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Frequently Asked Qustions
A traumatic brain injury is sudden physical damage to the brain
resulting from the head forcefully hitting an object. The major
causes of traumatic brain injuries are from motor vehicle accidents.
Other causes include falls, sports injuries, violent crimes, and
child abuse.
Physical, behavioral, or mental changes are dependent upon which
areas of the brain are injured. Most often focal brain damage is
done, which is damage confined to just a small area of the brain
usually where the head has hit an object. Closed head injuries often
times causes scattered brain injuries or damage to other areas of
the brain. Diffuse damage is the result of an impact causing the
brain to move back and forth against the skull.
Frontal and temporal lobes, responsible for speech and language,
are often the most affected because they sit in the areas of the
skull that allows more room for the brain to shift and sustain injury.
Speech and language is therefore affected, as well as voice, swallowing,
walking, balancing, and coordination difficulties and changes in
the ability to smell and in memory and cognitive skills.
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Cognitive and communication problems that result from traumatic
brain injury vary from person to person, dependent on many factors,
which include an individual's personality, pre-injury abilities,
and the severity of the brain damage.
The traumatic brain injury effects are generally greatest immediately
following the injury. However, some effects from traumatic brain
injury may be misleading. The newly injured brain often suffers
temporary damage from swelling and a form of "bruising"
called contusions. These types of damage are usually not permanent
and the functions of those areas of the brain return once the swelling
or bruising goes away. Therefore, it is difficult to predict accurately
the extent of long-term problems in the first weeks following traumatic
brain injury.
Focal damage, however, may result in long-term, permanent difficulties.
Improvements can occur as other areas of the brain learn to take
over the function of the damaged areas. Children's brains are much
more capable of this flexibility than are the brains of adults.
For this reason, children who suffer brain trauma might progress
better than adults with similar damage.
In moderate to severe injuries, the swelling may cause pressure
on a lower part of the brain called the brainstem, which controls
consciousness or wakefulness. Many individuals who suffer these
types of injuries are in an unconscious state called a coma. A person
in a coma may be completely unresponsive to any type of stimulation
such as loud noises, pain, or smells. Others may move, make noise,
or respond to pain but be unaware of their surroundings. These people
are unable to communicate. Some people recover from a coma, becoming
alert and able to communicate.
In conscious individuals, cognitive impairments often include having
problems concentrating for varying periods of time, having trouble
organizing thoughts, and becoming easily confused or forgetful.
Some individuals will experience difficulty learning new information.
Still others will be unable to interpret the actions of others and
therefore have great problems in social situations. For these individuals,
what they say or what they do is often inappropriate for the situation.
Many will experience difficulty solving problems, making decisions,
and planning. Judgment is often affected.
Language problems also vary. Problems often include word-finding
difficulty, poor sentence formation, and lengthy and often faulty
descriptions or explanations. These are to cover for a lack of understanding
or inability to think of a word. Many have difficulty understanding
multiple meanings in jokes, sarcasm, and adages or figurative expressions.
Individuals with traumatic brain injuries are often unaware of their
errors and can become frustrated or angry and place the blame for
communication difficulties on the person to whom they are speaking.
Reading and writing abilities are often worse than those for speaking
and understanding spoken words. Simple and complex mathematical
abilities are often affected.
The speech produced by a person who has traumatic brain injury
may be slow, slurred, and difficult or impossible to understand
if the areas of the brain that control the muscles of the speech
mechanism are damaged. This type of speech problem is called dysarthria.
These individuals may also experience problems swallowing. This
is called dysphagia. Others may have what is called apraxia of speech,
a condition in which strength and coordination of the speech muscles
are unimpaired but the individual experiences difficulty saying
words correctly in a consistent way.
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The assessment of cognitive and communication problems is a continual,
ongoing process that involves a number of professionals. Immediately
following the injury, a neurologist or another physician may conduct
an informal, bedside evaluation of attention, memory, and the ability
to understand and speak. Once the person's physical condition has
stabilized, a speech-language pathologist may evaluate cognitive
and communication skills, and a neuropsychologist may evaluate other
cognitive and behavioral abilities. Occupational therapists also
assess cognitive skills related to the individual's ability to perform
"activities of daily living" (ADL) such as dressing or
preparing meals. An audiologist should assess hearing. All assessments
continue at frequent intervals during the rehabilitative process
so that progress can be documented and treatment plans updated.
The rehabilitative process may last for several months to a year.
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Some TBI cases are difficult to detect because even a CT scan
can show proper brain functioning when there is in fact brain damage.
Brain damage is not just a result of unconsciousness, and headaches
and mood swings are both symptoms that can come from a closed head
injury. Some symptoms may not appear until much after the injury.
Often times neurologist reserve their time for only serious head
injuries and a regular physician may not catch a problem in a routine
office visit.
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It is best to begin treatment early when cognitive and communication
problems arise from a TBI. If a hospital visit resulted from the
injury treatment usually begins there. A therapist will work with
the individual to help them focus on improving their orientation
to the surrounding situation and to stimulate speech and understanding.
Oral motor exercises are used when there is speech and swallowing
problems. Long-term rehab can be assessed by the individuals
injuries and needs. There is rehab specific to people with traumatic
brain injury, including speech language pathologists, physical therapists,
occupational therapists, and neuropsychologists.
Rehab will help a TBI sufferer reach the highest level of independent
functioning that they can, depending on the seriousness of the accident.
Therapy works on restoring lost skills. Some people lose abilities
after a traumatic brain injury and will have to learn to compensate
for them. The most difficult part of traumatic brain injury is receiving
the proper treatment. If a head injury does not result in a hospitalization
and the injury is a closed head injury, failure to diagnose a problem
during an office visit may result.
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Every 15 seconds someone in the U.S. sustains a traumatic brain
injury according to the Brain Injury Association. The traumatic
brain injuries leave about 80,000 Americans with long-term disabilities
every year, causing permanent cognitive and emotional problems.
There are currently an estimated 5.3 million Americans suffering
from disabilities because of a traumatic brain injury.
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Traumatic brain injury patients face large medical, legal and financial
issues. Some TBI sufferers may appear unharmed, especially with
a closed head injury, but may need physical, cognitive, and emotional
treatment. The Brain Injury Association estimates hospital and fatal
injury costs relating to traumatic brain injuries in the U.S. exceed
$48 billion. If you have questions regarding
a traumatic brain injury that you, or a family member, have suffered
from, please contact us.
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