Understanding Mental & Physical Health Issues After Severe Head Injuries or a Traumatic Brain Injury
What Is a Traumatic Brain Injury?
A traumatic brain injury (TBI) comes in two forms. Either a violent blow to the head causes the brain to strike the inside of the skull, or an object penetrates the brain. This kind of injury can be very serious. It may cause bleeding or swelling of the brain and damage its nerve cells. The brain is at the center of human functioning, and an injury to it can affect the messages that it issues to the body. In turn, these kinds of injuries can affect behavior, speech, sensation, and movement.
Health Affects After a TBI
The effects on a person with TBI can vary considerably. It all depends on the severity and location of the injury.
How Is Cognition Affected?
People with TBI can experience problems with basic cognitive skills. They may have issues with attention, concentration, and memory. Their behavioral speed may slow down. This can include thinking and speech. Also, their speech may be generally impaired. They may have problems recalling the correct word and understanding what other people are saying.
The executive functions of a person’s brain may be affected by TBI. Executive functions are a group of processes that include attentional control, inhibitory control, working memory, and cognitive flexibility. They also include reasoning, problem solving, and planning. All of these processes are necessary for the cognitive control of behavior.
With some training, people who have cognitive deficits from TBI may come to compensate for them. For more information on the cognitive deficits that may accompany TBI, go to brainline.org.
Effects on Mood and Behavior
When a person suffers a traumatic brain injury, the centers in the brain that regulate a person’s social-emotional life may be affected. These changes may be so significant that the person becomes a totally different person to their friends and family. Their personality may radically change. This may change an optimist into a negative person or make a person who is conservative in their behavior into one that lacks behavioral control.
The victim of TBI may not notice the changes in their abilities and behavior. This may be because either those changes are too painful to recognize, or the neurological damage may affect their ability to evaluate things properly.
Psychiatric illness, particularly depression, can occur as a result of TBI. This seems to be because the parts of the brain most subject to trauma are the frontal and parietal lobes. These two locations in the brain are often associated with mental illness.
The changes in thinking and behavior that accompany a TBI can affect the relationships that the victim has with others. As a result of the inability to relate to others, the patient may end up feeling very lonely. This can occur because of the following reasons:
– It may be difficult for someone with a TBI simply to understand what others are saying. This can tend to make the patient feel isolated and lonely.
– The victim might feel self-conscious about their condition. They may feel that they are less capable than other people, so they shy away from interacting with others.
– The victim may lack behavioral control. This may lead them to say things that they ordinarily would not to others.
– There may be practical issues with respect to getting together with others. The patient may not be able to drive, and they may need to stop working. This means that they won’t be seeing and interacting with others as much.
TBI can also have a severe impact on marriages. The spouse of a person with a TBI many times must assume a lot of the responsibilities that the patient used to take care of. This can be with respect to employment or any other major responsibility. Also, as mentioned before, the personality of someone with a TBI can dramatically change after their injury. This may drive a wedge between the couple.
Changes in Consciousness
Moderate and severe TBI can cause changes in a person’s consciousness and awareness. Altered states of consciousness can include:
– Coma – A person in a coma is unconscious and is not responsive to any external or internal stimuli.
– Vegetative state – This is different from a coma in that the patient may be partially conscious. He or she may open their eyes or move. However, the person remains unaware of their surroundings.
– Minimally conscious state – In this condition, the patient has severely altered consciousness but may have some awareness of their surroundings.
– Locked-in syndrome – Someone in this condition is aware of their environment but cannot speak or move. They may, however, be able to blink their eyelids.
– Brain-death – This occurs when there is no activity in the brain and brainstem. If someone is in this condition, the removal of life support will cause a cessation of breathing.
Sensory Problems after a TBI
Sensory and perceptual problems can occur in the TBI patient when there is damage to the right side of the brain or the parietal and occipital lobes. TBI can disrupt the senses and affect how stimuli are perceived. This may affect any of the sensory systems. This includes the auditory, visual, tactile, olfactory, and gustatory (taste) systems.
