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Brain Tumor / Injuries

Traumatic Brain Injury (TBI)/ Acquired Brain Injury (ABI)

Brain injury, also called acquired brain injury (ABI), is any damage to the brain that affects a person physically, cognitively, emotionally and/or behaviourally. Brain injuries can happen at birth, or later, from an illness or a trauma, and are called either traumatic or non-traumatic, depending on the specific cause.

Causes

Traumatic Brain Injury (TBI) involves external forces, like:

  • Vehicle-related collisions
  • Falls
  • Violence or gunshot wounds
  • Explosive blasts
    TBI’s do not always include an open head wound, skull fracture or even a loss of consciousness.

Non-Traumatic Brain Injury (NTBI) involves no external force or action, like:

  • Stroke (leading cause)
  • Lack of oxygen
  • Tumours
  • Other illness such as cancer
  • Brain infection or inflammation
  • Other infections

The severity of an ABI can be described as mild, moderate or severe. The level is primarily determined by the length of loss of consciousness, as well as memory loss. It does not describe or predict the expected outcomes and effects on the patient’s life.

Effects

Physical changes following a brain injury may include:

  • Headache
  • Difficulty with co-ordination & balance
  • Visual disturbances
  • Seizures
  • Changes in sensory perception
  • Trouble speaking and swallowing
  • Sleep pattern disturbances
  • Bowel and bladder control difficulties
  • Changes in sexual function
  • Motor impairment (trouble moving the body normally)

Cognitive/ Behavioural/ Emotional changes may include:

  • Confusion
  • Disorientation
  • Poor attention & concentration
  • Communication problems
  • Difficulty with reasoning, planning, organization and initiation
  • Memory impairments
  • Depression
  • Personality changes
  • Mood swings
  • Behaving inappropriately
Understanding how the brain works

It’s important to understand the complexity of the human brain. The human brain weighs approximately 1. 3 kg,  but is estimated to have about 100 billion cells. It is hard to get to grips on a number that large (or connections that small). Let’s try to understand this complexity by comparing it with something humans have created; the entire phone system for the planet. If we took all the phones in the world and all the wires, the number of connections and the trillions of messages per day would not equal the complexity or activity of a single human brain. Now let’s take a “small problem”; break every phone in Gauteng and cut every wire in the province. How long would it take for the entire province to get phone service back? A week, a month, or several years? If you guessed several years, you are now beginning to see the complexity of recovering from an acquired brain injury. In the example used, Gauteng Province residents would be without a phone service while the rest of the world had a phone service that worked. In the same way after a brain injury, some parts of the brain will work, while others are in need of repair or are slowly being reconnected.

Two Brains; Left and Right hemisphere

We have two eyes, two hands, and two legs, so why not two brains? The brain is divided in half, a right and left hemisphere.

  • The right hemisphere does a different job to the left. The right hemisphere deals more with visual activities and plays a role in putting things together. So it takes visual information, puts it together, and says “I recognize that–that’s a chair,” or “that’s a house.” It organizes or groups information together.
  • The left hemisphere tends to be the more analytical part; it analyzes information collected by the right. It takes information from the right hemisphere and applies language to it. The right hemisphere “sees” a house, but the left hemisphere says, “I know whose house that is–it’s Uncle Bob’s house.”
Problems experienced as a result of acquired brain injury

Muscle weakness, paralysis and spasticity (stiffness).

  • This may affect the whole body, only one side or just an arm or a leg. The area and pattern of involvement is related to the area of the brain that is injured and can vary greatly amongst individuals.

Problems with balance or co-ordination.

  • This makes it difficult for the person to sit, stand, or walk, even if the appropriate muscles are strong enough.

Problems using language (aphasia and dysarthria).

  • A person with aphasia may have trouble understanding speech or reading. Or, the person may understand but may not be able to think of the words to speak or write.
  • A person with dysarthria knows the right words, but has trouble pronouncing them clearly, often because of muscle involvement.

Being unaware of or ignoring things on one side of the body (bodily neglect).

  • Often, the person will not turn to look toward the weaker side, eat food from half of the plate on that side, or even write on that side of a paper.

Problems with memory, thinking, attention, or learning (cognitive problems)

  • A person may have trouble with many mental activities or just a few. For example, the person may have trouble following directions, may get confused if something in a room is moved, or may not be able to keep track of the date or time.

Being unaware of the effects of the brain injury.

  • The person may show poor judgment and try to do things without realizing that they are unsafe.

Trouble swallowing (dysphagia)

  • This can make it difficult for the person to get enough food. Also, care must sometimes be taken to prevent the person from breathing in food (aspiration) while trying to swallow it.

Problems with bowel or bladder control.

Getting tired very quickly.

  • Becoming tired very quickly may limit the person’s participation and performance in the rehabilitation programme.

Sudden bursts of emotion, such as laughing, crying, or anger.

  • These emotions may indicate that the person needs help, understanding, and support in adjusting to the effects of the brain injury. The injured person is generally not able to control these outbursts, which is very frustrating for the patient and family.

Depression

  • This is common in people who have had a brain injury. It can begin soon after the injury or many weeks later, and family members often notice it first.

Fatigue

  • An almost universal complaint that people have with head injury is fatigue.

Sleep disorders

  • Several head-injured patients suffer from some form of a sleep disorder ie not being able to sleep – “not enough sleep” or “interrupted sleep” due to the interruption of the normal brain patterns. This is rather confusing because people with head injuries can also have a fatigue disorder. You would think people with a fatigue disorder would want to sleep all the time. You can, however, have both problems.

Headaches

  • Headaches can be a serious problem following a head injury. In one study of head-injured people, 50% reported having a headache when they were discharged from the hospital. After one year, 33% of this same group of people still suffered from headaches.

Behavioural and emotional changes after brain injury are many and varied.

  • They may appear to be an exaggeration of previous personality characteristics or emotional reactions, while others may seem completely out of character for that person. This can be distressing for both the person affected and their family and friends. The cause may be directly related to the injury, part of the emotional reaction to the injury or related to biochemical changes within the brain. 

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