goal of recovery.
There may be times when your loved one needs a shoulder to cry on, a coach to push them to recover, or merely to be left alone. You, family and caregivers may at times serve as emotional punching bags for your loved one. In fact, they may feel so loved and reassured by you and the family that they feel safe enough to express feelings this way. On the other hand, your loved one may be surprisingly cheerful.
No matter how your loved one acts and reacts, they’ll need to know that you, the family and friends are available for support. This includes encouraging them, leaving them alone when asked, and making a joke to cheer them up. If your loved one does take some anger out on you or anyone else, it’s important that everyone doesn’t take it personally.
It’s also important to know and prepare for the fact that your loved one won’t be the exact same person that they were before the injury.
Tips For You And The Family
- Be with your loved one as much as you can.
- Try to think of the medical and rehabilitation staff as a team, which also includes family members, friends and anyone else who is contributing to your loved one’s recovery and wellbeing.
- Share information with them, such as nicknames and favourite music.
- Remember to thank them for their hard work.
- Keep the lines of communication open so that everyone knows the progress your loved one is making. Be positive and hopeful without misrepresenting or skewing reality.
For when you’re with your loved one
- A warm, caring touch is wonderful.
- “I love you” really helps.
- Any kind of cognitive stimulation is a good thing. Listen to music, read books aloud, sing, read the newspaper or watch sports.
- Bring the outside world to them.
- Include your loved one in the conversation, even if there is not much response.
- Talk to them, not about them.
- Play games, ask questions, and bring in puzzles.
- Review things that you did twenty years ago.
- Ask and discuss trivia questions about a vacation you have taken.
- Talk about family members.
- Dream up anything you can to get your loved one’s mind working on anything.
Mild traumatic brain injury is also called concussion. A concussion will usually resolve itself without any specific treatment, but it is important if your loved one is concussed, they don’t exert themselves, and they’re protected from any possible further injury.
Concussion is the most common head injury in sport and can occur following sudden violent movement of the head, often in a tackle or collision. Most damage is caused by rotation and acceleration (e.g. spinning of the head caused by a blow to the side of the head). It may occur with or without loss of consciousness.
Signs of concussion include:
- A vacant stare.
- Slow responses (e.g. slow to answer questions or follow instructions).
- Slurred or incoherent speech.
- Forgetting events prior to or after impact.
- Inability to focus attention (e.g. easily distracted).
- Disorientation (e.g. walking in wrong direction, unaware of time, date, place).
- Uncoordinated (e.g. stumbling, unable to walk in a straight line).
- Emotional confusion (e.g. aggressive, appearing distraught, crying for no apparent reason).
- Being dazed or stunned.
If your loved one is playing sport and shows any of these signs, they should not continue playing.
Symptoms of concussion include:
- Feelings of nausea (sickness).
- Double vision or fuzzy vision.
- Ringing in the ears.
- Any period of loss of consciousness.
- Different sized pupils.
- Sensitivity to light or noise.
- Feeling sluggish, groggy or dizzy.
- Concentration or memory problems.
It may take days or weeks to fully recover from concussion. There is no pre-determined way of knowing how long recovery will take.
If your loved one is concussed, they shouldn’t return to training or play sport for a period of three weeks after they were concussed. After this period your loved one may only resume participation when they are symptom free and have received a medical clearance.
Many symptoms are made worse by exercise so rest is advised.
About Residential Rehabilitation
Residential rehabilitation services may be funded by ACC for someone who has been injured in an accident, or funded by the Ministry of Health or a District Health Board through a Needs Assessment and Service Coordination (NASC) service. Sometimes an individual or an insurance company may pay privately.
Your loved one might be referred for residential rehabilitation services if:
- They’ve recently been injured and require short-term or medium-term residential support in preparation for going home and possibly returning to work.
- They’ve been very seriously injured and the long-term outcome is uncertain.
- They’ve been seriously injured, perhaps some time ago, and need a residential service to keep them safe and maximise their quality of life.
- They’ve got mental health issues or addiction issues as well as a brain injury.
Families and Residential Rehabilitation
It helps when you and the family are consistent, persistent, positive, hopeful and determined to be involved. We welcome and support your and your family’s frequent and ongoing participation. The team may be highly capable and very motivated, but they don’t and can’t know your loved one as well as you.
The healthcare team is an important source of education and support to your loved one, you and the family. The team can recommend a treatment plan and help you learn skills to meet your loved one’s specific needs.
The team members may include:
- Your loved one with a brain injury is the most important member of the team. Their active participation in treatment and rehabilitation is essential to their recovery, and care will be planned based on how they respond to treatment.
- You, the family and friends are also very important members of the team. You can all provide the rest of the team with important facts about your loved one’s history and can help watch for changes. The involvement of all family members, caregivers, friends and co-workers can help your loved one successfully return home and to the community.
- Registered nurses help to co-ordinate care of your loved one and support and educate you about the injury and recovery process. Nurses check people’s vitals (temperature, blood pressure, heart and breathing rate) and watch for changes in strength and thinking. They help with daily activities such as eating and bathing. They liaise with medical staff about general health matters.
- Physiotherapists evaluate and treat changes in physical abilities. Physical therapists evaluate and treat weaknesses in your loved one’s strength, flexibility, balance, rolling, sitting, standing and walking. Treatment may include exercises or instruction in use of equipment such as walkers, canes, or wheelchairs.
- Occupational therapists evaluate and treat thinking and perception problems. Occupational therapists also evaluate your loved one’s ability to dress, bathe, make a home and perform activities that require memory and organisation. They recommend treatment or equipment needed for safe, independent living.
- Speech therapists test and treat speech, language, thinking and swallowing problems.
- Clinical psychologists test thinking, memory, judgment, emotions, behaviour and personality. They use the information to help guide your loved one’s treatment.
- Dieticians assess your loved one’s nutritional needs and advise the rest of the team.
- Rehabilitation coach assistants provide support in everyday tasks and ensure that the rehabilitation programme is followed at all times of the day.
- Primary care physicians/General Practitioners (GP) look after your loved one’s general health. Your loved one’s own GP is involved as much as possible, but if there are issues with distance, another GP will look after them during residential rehabilitation.
- Medical specialists and neuropsychologists are specialists who may assist your loved one if they have particular needs.
Our peer support groups are specially formed for you and your family. It’s a social situation in which you can sit and talk with other families who also have a loved one rehabilitating from an injury, whatever the severity. You can get to know one another, share stories and offer support over coffee or dinner.
If you’re interested in joining our group, give us a call on 0800 60 80 99.