WIXLIB

IntroductionTypes ofbrain injuriesand disordersHypoxicLack of oxygene.g. drowning, self-harmConcussionStrokeEpilepsyTraumatic brain injury(TBI)Traumatic brain injury has been defined as ‘an injury to thebrain resulting from an externally applied mechanical forcethat affects the brain and leads to loss of consciousnessor coma’ (Kay and Lezak, 1990).TBI is caused by either a blow to the head or by the headbeing forced to move rapidly forwards or backwards.Brain tissue may be torn, stretched, penetrated, bruised orbecome swollen. Oxygen may not be able to get throughto the brain cells and there may be bleeding.Common causes include motor vehicle accidents, assault,falls, sporting accidents, domestic violence, and babiesbeing shaken. The effects can be temporary or permanent,and range from mild injury, such as being momentarilystunned while playing football, to a very severe injury thatmay cause prolonged loss of consciousness.Apart from the injury to the brain caused by the initialtrauma, there are secondary effects that can arise frombleeding, bruising, lack of oxygen and increased pressurewithin the skull.Hypoxic/anoxic braininjury (lack of oxygen)Brain injury can occur when there is a reduction in(hypoxic) or complete lack of (anoxic) oxygen supply tothe brain. Oxygen is crucial to the brain as it is used tometabolise glucose, which provides energy for all bodycells. Brain cells are sensitive to the effects of restrictedoxygen supply and can die within minutes of oxygenrestriction. The immediate outcome of severe oxygenrestriction is often coma and in very severe cases braindeath.Causes include stroke, near drowning, heart attack,drug overdose, strangulation, severe asthma, accidentsinvolving anaesthesia, and carbon monoxide inhalationand poisoning. Hypoxia can also occur as a secondaryinjury following a TBI (e.g. When there is serious bloodloss resulting in low blood pressure, or as a result of brainswelling that restricts oxygen supply to areas of the brain).Recovery is similar to that of other types of brain injury,but because a hypoxic injury usually results in widespreadinjury to the brain outcomes are likely to be lower thanother brain injuries.6 Synapse Brain Injury Association of Queensland synapse.org.au

IntroductionDegenerativee.g. Alzheimer’s disease, Parkinson’sdisease, multiple sclerosisBrain tumourTraumatic brain injurye.g. motor vehicle accidents, falls, assaultDegenerative conditionsThere are a number degenerative conditions which involvebrain impairment. The more commonly known of theseare multiple sclerosis, Parkinson’s disease and Alzheimer’sdisease.In multiple sclerosis, nerve cells die when the Myelin isremoved. Myelin is a fatty coating that acts in a similarway to the plastic insulation on electrical wiring. Theexact cause is unknown, and there is no cure, althoughtreatments exist that can reduce the symptoms.Parkinson’s disease results from the loss of cells invarious parts of the brain, including an area that createsdopamine. Loss of dopamine causes neurons to firewithout normal control, leaving people less able to director control their movement. The exact cause of Parkinson’sdisease is unknown, and the single biggest risk factoris advancing age. The effects include slowness ofmovement, rigidity, tremors and balance problems.Alzheimer’s disease is the most common type ofdementia, accounting for around 50 per cent to 75 percent of dementia cases worldwide (AIHW, 2012 ). Thecauses are poorly understood, but genes play a majorrole and there is no cure. Plaques and tangles in the brainusually develop later in life and lead to problems withshort-term memory, disorientation, mood swings andbehavioural issues. The average life expectancy is three tonine years after diagnosis.Infection or diseasee.g. meningitis, encephalitisBrain tumoursBrain tumours can restrict blood supply to other cells ormay squash cells through exerting physical pressure uponthem. Infectious substances may cause cell death throughexerting pressure if the brain swells (encephalitis) or thetissue surrounding the brain swells (meningitis), or may killcells through direct infection. Viral infections may result ina widespread injury that can appear as fatigue disorderssuch as chronic fatigue syndrome.More information can be found in our factsheets at synapse.org.auReferences: AIHW (2012) Australian Institute of Health and Welfare 2012.Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW.AIHW (2007). Australian Institute of Health and Welfare. Disability in Australia:Acquired brain injury, Bulletin 55, Canberra: AIHW.Kay, T., and Lezak, M. D. (1990). The nature of head injury. In D. W. Corthell(Ed.), Traumatic brain injury and vocational rehabilitation (pp. 21-65).Menomonie, WI: University of Wisconsin Stout, Research and Training Center.synapse.org.au Brain Injury Association of Queensland The facts 7

