Question

What You Need To Know About Brain Injury?

Dr.Haresh Sampathkumar · Accepted Answer

TYPES

Traumatic Brain Injury - Happens due to trauma
Anoxic/Hypoxic brain injury - Happens due to decreased blood or oxygen supply to the brain.
Ischemic or hemorrhagic cerebrovascular accident (commonly referred to as stroke) - Happens due to clots occluding the blood vessels in the brain or due to bleeding of blood vessels in the brain
Brain tumors and metastasis (spreading of cancer) to the brain
Vascular malformations of the brain such as Arteriovenous malformation, aneurysm etc -
Brain infections
Autoimmune conditions such as Multiple Sclerosis and auto-immune encephalitis -
Toxic/metabolic causes such as post transplantation, sepsis, liver failure and kidney failure
Basically any injury or illness that affects your brain function for a prolonged period of time causing temporary or permanant damage
SYMPTOMS

Usually individuals affected by these conditions can have a number of symptoms directly related to the brain injury such as

One-sided or both sided weakness and numbness of the arms and legs
Pain and tightness of the arms and legs
Difficulty with speech
Impaired consciousness (i.e. impaired arousal)
Cognitive impairment such as memory problems, slow thinking skills, problems with attention
Changes in their behavior such as aggression
Changes in their mood such as depression and anxiety
Difficulty in swallowing
Bladder and bowel incontinence
Visual problem
Hearing problem
MEDICAL COMPLICATIONS

There are medical complications that can be noted a few weeks or months after a brain injury. Some common ones include

Pneumonia
Urinary tract infection
Deep vein thrombosis blood clot in the veins of your arms and legs
Pulmonary embolus blood clot in your lungs
Pressure ulcers
Heterotopic ossification a condition which causes stiffness of your joints
Seizures
Post-stroke shoulder pain shoulder pain in the weak arm
Spasticity tightness of the muscles of the affected arm and leg
Paroxysmal sympathetic hyperactivity a condition which causes fluctuations in your blood pressure, heart rate, and also causes abnormal stiffness of the arms and legs
Headache
Hydrocephalus a condition where fluid builds up in your brain
HOW REHABILITATION CAN HELP?

A comprehensive, interdisciplinary team approach (i.e. care being provided by various disciplines in a coordinated fashion) with Physician (Physiatrist), Physiotherapist, Occupational Therapist, Speech and Language Therapist, Neuropsychologist, Nutritionist and a Nurse can help reduce your symptoms directly related to the injury as well as prevent and treat common medical complications post brain injury. Not all patients will require all services and usually, a combination of these services is required for an individual patient.

PHYSICIAN (PHYSIATRIST)

Patients can be evaluated by the Physician first to determine the nature and severity of the medical condition then come up with a treatment plan that best suits them. Depending on the patient s symptoms and medical complications (listed above), the treatment plan will include recommending therapy services, prescribing medications and performing injections. Medications are commonly prescribed for medical complications as well as to reduce symptoms directly related to brain injury such as arm and leg weakness, muscle tightness, speech impairment, mood and behavior issues, cognitive impairment and impaired arousal. The physician performs injections such as tendon injections, joint injections for joint or muscle pain as well as Botulinum toxin (commonly referred as Botox injections) and nerve block injections to help relieve muscle and tendon tightness.

PHYSIOTHERAPIST

A Physiotherapist will focus on various physical exercises to improve weakness in the arms and legs, improve their walking and balance and to reduce muscle tightness. They might use physical modalities to reduce pain and inflammation, muscle and tendon tightness and prevent muscle atrophy. They can also fit you with an orthosis to reduce muscle tightness as well as improve your walking and arm function.

OCCUPATIONAL THERAPIST

An Occupational Therapist will focus on various physical activities required for daily living for patients with severe physical and/or cognitive impairment and also teach cognitive exercises thereby compensating the cognitive deficits. Visual Training exercises are provided to individuals with visual impairment due to the neurological problem. The final phase of treatment involves patient training for successful community integration (education, employment etc).

SPEECH-LANGUAGE PATHOLOGIST

A Speech Language Pathologist (commonly referred to as a Speech and Language Therapist), will evaluate the patient s speech, communication and swallowing skills. The treatment plan is broken down after an initial evaluation. The program will vary depending on the extent of the injury, the stage of recovery, and the individual s particular areas of difficulty. Specific retraining and compensatory exercises are taught to improve the above skills. However, the major focus is on helping the individual gain back his/her quality of life.

NEUROPSYCHOLOGIST

A Neuropsychologist evaluates patients with depression and anxiety, that is commonly seen after any major life-changing illness or injury and guides them through the process of rehabilitation thereby improving their quality of life through motivation and counseling. Performing an in-depth cognitive assessment and planning cognitive re-training exercises and compensatory strategies is also a major treatment aspect of a Neuropsychologist.

NUTRITIONIST

Malnutrition or undernourishment is a common problem in this population. For optimal recovery, a Nutritionist recommends an appropriate intake of nutrition.

REHABILITATION NURSE

A Rehabilitation Nurse trains patients with central nervous system injury to manage their bowel and bladder independently. Performing and training wound care management for patients with pressure ulcers are also handled by a Rehabilitation Nurse.

EXPECTATIONS OF RECOVERY

Depending on the severity and chronicity (time duration since injury/illness) of the injury/illness, your recovery time may differ. Complete neurological recovery is often possible if the injury is mild to moderate. In the case of a moderate to severe injury, a complete neurological recovery may not be possible and therefore the goal will be to help you be as independent as possible and integrate you into the community despite your physical and/or cognitive limitation. If the injury is too severe, then the goal would be to improve your quality of life by helping you be as independent as possible with your day to day living, decrease pain and prevent complications.

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