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N7GCW > VETS 21.03.05 19:19l 214 Lines 7240 Bytes #999 (0) @ WW
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Subj: Understanding Brain Injury
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Sent: 050318/1700z @:WA7V.#SEWA.WA.USA.NOAM [Walla Walla] $:40070_WA7V
UNDERSTANDING BRAIN INJURY
Although it is most common for a brain injury to occur from an accident
or fall, lasting injury to the brain can be caused by lack of oxygen
(anoxia), concussion - loss of consciousness (extended = coma), cardiac
arrest or stroke, exposure to toxic substances (street drugs, lead paint
chips, carbon monoxide), diabetic coma, near-electrocution, taking the
wrong medication or incorrect dosage, untreated spinal cord or brain
infection, criminal assaults and domestic violence.
The trauma referred to by Traumatic Brain Injury (TBI) may be from
impact to the head or from the effect of the motion of the head on the
brain. Impact injury can result from a moving object striking a
stationary head (a sign falling on someone's head) or from a moving head
striking a stationary object (tripping and striking one's head on the
sidewalk). Motion injury involves the sudden acceleration/deceleration
of the brain within the skull (whiplash from car accident).
The acceleration forces acting on the brain may be linear (transitional)
or angular (rotational). A linear force would be a baseball striking the
head and propelling the brain straight against the opposite side of the
skull. A rotational force would be any force which rapidly twists the
brain such as a rear-end car crash which occurs when the driver's head
is turned left or right. Rotational force tends to be more injurious to
the brain because the brain is built up of layers of tissue that may
fissure from rapid rotation. Impact injuries tend to cause focal
contusions (bruises) with bleeding to the brain tissue. Motion injuries
tend to cause diffuse damage to nerve fiber and junctions throughout the
brain. A given event may cause both an impact injury and a motion injury
to the brain (a crate falling off a high shelf, striking one's head and
twisting the head in the fall).
A traumatic brain injury may be closed head or open head. A closed head
injury refers to an injury that does not penetrate or fracture the
skull. An open head injury refers to the entry of a "missile" into the
brain through the skull (bullet or knife) or an inward cracking of the
skull with depression of the fractured fragments into the brain.
The trauma causing brain injury can be a one-time event (auto accident)
or cumulative events (boxing, heading soccer balls) or domestic physical
abuse. The risk of sustaining a second TBI injury geometrically
increases the scope of damage. Prevention of a second injury is very
important for all head injury survivors. This is why student athletes
must be aggressively monitored for concussion.
The following section describes areas of the brain, what they control
and what symptoms develop after and injury to that area.
Frontal Lobe: behind the forehead
Functions:
Motivation
Controls attention
Judgment
Problem solving
Decision making
Guide/control social behavior
Emotional responses/control
Expressive language
Motor integration
Voluntary movements
Problems:
Loss of simple movement of body parts (Paralysis)
Inability to plan a sequence of movements needed to complete multi-step
tasks such as making coffee (Sequencing)
Inability to focus on a task (Attending)
Difficulty with problem solving
Loss of spontaneity in interactions with others
Loss of flexibility in thinking
Persistence of a single thought (Perservation)
Inability to express language
Mood changes
Changes in social behavior
Changes in personality
-----
Parietal Lobe: near the back and top of the head
Functions:
Visual attention
Touch perception
Manipulation of objects
Awareness of spatial relationships
Academic skills (reading)
Problems:
Inability to attend to more than one object at a time
Inability to name an object (Anomia)
Inability to locate the words for writing (Agraphia)
Problems with reading
Difficulty drawing objects
Difficulty distinguishing left from right
Problems with mathematics
Lack of awareness of certain body parts and/or surrounding space that
leads to difficulties in self-care
Inability to focus visual attention
Difficulties with hand to eye coordination
-----
Occipital Lobe: back of the head
Functions:
Visual perception
Visual input
Reading (recognition of printed words)
Problems:
Defects in vision
Difficulty locating objects in current environment
Difficulty identifying colors
Hallucinations
Visual illusions - inaccurately seeing objects
Inability to recognize words
Difficulty recognizing drawn objects
Inability to recognize the movement of an object
Difficulty reading and writing
-----
Temporal Lobe: side of head above the ears
Functions:
Hearing (musical awareness)
Learning
Memory acquisition
Emotions
Problems:
Difficulty recognizing faces
Difficulty understanding spoken words
Disturbance of selective attention - visual and hearing
Difficulty identifying and verbalizing about objects
Short-term memory loss
Interference with long-term memory
Changes in sexual behavior
Inability to categorize objects
Right lobe damage can cause persistent talking
Increased aggressive behavior
-----
Brain Stem: deep in the brain - leads to spinal cord
Functions:
Breathing
Heart rate
Swallowing
Reflexes for seeing and hearing
Controls sweating, blood pressure, digestion, temperature (Autonomic
Nervous System)
Affects level of alertness
Affects ability to sleep
Sense of balance
Problems:
Decreased vital capacity for breathing - important for speech
Difficulty swallowing food and water
Difficulty with organization and perception of environment
Problems with balance and movement
Dizziness and nausea (Vertigo)
Sleeping difficulties
-----
Cerebellum: base of the back of the skull
Functions:
Coordination of voluntary movements
Balance and equilibrium
Memory for reflex motor acts
Problems:
Loss of ability to coordinate fine movements
Loss of ability to walk
Inability to reach out and grab objects
Tremors
Dizziness
Slurred speech
Inability to make rapid movements
-----
The brain functions by interrelating its component parts and uses a
network of neuron cells to send "messages" to all parts of the body. An
injury to one part of the brain disrupts the "message system" and
activity associated with that part of the brain is no longer connected
to the message network. This interruption of activity, at any particular
step, reveals problems associated with the injury. Everyone has a unique
set of neurons transmitting these messages; therefore every injury has a
unique set of associated problems.
Physical and behavioral effects of TBI present significant challenges
for rehabilitation but the cognitive deficits are often the most
difficult for the caregivers and family. Cognitive deficits are not
physically obvious and are therefore more difficult for others to
understand.
Advances in medical treatment and emergency services are providing
brain-injured patients with better diagnoses and specialized care.
Identification of the effects of a head injury is an important step in
helping the injured and their families. Rehabilitation programs include
physical restoration, psychosocial and vocational programs designed to
help the patient to live a functional life.
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