IntroductionChildrenand brain injury:an introductionOne of the most important differences between children and adults who acquire abrain injury is that a child’s brain is still developing.After a brain injury, rehabilitation for adults primarilyfocuses on relearning lost skills. However, a childmay be yet to learn many skills, so extra support isneeded to ensure development progresses as normally aspossible.skills have already been developed. However, a child’s ageonly has a limited impact on recovery, and the key factorsare still the severity and type of brain injury, how supportivethe family is, and rehabilitation and support at school.Predicting the degree of recoverySensory and motor skills: a child might either lose somepreviously acquired skills, or have difficulty learning newskills such as holding a pen, drawing, using a keyboard,constructing and manipulating objects, using cutlery,getting dressed, recognising objects and a variety ofother hand-eye coordination activities. Other problemsmay involve mobility, balance and coordination orswallowing and speech difficulties. Professionals suchas physiotherapists, occupational therapists and speechpathologists play an important role in the assessment andrehabilitation of sensory and motor disorders.Predicting how much recovery will occur after a brain injuryis always difficult, regardless of the cause. It becomeseven more so for children as specific problems may onlybecome apparent at certain stages of development. It isimportant to provide plenty of support to prevent the childlagging behind their peers in key areas.It was thought that younger children made a greaterrecovery due to neural plasticity – the ability of thedeveloping brain to reorganise itself. Unfortunately,research suggests this isn’t the case. Children are morevulnerable after a brain injury and will take longer torecover (Catroppa et al., 2008).In general, it appears that the earlier a brain injury occurs,the more impact it will have for the child. Recoveryappears to be an easier process when basic functionalEffects of a brain injuryCognitive abilities: a brain injury may lead to a generaldecline in a number of intellectual abilities. However,similar to adults, a child may be within the normal rangeon measures of intellectual functioning and yet displaysignificant problems in specific areas of attention, memory,language, visuospatial and executive functioning.8 Synapse Brain Injury Association of Queensland synapse.org.au

