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- Winter 2013
You, or someone you know, may have a brain injury. If so, your life has been changed. Depending on how bad this injury is, life will never return to the way it once was. This is a reality. When a person sustains a traumatic brain injury, whether from an accident, tumor, stroke, or any other cause, his or her life will never be the same. And this change is difficult.
People sometimes wonder where they can find candid answers, and others may not ask questions due to concerns over the answers they receive. The simple truth is that no one can accurately predict all eventual outcomes. This leaves family members, as well as those who have been brain injured, confused. The Brain Injury Alliance of Kentucky is appreciative to BIA-MI and BIA-WA for providing some of the following information to help answer frequently asked questions.
What is acquired brain injury?
There are currently 5.3 million Americans living with a disability caused by brain injury. Brain injury is acquired damage to the brain, the result of either an external physical force or internal causes, which results in an impairment of cognitive, emotional, and/or physical functioning. It is not of a degenerative or congenital nature but caused by an external physical force or by internal damage such as anoxia (lack of oxygen), stroke, disease, or tumor. It may produce a diminished or altered state of consciousness, which results in impairment of "thinking processes" and physical abilities. These impairments may be either temporary or permanent, and cause partial or total functional disability or psychosocial maladjustment.
What does the brain do?
The brain is the center of our body's control system. One part of the brain controls our breathing, heart and circulation. Other parts of the brain control our vision, physical movement, memory, hearing and emotions, to name a few. The brain is the most vital organ and is involved in every aspect of the body's functioning.
What is a concussion?
A concussion results from a blow to the head which causes the brain to strike the skull. A concussion does not cause any structural damage to the brain, but can cause temporary loss of functioning. Headaches, memory loss and sleep disturbance may be some of the problems suffered after such an injury.
What is a contusion?
A contusion is a more serious blow to the brain, which results in bruising of the brain and more noticeable loss of functions. More comprehensive care is required for a contusion. Follow up treatment and evaluation are required on a regular basis.
What is a skull fracture?
A skull fracture results in damage to the skin and bone of the skull as well as the brain itself. The form of medical treatment varies with the location and severity of the fracture. Close observation and follow up treatment are always required. Many skull fractures result in mild to severe problems associated with daily functioning such as walking, memory, vision and behavior.
What are "open" and "closed" head injuries?
An "open" head injury means the skull was either cracked or penetrated (such as from a bullet). A "closed" head injury is one in which the skull is intact but the brain itself is bruised or injured. A "head injury" generally refers to a traumatic force injury from an external source while a "brain injury" includes any injury to the brain from external or internal causes.
What is a hematoma?
The collection of blood in one or several locations of the brain creates a hematoma. A hematoma may occur between the skull and the covering of the brain (epidural) or may occur between the membrane covering the brain itself (subdural). Hematomas may require surgery (a craniotomy) to be performed.
What is a stroke?
Stroke is a "brain attack," cutting off vital supplies of blood and oxygen to the brain cells that control everything we do... from speaking, to walking, to breathing. A stroke happens when an artery leading to or in the brain becomes blocked or ruptures. These arteries can be blocked by blood clots (formed in the heart or elsewhere in the body) or by the gradual build-up of plaque and other fatty deposits. Brain arteries can rupture when weak spots on the blood vessel wall break. Roughly, one-third of strokes occur to individuals under the age of 65. For more information about stroke, contact the National Stroke Association website.
What is a coma?
Coma is defined as a prolonged state of unconsciousness. A person in a coma does not respond to external stimuli. There is no speech, the eyes are closed and the person cannot obey commands. Coma can last from hours to days, depending on the severity of the brain damage. It is possible for a person to remain in a comatose state for months and sometimes years. A person may eventually open his/her eyes, but if he/she remains unresponsive, the person could be in what is termed a "vegetative state."
What is a seizure?
These are electrical discharges in the brain that disturb normal brain function. They can involve changes in behavior or consciousness. Roughly one-fourth of people with brain injuries also have seizure activity.
What is medical stabilization?
