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Brain Injuries

Brain injuries are often misunderstood by family members, or overlooked during the initial assessment of an injured person.

Traumatic Brain Injuries (TBI) result in permanent neurobiological damage that can produce lifelong deficits to varying degrees. Brain injuries can range in scope from mild to severe.

Moderate to severe brain injuries typically refer to injuries that have the following characteristics:
• Moderate brain injury is defined as a brain injury resulting in a loss of consciousness from 20 minutes to 6 hours, and a Glasgow Coma Scale of 9 to 12
• Severe brain injury is defined as a brain injury resulting in a loss of consciousness of greater than 6 hours, and a Glasgow Coma Scale of 3 to 8

The impact of a moderate to severe brain injury can include:
Cognitive deficits:
• Attention
• Concentration
• Distractibility
• Memory
• Speed of Processing
• Confusion
• Perseveration
• Impulsiveness
• Language Processing
• “Executive functions”

Physical Changes:
• Physical paralysis/spasticity
• Chronic pain
• Bowel and bladder control
• Sleep disorders
• Loss of stamina
• Appetite changes
• Regulation of body temperature
• Menstrual difficulties

• Dependent behaviours
• Emotional ability
• Lack of motivation
• Irritability
• Aggression
• Depression
• Disinhibition
• Denial/lack of awareness

Speech and Language:
• Not understanding the spoken word (receptive aphasia)
• Difficulty speaking and being understood (expressive aphasia)
• Slurred speech
• Speaking very fast or very slow
• Problems reading
• Problems writing

• Convulsions associated with different types of epilepsy and that can involve disruption in consciousness, sensory perception, or motor movements

• Difficulties with interpretation of touch, temperature, movement, limb position and fine discrimination

• Difficulties with the integration or patterning of sensory impressions into psychologically meaningful data

• Partial or total loss of vision
• Weakness of eye muscles and double vision (diplopia)
• Blurred vision
• Problems judging distance
• Involuntary eye movements (nystagmus)
• Intolerance of light (photophobia)

• Decrease or loss of hearing
• Ringing in the ears (tinnitus)
• Increased sensitivity to sounds

• Loss or diminished sense of smell (anosmia)

• Loss or diminished sense of taste

Further in depth information on Brain Injuries
As indicated above, Traumatic Brain Injury (TBI) can significantly affect many cognitive, physical, and psychological skills. Physical deficits 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. Adjustment to disability issues are frequently encountered by people with TBI.

With TBI the brain may be injured in a specific location or the injury may be diffused to many different parts of the brain. It is this indefinite nature of brain injury that makes treatment unique for each individual patient. All the activities we perform each day, whether physical or mental, are directed by different parts of our brains.

Mild Traumatic Brain Injury (MTBI) is characterised 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.

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 behavioural 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 personal control centre. Damage to this area can result in decreased judgement and increased impulsivity.


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