with caring families and school communities, coupled withpersonal skills that enable young people to develop selfesteem and confidence. It is also helpful to have a stablefamily structure, open lines of communication, a proactiveapproach to solving problems and a good relationship withan adult outside the family – someone who believes in theyoung person.Social, behavioural and emotional issues: a child canexperience difficulties relating to peers and siblings andhave difficulty joining group activities. They can demand alot of attention from parents or teachers, and have difficultyfollowing rules and instructions. Behavioural problemsinclude: depressed or anxious mood, hyperactivity,distractibility, impulsivity, poor judgement, reduced controlof anger and frustration, mood swings, aggression, sleepdisturbance and poor motivation. There are variousrehabilitation strategies to help children manage theiremotions and behaviour. These should be introduced asearly as possible.Challenging behaviours are a normal part of growing up aschildren test their boundaries. While the effects of a braininjury can further complicate this, the appropriate adultresponse to this behaviour is the same: The best basis for helping children is a loving, caringrelationship, so it is important to see children asseparate from their behaviour and use language suchas: ‘I love you, but I don’t like what you’re doing’. Structure and routine become even more importantafter brain injury. Specific rules and structures need tobe set up for particular situations and rehearsed eachtime a similar situation comes up. Children will be encouraged to behave well whenpraised or rewarded. Challenging behaviour should notbe rewarded. Instead, adults can help children to learnfrom experience by talking about what he or she didright or wrong, and how there might be other ways ofresponding. Children will also learn to get along with others andhandle difficulties by watching how adults behave. Most importantly, young people with a brain injury mayneed very concrete, detailed and explicit instructionsand rules about what to do in particular situations.Brain injury and your child’s developmentA brain injury can disrupt normal development in termsof language and speech, learning, memory, behaviour,movement, balance and coordination. Children with a braininjury will often make good progress, even if it is limited tosome extent by the injury. Support and assistance tailoredto each child’s needs will ensure they develop to their fullestability. This is especially true at school where there can bea tendency to underestimate the degree of support neededwithin the education system.Balancing risk & independenceOne of the important things parents do is to help youngpeople learn to manage and judge risk. It is important toencourage independence and allow a manageable elementof risk, but a child’s brain injury can cause problems withanticipating danger, judging risk, or showing self-control.Research shows that important factors in protecting youngpeople from high-risk activities include a strong connectionChallenging behavioursFor more information, view our parents’ guideat synapse.org.auReference: Catroppa, C., Anderson, V. A., Morse, S. A., Haritou, F., andRosenfeld, J. V. (2008). Outcome and Predictors of Functional Recovery 5Years Following Pediatric Traumatic Brain Injury (TBI). Journal of PediatricPsychology, 33(7), 707-718. doi:10.1093/jpepsy/jsn006synapse.org.au Brain Injury Association of Queensland The facts 9IntroductionLanguage and communication: many childrenexperience receptive problems which involve difficultyprocessing different parts of spoken or written information.Comprehension problems occur when a child cannotunderstand what he or she is reading or what anotherperson is saying. Spoken or written language expressionmay be affected in terms of pronunciation, fluency,grammar, intelligibility or the meaning and retrieval of words.

IntroductionStrokeA stroke is an interruption of blood supply to part of the brain. Ifarteries become blocked, bleed or break, then the brain tissue thatwas being nourished deteriorates.When this lack of blood supply occurs to the heartit is called a heart attack. When it occurs in thebrain it is called a stroke.Types of strokeEmbolism is where an object, most commonly a bloodclot, blocks an artery. These clots can occur in other partsof the body then break up and travel to the brain wherethey lodge in the brain’s smaller blood vessels.Thrombosis is where there is a gradual closure of a bloodvessel. In a stroke, this is most commonly fatty lipidscalled plaques building up on the walls of blood vesselsand restricting blood flow. As a result symptoms usuallydevelop slowly but may be rapid in some cases.Haemorrhage is severe bleeding. There are two kindsthat can cause a stroke. An intracerebral haemorrhage iscaused by a ruptured artery leaking blood directly into thebrain. A subarachnoid haemorrhage occurs on the surfaceof the brain and the blood fills the space around the brainand creates pressure.Effects of strokeThe after-effects of a stroke vary widely for each strokevictim as different parts of the brain are responsible forthought processes, comprehension, movement and oursenses. The extent of blood shortage also determines theeffect of the stroke. A stroke may result in paralysis, lossof feeling, communication difficulties, visual problems andmany other issues depending on which part of the brain isaffected.TreatmentSurgery, drugs, acute hospital care and rehabilitation areall accepted stroke treatments depending on the type ofstroke.An example of surgery is a carotid endarterectomyto remove plaque if a neck artery is blocked. Aspirinis a common drug used for thinning the blood. Othermedications aim to dissolve clots that lead to stroke. Newtechniques continue to arise, such as cerebral angioplastywhere balloons, stents and coils are used to dilate smallintracranial arteries.10 Synapse Brain Injury Association of Queensland synapse.org.au