Even more noticeable than the disruption of sensory systems are visuo-spatial problems. Problems with these skills include:
– Recognizing objects
– Distinguishing right from left
– Analyzing and remembering visual information
– Manipulating or constructing objects
– Awareness of the body in space
– Perception of the environment
A typical issue happens where the patient ignores one side of their perceptual field. This usually occurs on the left side. A patient with this issue may ignore the food on one side of the plate or be unable to copy the features from the left side of a picture.
This occurs where the patient can no longer recognize faces appropriately. People with this uncommon problem need to use other features of people to identify them, such as their voice or clothing.
People with a traumatic brain injury have a very high incidence of visual problems. This can occur with respect to vision itself or the perceptual system. More than 50% of neurologically impaired patients have visual and visual-cognitive disorders.
The following are the most devastating and impairing visual problems that result from a brain injury:
Visual Field Loss
In this condition, the patient becomes blind to half of their visual field. Further injuries can occur from bumping into objects.
This is a serious condition that can occur in patients with a brain injury. Patients who have this problem can use a patch over one eye many times to resolve the issue.
Visual Balance Disorders
These can be caused by disruptions of central and peripheral visual processing and other issues.
Vision can also be affected in many other ways. These include: Loss of vision, blurred images, and reduced depth perception.
A small percentage of victims of TBI experience seizures. In most cases, the seizures will occur soon after the injury. In a few cases, the seizures may happen even many years after the injury. There are two types of seizures that may happen. Major motor seizures involve loss of consciousness and the uncontrolled movement of the major muscle systems. Local motor seizures do not involve a loss of consciousness and have less muscular movement. There are medications that can be used to control the seizures.
In addition to the altered states of consciousness mentioned above, a traumatic brain injury can result in paralysis. This depends on the location of the brain that is affected. Spasticity is also a possible outcome of the injury.
Damage to brain tissue can also cause chronic types of pain, including headaches. There is now evidence that other body systems can be affected. These include the hormonal and endocrine systems. As a result of this, a person could lose control of their bowel and bladder functions or get a variety of other symptoms.
Doctors don’t have the ability to accurately predict the outcomes of traumatic brain injuries. The brain is very complicated, and it is hard to tell exactly which body systems and skills will be affected by the injury.
The changes that take place in the patient are dependent upon many factors. These include:
– The severity of the injury
– The patient’s age
– The amount of time spent in a coma
– The amount of time since the injury took place
– The skills that the patient needs for their particular life situation
The Process of Recovery from Traumatic Brain Injuries
The beginning of treatment for a TBI begins in the hospital. At the hospital, the team of medical professionals will generally be led by a trauma surgeon. The trauma staff will make sure that the patient’s vital signs are stable and resuscitate them if need be. The patient may need surgery for their injuries.
Once the patient is stabilized, they will be taken to the trauma care unit. There, the patient is monitored for infection and pain.
After this period, most patients will be transferred to a rehabilitation facility. The staff there specialize in the care of trauma victims. The goals of the team at the facility will be to:
– Stabilize the patient with respect to medical issues
– Prevent secondary complications, such as infections
– Restore any lost abilities
– Discuss with the patient’s family any changes in the home environment that are necessary
Every day, the patient will undergo therapy. This may be difficult at first because of the lack of certain skills. The care of the patient is directed by a physiatrist. A neuropsychologist will also make an assessment of any changes in the patient’s thinking and behavior. Other members of the team, such as a physical therapist and an occupational therapist, will help the patient with their pain and the skills that they need to adapt to their new life situation.
Surgery is often used as a treatment in cases of TBI. In cases of a closed head injury, surgery is not used. An intracranial pressure monitoring device may be put in the skull to determine pressure in the brain cavity. If there has been any bleeding there, then it may be drained. In severe cases, the surgeon may remove damaged brain tissue.
A traumatic brain injury can bring a lot of complications, both immediate and long-term. Since the brain is so complicated, it may be difficult to know the exact prognosis for how the patient’s condition and life will change. It is important to emotionally support someone with a TBI because they may feel isolated and alone when they have troubles communicating with others. With the help of a strong rehabilitation team, the patient can relearn how to do certain life activities.