Many patients with a head injury require time in the hospital for medical treatment such as recovery from surgery, healing of wounds, and setting of fractures. This is known as medical stabilization. Patients may be transferred from the emergency room or ICU to a medical floor for observation, medical treatment and the beginning of rehabilitation services such as physical therapy.
What happens after medical stabilization?
After the patient has gone through medical stabilization, which can take from several days to several months, there are a variety of directions which may be taken.
- The patient may be transferred to a physical rehabilitation unit within a general hospital, or a specialized rehabilitation treatment center providing skilled nursing care. Physical, occupational, speech/cognitive and neuropsychological services can be provided on an intensive basis.
- Some people will not require skilled nursing care and may be transferred to a community program for brain injury patients. These programs offer both inpatient and outpatient services.
- Some people will go home with their families and return to the hospital or a special outpatient program for their therapies and treatment.
- Some people who require extended skilled nursing care will be transferred to a long-term care facility.
- Some people will return home to receive therapy and "around-the-clock" nursing care.
What is rehabilitation?
Rehabilitation is the process that helps an individual reach optimum function by providing a variety of services. Rehabilitation often uses a team concept which includes services of the physicians as well as physical, occupational and speech therapists, neuropsychologists, social workers, therapeutic recreational specialists and nurses. In addition, other professionals in education and vocational training help provide treatment services. However, the most important members of the treatment team are the patient and the patient's family.
Which is the best choice?
The appropriate choice for continued treatment is a major decision to be made by the patient and family. It is important to talk to your treatment team and fully understand the patient’s needs. Each person with a brain injury is different, with a set of individual needs. You must seek out as much information as possible to educate yourself about available resources.
What do families go through?
Shock, anger, hurt, denial, and depression are some of the first reactions families experience. A loved one's brain injury can change the family's life as well. A grown and independent child may require more attention from you. An injured parent may need the assistance of adult children. As the patient goes through the stages of recovery, so does the family. Support and guidance may help you deal with changes that are ahead. The key is to take one day at a time.
What can the family expect?
Every brain injured case is different. You cannot compare brain injuries like you can a broken arm or leg. The effects of each brain injury are very individualized. There is often an onset of depression following a brain injury. No one person has all the answers. It will certainly create a sense of family changes. You must start to read and gather information on brain injury, its effects and possible treatment avenues open to you. Educating yourself is important in setting realistic expectations.
Helpful suggestions for families
- Establish a balance between pushing the person with the brain injury beyond his or her ability to function and not giving enough encouragement.
- Establish and maintain a daily routine.
- Approach the person with the injury on their good side.
- Use familiar photographs of family members, friends, pets or possessions.
- Speak of familiar names, places, interests, and activities.
- Be yourself with the individual with a brain injury.
- Do not overwhelm or overload the person with information.
- Provide the individual with ample time to respond.
- Do not present the person with a task that is too complex.
- Try to reduce confusion in his/her surroundings.
- Talk openly about his/her gains and abilities.
- Communicate with the doctors, nurses, therapists, and the brain injured individual.
- Include the person with a brain injury in jokes and respond to appropriate humor.
- Write things down. Mark any changes in your loved-one’s condition, write down questions you have for the doctors and their answers. If you have a friend or a family member who is willing, have them keep records for you.
Good Family Health
REST, REST, REST
To be an effective help to your loved one, it is recommended that you allow yourself adequate rest periods. Many times brain injury recovery is a long process and you will need lots of energy to handle the “ups” and “downs”.
You will need all the energy you can to cope, both physically and emotionally, with this traumatic situation. Try to avoid eating on the run or eating junk food. A daily well-balanced diet, including a variety of foods at regularly scheduled mealtimes is recommended.
Maintain Your Life
Unfortunately, your everyday life does not come to a standstill when someone you love experiences a brain injury. Try to balance your personal needs with the situation. Allow yourself time for hot baths, exercise and time out with friends. Your loved one is in a safe environment with professionally trained personnel.
What do I need to know when they come home?
If your loved one is discharged from rehabilitation and you live some distance from either the trauma center that treated them or the rehabilitation hospital; be sure to have copies of necessary medical records transferred to your local doctor (General Practitioner) so, in the event of a medical emergency, they will know how to treat them after the brain injury.