What is Brain Injury?
Brain injury has been called the "silent epidemic" since most people don't know about brain injury, let alone its consequences or how it affects people.
Acquired Brain Injury (ABI) is defined as an injury to the brain which is not hereditary, congenital or degenerative that has occurred after birth. Causes of ABI include external forces applied to the head and or neck (traumatic brain injury), anoxic/hypoxic injury (cardiac arrest, carbon monoxide poisoning, airway obstruction, hemorrhage, drowning), intracranial surgery, infectious diseases, seizure disorders, toxic exposure (substance abuse, ingestion of lead and inhalation of volatile agents) aneurysms, and vascular obstruction (stroke).
Traumatic Brain Injury (TBI) is defined as an insult to the brain, not of degenerative or congenital nature, caused by an external physical force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning. Traumatic brain injury is the leading cause of death and disability in children and young adults. Shaken Baby Syndrome is a form of traumatic brain injury.
Among all types of injury, Traumatic Brain Injury (TBI) is most likely to cause death or permanent disability.
Levels of Brain Injury
Mild
A mild brain injury is also known as a concussion.
Brief (less than 15 minutes) or NO loss of consciousness.
A dazed, vacant stare right after the injury.
Testing and scans may appear normal.
Symptoms may not appear until later. "Post concussive syndrome" can include temporary headaches, dizzines, mild mental slowing and fatigue. Symptoms of mild brain injury usually improve over 1-3 months.
Moderate
A moderate brain injury is one that results in a loss of consciousness that can last minutes or a few hours and is followed by a few days or weeks of confusion.
Physical, cognitive, and/or behavioral impairments may last for months or be permanent.
Severe
Severe brain injury almost always results in prolonged unconsciousness or coma lasting days, weeks, or months.
Unique Aspects of Traumatic Brain Injury
(Excerpts from "Gaps in Service", presented by The Texas Traumatic Brain Injury Advisory Council, March 1999)
After a TBI cognitive and behavioral needs tend to escalate. Services generally available in Texas are designed to address medical, nursing, and therapeutic needs rather than cognitive and behavioral issues.The disabilities or limitations resulting from a TBI frequently leave the individual in need of assistance in order to accomplish the basic tasks of daily living. The availability of services such as health care and rehabilitation, home and community-based support services, job training and placement, income support and education can make the difference between a wasted life and a fulfilled life in the community.
People with brain injuries do not require a prescribed set of services. Rather, they need the availability of a range of services that are designed to meet individual needs, are diverse and change over time. Ideally, services and supports should be flexible, allowing people with brain injuries and their families access to services when they need them and not just when the system offers them. Persons with a brain injury should have control over the services received. To be cost efficient, the system should allow for individuals to progress to a less restrictive environment, until they reach their maximum level of independence. If options exist in the community, these individuals can avoid stays in more-expensive institutions.
In most situations, the Standards of Care1 for providing medical services and the traditional philosophies of service delivery do not adequately address the needs of individuals with brain injuries. The effects of traumatic brain injury are very personal as brain injury impacts the personality of each individual along with the physical, medical, and cognitive. Therefore, long term effects and needs vary greatly.
Families are grasping at straws when trying to get help for their family members because the family member with the brain injury often fails to qualify for eligibility to existing services and supports. As a result, families and individuals will accept an inappropriate label such as a psychiatric diagnosis, in order to access existing services.
Short term mental health or behavioral management services may be helpful but problems often occur when the individual or the family member with a brain injury receives services only to discover the services are inappropriate for the person's needs.
Because so little has been known about the overall consequence of brain injury to the survivors or what is required for their rehabilitation, the fate of those injured has gone largely unnoticed. For this reason, it has been referred to as the "Silent Epidemic."
Most traumatic brain injuries occur as a result of motor vehicle accidents, falls, acts of violence, and sports accidents. The number of people surviving TBI with impairment has increased significantly in recent years, which is attributed to faster and more effective emergency care, quicker and safer transportation to specialized treatment facilities, and advances in acute medical management. TBI affects people of all ages and is the leading cause of long-term disability among children and young adults. Although TBI may result in physical impairment, the more problematic consequences involve the individual's cognition, emotional functioning, and behavior. These impact interpersonal relationships, school, and work. (NIH Consensus Statement, Vol. 16, No.1, October 1998)
Cognition is a complex collection of mental skills that includes attention, perception, comprehension, learning, remembering, problem solving, reasoning...These mental attributes allow us to understand our world and to function within it. After a brain injury, a person typically loses one or more of these skills. Cognitive rehabilitation is the art and science of restoring these mental processes after injury to the brain. (Parene, R. and Herman, D. [1996]. Retraining Cognition: Techniques and Applications. Aspen Publishers, Inc.)
1 Standard of Care, "A statement of actions consistent with minimum safe professional conduct under specific conditions, as determined by professional peer organizations." Tabers' Cyclopedic Medical Dictionary, Eighteenth Edition, 1997 E.A. Davis Company, pg. 1822. Also used in measuring outcomes and critical pathways for disease progression and treatment.
Head in injury is a general term indicating damage to any part of the head, including the skin covering the skull, face or jaw, or the brain itself. Brain injury is a more specific term indicating damage to brain cells, causing temporary or permanent interruption of their functioning. In order to be more precise in its terminology and its message, the National Head Injury Foundation changed its name to the Brain Injury Association in 1995. The Board of the Texas Head Injury Association followed suit, changing our name to the Brain Injury Association of Texas.