Traumatic Brain Injury
Traumatic brain injury (TBI) can significantly affect many cognitive, physical, and psychological skills. Physical deficit can include ambulation, balance, coordination, fine motor skills, strength, and endurance. Cognitive deficits of language and communication, information processing, memory, and perceptual skills are common. Psychological status is also often altered. Many people with TBI have difficulty adjusting to their new disability.
Brain injury can occur in many ways. Traumatic brain injuries typically result from accidents in which the head strikes an object. This is the most common type of traumatic brain injury. However, other brain injuries, such as those caused by insufficient oxygen, poisoning, or infection, can cause similar deficits.
Mild Traumatic Brain Injury (MTBI) is characterized by one or more of the following symptoms: a brief loss of consciousness, loss of memory immediately before or after the injury, any alteration in mental state at the time of the accident, or focal neurological deficits. In many MTBI cases, the person seems fine on the surface, yet continues to endure chronic functional problems. Some people suffer long-term effects of MTBI, known as post-concussion syndrome (PCS). Persons suffering from PCS can experience significant changes in cognition and personality.
Most traumatic brain injuries result in widespread damage to the brain because the brain ricochets inside the skull during the impact of an accident. Diffuse axonal injury (Figure 1) occurs when the nerve cells are torn from one another. Localized damage also occurs when the brain bounces against the skull. The brain stem, frontal lobe, and temporal lobes are particularly vulnerable to this because of their location near bony protrusions.
The brain stem is located at the base of the brain. Aside from regulating basic arousal and regulatory functions, the brain stem is involved in attention and short-term memory. Trauma to this area can lead to disorientation, frustration, and anger. The limbic system, higher up in the brain than the brain stem, helps regulate emotions. Connected to the limbic system are the temporal lobes, which are involved in many cognitive skills such as memory and language. Damage to the temporal lobes, or seizures in this area, have been associated with a number of behavioral disorders. The frontal lobe is almost always injured due to its large size and its location near the front of the cranium. The frontal lobe is involved in many cognitive functions and is considered our emotional and personality control center. Damage to this area can result in decreased judgment and increased impulsivity.
How can the brain be rehabilitated? Why do we want to do this?
As adults we lose neurons everyday due to aging. The remaining neurons set up new connections, new pathways, and the brain adapts. There are some indications from studies of persons with stroke who recover that the surrounding tissues in the brain try to take over the functions that are lost in the area of tissue destruction. So the brain does try to adapt, even in adults. It may not be as quick as in children, but it does happen.
When an individual has a significant injury to the brain, several things can cause improvement. One source of improvement is the neurochemical changes that take place. If the chemistry in the brain is disrupted, the neurons cannot function. This results in disruptions of thinking and behavior. It can take weeks or months for the brain to resolve the chemical imbalance that occurs with TBI. One reason we see progress early in recovery is because the neurochemistry is resolving and getting back to normal state. Over the long term, there can also be sprouting of dendrites in the brain. The remaining neurons sprout, establishing new connections. After a traumatic brain injury, the brain tries to recover by creating new pathways. However, that occurs only to the extent that a person is active and doing things (as in rehabilitation). The brain does not adapt if it's inactive.
Other evidence of brain recovery is seen from sequential lesions. This has been noted in individuals who have had a stroke, recovered, and then had another stroke. This is a sequential lesion. In animals, more objective studies have been done. A lesion is made to the animal's brain and the animal is allowed to heal for a month. Then another lesion is made to another part of the brain or in the area of the existing lesion. Typically, the combined, sequential lesions do not have the same impact as if a single lesion had injured the same area of tissue covered by the sequential lesions. So essentially, the brain is adapting between the two lesions. Research indicates this effect will be seen if during the interval between lesions, the animal is active, such as by being placed in a stimulating environment. If there is no stimulation, the brain does not adapt. The same is true for an individual with a brain injury. Their brain will try to recover, but in order for that to happen, they have to be active. They have to be stimulated. Rehabilitation involves stimulation.
What will I do in rehabilitation?
What you do in rehabilitation depends on what you need to become independent. You may work to improve your independence in many areas. These include:
- self-care skills such as feeding, grooming, bathing and dressing
- mobility skills such as transferring, walking or self-propelling a wheelchair
- communication skills in speech and language
- cognitive skills such as memory or problem-solving
- social skills for interacting with other people
When does rehabilitation begin?
Rehabilitation will begin when your doctor determines that you're medically stable and able to benefit from it. Referral to rehabilitation may be requested by your physician, yourself, a family member, or any other interested party, such as a social worker or case manager. At Highlands, we provide an entire spectrum of rehabilitative services, including inpatient and outpatient therapy.
What is a rehabilitation program?
Under your doctor's direction, rehabilitation specialists at Highlands come together to provide a treatment program specifically suited to your needs. Physicians who specialize in rehabilitation are called physiatrists. The number of services you receive will depend on your needs. Services may include:
- rehabilitation nursing
- physical therapy
- occupational therapy
- speech-language pathology
- recreational therapy
- nutritional care
- social work
- patient/family education
- support groups
How can I learn more?
Talk to your doctor, nurse or healthcare professional. You or your family members are welcome to come to Highlands for a tour. The best way to learn about the rehabilitation programs that we have to offer is to visit and see for yourself. No appointment is necessary.