What is an Acquired Brain Injury?

The World Health Organization defines an acquired brain injury as:

‘Damage to the brain, which occurs after birth and is not related to a congenital or a degenerative disease.  These impairments may be temporary or permanent and cause partial or functional disability or psychosocial maladjustment.’ World Health Organization (Geneva 1996)

These are some examples of things that can cause acquired brain injuries:

  • Traumatic forces to the head which cause damage to the brain
    • Car crashes                                        
    • Gunshot wounds to the head
    • Objects falling on the head
    • Falls
    • Assaults
  • Stroke 
    • Blood flow to the brain blocked by a blood clot or a blood vessel bursting in the brain.
    • Embolism
    • Thrombosis
    • Aneurysm
  • Bleeding in the brain
    • Intracranial surgery
    • Hemorrhage
    • Hematoma
  • Lack of oxygen to the brain
    • Anoxia/hypoxia
    • Near-drowning
    • Cardiac arrest 
    • Drug overdose
  • Infections in the brain
  • Toxic exposure
    • Carbon monoxide poisoning
    • Inhaling toxic chemicals
    • Solvent sniffing
    • Excessive and prolonged use of drugs and/or alcohol
  • Fluid build-up in the brain
  • Brain tumours

Understanding Changes after Acquired Brain Injury

Acquired brain injuries can result in changes to how a person functions in the following ways:

  • Physical Changes
  • Problems with walking, sitting, transfers, bathing, household tasks
  • Slurred speech
  • Chronic pain including headaches
  • Fatigue and sleep difficulties
  • Cognitive Changes
  • Taking more time to make sense of information
  • Problems with planning, organizing or starting tasks
  • Problems with vision
  • Problems understanding conversations, coming up with the right word, talking in grammatically complete sentences
  • Lack of focus
  • Poor memory
  • Difficulty with judgement and decision making
  • Perseveration – getting ‘stuck’ on a topic, idea or activity
  • Confusion – may not know the date, year, time of day, where you are
  • Impulsivity – act before you think
  • Disinhibition – no “social filter” to tell you when you shouldn’t do or say something
  • Emotional Changes
  • Irritability – “short fuse”
  • Mood disorders like depression, anxiety, anger management problems
  • Emotional lability – crying for no apparent reason
  • Emotional or behavioural outbursts
  • “Normal” emotional responses to the incredibly devastating impact of the brain injury
  • Sadness, anger, frustration, loss of sense of self, anxiety about having another stroke or injury
  • Social Changes
  • Awkwardness or inappropriate behaviour because of difficulty reading social cues
  • Isolating yourself because you feel different and therefore leading to being treated differently
  • Trouble with social and work relationships because of awkwardness and poor coping skills
  • Family breakdowns
  • Loss of privacy, independence, future plans, income
  • Change in roles – i.e.: was a caregiver, now has to receive care from others

Understanding the Brain

Here is a simplified analogy of how the brain works:

“I find it helps to understand how the brain works if you think of the brain as a company. The company runs at peak efficiency when all the parts are working. Up at the front of the company (frontal temporal lobes) are the vice presidents, and there are several vice presidents. They make the plans for the company; they decide who is going to do what and when. As things get under way, they get feedback or information as to how well things are going and they judge it – that looks good or not so good; and they make further decisions – change that, keep this; and show appreciation or annoyance. So, up at the front you have planning, organization, decision-making, judgment and appreciation.

In the middle (parietal association cortex) are the managers and each manager runs his own department. On the left side of the brain is a speech department (move the tongue and lips and throat muscles), a language department (find the words that you want, know what the words mean) and a motor department (move the right arm and right leg). On the right side is another motor department (move the left arm and left leg), and a spatial reasoning department (find your way around a building, know where you are when driving a car, down to the basic getting your arm through a sleeve). Also over there is a music department and a few incidentals.  The right side is the picture side and the left side is the talking side.

Now the managers, they know what the plan is from the vice presidents, and they make sure it gets carried out. In order to do this, they communicate frequently with each other; they send messages back and forth.

At the bottom, (limbic region, amygdala, basal ganglia) are the workers. They don’t know what the plan is from the vice presidents, but they know their job and they do the same job day in and day out. Things like appetite control, need for water, staying alert and awake or going to sleep, and basic emotions – turn on the tears, make the face red, and increase the pulse rate.

Basically, in a brain injury, someone gets fired. It can be a vice president, a manager or a worker, depending on the injury. You can also have someone going on a leave of absence; that occurs when there is a temporary swelling or loss of blood supply that is returned in a short time. The result of the injury is to reduce the efficiency of the company. Messages are sent but are not picked up. The vice presidents get annoyed, the managers get fatigued, and the emotional workers get overwrought. Confusion reigns. A primary purpose of rehabilitation is to find out who got fired and who is still on the job, so messages can be re-routed and the company can become more and more efficient again.”

                                                                                                   Verna Amell, Ph.D.

                                                                                                          Psychologist

http://www.vch.ca/Documents/Brain-as-Company.pdf

*Reprinted with permission of the BC Rehab Society- now known as the Vancouver Hospital and Health Sciences Centre