IntroductionRecoveryGenerally speaking, the brain does not regenerate if braintissue dies after an embolism or thrombosis. The individualmay regain some function after the pressure caused by thebleeding (haemorrhage) has decreased.Recovery after a stroke depends ona number of factors including the: type and severity of the stroke part of the brain involved extent and nature of the damage existing medical problems type of treatment andrehabilitation.Recovery usually involves a lot of relearning of activitiessuch as walking and talking. This learning can becomplicated by the fact that many people have troubleconcentrating after a stroke.InfectionsInfections, such as meningitis and encephalitis, can injurethe brain and even lead to death very quickly, so urgentmedical attention is critical.Meningitis is an inflammation of the protectivemembranes that cover the brain and spinal cord, leadingto high fever, headaches, sensitivity to light, confusion,and occasionally seizures. Vaccination of young childrenis strongly recommended as a preventative measure. Themost common causes of meningitis are viruses, bacteria,fungi, and protozoa.Encephalitis is a swelling of the brain caused byviruses or bacteria. This can occur through insectbites, contaminated food, or other existing infectionsand diseases. Symptoms include an unsteady walk,sleepiness, confusion, fever, headache, light sensitivity,seizures, paralysis and impaired cognition.EpilepsyEpilepsy involves recurring brief episodes of abnormalelectrical activity in the brain leading to either uncontrolledconvulsions and unconsciousness, or just a momentaryloss of awareness. The exact cause is unknown, butthe majority of recurring seizures can be prevented bymedications. While epilepsy is a brain disorder itself, it canalso be caused by other disorders such as a TBI or stroke.More information on injury on stroke can befound in our fact sheets at synapse.org.ausynapse.org.au Brain Injury Association of Queensland The facts 11

In the hospitalIn the hospitalIt is important to become familiar with the hospital’s departments, wards and keystaff providing treatment for acquired brain injury.Patients presenting athospital with a brain injuryare typically admitted to theneurosurgical unit under the careof a neurosurgeon. A number ofspecialists may attend patients withmultiple injuries. The specialist incharge can vary depending on theneeds of the patient. For example, incases of bone injury, an orthopaedicsurgeon will be in charge, but thepatient will have access to a range ofspecialists according to their needs.A registered nurse (RN) is alwaysavailable and assigned to patients.Understanding medicalinformationUnderstanding medical terminologycan be difficult, especially duringtimes of stress. It is important forpeople to ask questions in orderto understand what is happening.People may prefer to direct suchquestions to a person with whomthey feel comfortable, such as amember of the nursing staff, a doctoror an allied health professional. Wehave included a glossary of terms atthe back of this resource.It is common for hospitals to holdmeetings with family members andvarious members of staff involved inthe patient’s care. Family memberscan request a meeting throughthe social worker if it has not beenoffered. These meetings providea good opportunity for relativesto direct questions to specificprofessionals. It may be helpful forthose attending a meeting to writedown the most important points orquestions they wish to raise ahead oftime.AdvocacyCoping strategiesFamilies are entitled to ensure thattheir family member’s best interestsare being served. Most hospitalsprovide support for families to obtaininformation and make decisionsabout a patient’s care. The personproviding this support is often a socialworker, who will advocate for thepatient on the family’s behalf.The following ideas are designed tohelp friends and relatives come toterms with the traumatic experienceof having someone sustain a braininjury: acknowledge personal reactions tostressful experiences reduce sources of stress wherepossible accept support: whether it betalking things over or getting helpwith the housework talk with other people about yourfeelings and experiences as thiscan help you process what hashappened be aware that other familymembers may deal with thesituation differentlyInforming the patientThe focus of family members at thistime is typically the wellbeing of theirloved one, and they may be reluctantto convey potentially upsettinginformation to the injured person.Conversations about the pe

Contents The facts In the hospital 12 Brain injury: treatment and diagnosis 16 Brain injury diagnostic tests and scans 18 Recovery from a brain injury 19 Why predictions of recovery are difficult 20 Emotional recovery Rehabilitation and recovery 21 What is rehabilitation? 22 Rehabilitation tips 24 The post-reha