4. Understanding Non-Traumatic Brain Injury and Stroke – Brain Injury 101

>> JUDY FORTIN: This chapter covers specific facts and information about your loved one’s diagnosis of non-traumatic brain injury. >> DR. DAVID W. WRIGHT: A non-traumatic brain injury, unlike traumatic brain injury, is not caused by an external force to the head. Instead, non-traumatic brain injuries usually result from illness, infections, or tumors. Strokes are the leading cause of non-traumatic brain injury, followed by brain tumors, brain infections or inflammations, lack of oxygen or toxic poisoning.

A stroke is an interruption of the blood flow to any part of the brain caused by an artery blockage, hemorrhage or aneurysm. A decrease in blood flow results in little or no oxygen reaching brain cells. Sometimes it’s called a “brain attack.” The effects on the person depend on where in the brain the stroke occurs in the brain and how much of the brain is damaged. There are many causes for lack of oxygen to the brain. Technically called anoxia or hypoxia; it can include heart attack, airway obstruction, or near drowning.

>> DR. LEON HALEY: Physical symptoms of a non-traumatic brain injury can include difficulty coordinating balance and walking, blurred vision, headaches, trouble speaking and swallowing, and lack of bowel or bladder control. People with non-traumatic brain injury may have trouble moving their body normally – doctors call this motor impairment. This person may have seizures, vision problems, and changes in sensory perception, sleep patterns, and sexual function. Persons with non-traumatic brain injury can have personality changes, trouble communicating, and memory impairment. They may be depressed and disoriented, have mood swings, be forgetful, and have difficulty forming sentences or choosing vocabulary. They may act inappropriately, and struggle with reason, focus and logic. After a brain injury, conversation with your loved one may be difficult. He or she may have poor concentration, a limited attention span or difficulty remembering what was said.

Dr. Susan Connors, Brain Injury Assn: As the loved one of a patient with non-traumatic brain injury, it’s a good idea to prepare for these changes by developing coping skills and locating resources for support. >> DR. BRUCE DOBKIN: It’s helpful for the medical team to understand what your loved one was like before that injury so that they can get a sense of their general intellect, their general rapport with people, the things they like to do.

All of these little things can be used during rehabilitation to try to help reestablish this that quality of life that your loved one once had. >> JUDY FORTIN: The first step toward helping your loved one regain any recovery possible is to assess his or her condition using one or several diagnostic tests. >> DR. LEON HALEY: Computerized Tomography or CT scan, provides doctors with more detailed information about spinal cord or brain damage than x-rays can show. A CT scan uses computers to form a series of cross-sectional images that show damage with more accuracy. Magnetic Resonance Imaging or MRI uses a strong magnetic field and radio waves to produce computer-generated images.

An MRI can help identify blood clots, swelling, or skull fractures that may be compressing the brain and/or spinal cord. An MRI offers an even greater level of detail than a CT, although in general, CTs are more common for identifying abnormalities after brain injury. If your loved one remains in a coma, or a minimally conscious state, he or she may be assessed using the JFK Coma Recovery Scale. This scale measures everything from hearing to vision to movement to communication and arousal to help determine the patient’s long-term prognosis. The JFK scale can also be used throughout rehabilitation to gauge recovery. >> DR. SUSAN CONNORS: Once your loved one is stable and has moved on to some type of rehabilitation program, they may be given a comprehensive neuropsychological assessment.

This series of tests evaluates multiple aspects of the mind, including basic hand-eye coordination, higher-level thinking and the cognitive skills necessary for everyday functioning. These tests measure things like: Knowing and understanding where you are and what happened to you What new things you can learn How your memory was affected by the trauma What basic intelligence and language skills you have How you perceive what you see, and More complex functions like planning, abstract thinking, understanding and obeying rules, initiating appropriate actions and inhibiting or avoiding inappropriate actions. Neuropsychological assessment also focuses on a person’s psychological, personal, interpersonal thoughts, behaviors and skills. Together this assessment helps your loved one’s treatment team and doctors develop an effective plan of care for rehabilitation. >> JUDY FORTIN: Through the tests and diagnostic tools available to them, your loved one’s doctors will do their best to give you as much information as possible. Some of the words and definitions they will use will be new to you, and may be a bit overwhelming. Here are some terms you may hear and basic definitions of each: Aneurysm is the ballooning of a weakened wall of a vein, an artery or the heart caused by disease, injury or a birth defect.

Anoxia is lack of oxygen to the body and brain tissues which can cause cell damage or cell death. >> DR. DAVID W. WRIGHT: Cerebral atrophy is the loss of the brain’s neurons, or nerve cells, and the connections between them. It can be focused in one particular area of the brain or affect the whole brain, and can be caused by stroke, traumatic brain injury, or other disease. Edema is the word for swelling. After an injury, the brain swells just like any other injured body part. This swelling inside the skull can squeeze brain cells or interrupt blood flow and oxygen to brain tissue. Severe swelling can also press on the brain stem and cause death. Encephalitis is a potentially life-threatening inflammation of the brain.

>> JUDY FORTIN: A hematoma is a pool of blood or bruise inside the skull caused by damaged blood vessels. Hematomas can increase pressure inside the brain. Surgery may be needed to drain blood out of the skull. A hemorrhage is internal or external bleeding caused by damage to a blood vessel. >> DR. DAVID W. WRIGHT: Some of these types of injuries can cause increased Intracranial pressure, or ICP. Intracranial pressure can be monitored by a catheter threaded into one of the brain’s cavities or just inside the skull.

Meningitis is an infection that causes inflammation of the membranes and cerebrospinal fluid surrounding the brain and spinal cord. Shock is a body’s response to loss of blood to the brain, and may indirectly injure brain tissue. A stroke is an interruption of blood flow to a part of the brain caused by an artery blockage, hemorrhage, or aneurysm. Decreased blood flow results in little or no oxygen to the brain cells. >> JUDY FORTIN: There are three stages of consciousness. In order from least severe to most severe they are minimally conscious state, vegetative state, and coma. A minimally conscious state describes when medical professionals and perhaps family members can detect some small, consistently identifiable and deliberate behavior by the patient.

A semi-coma or vegetative state is when the patient’s eyes are open, but not always aware of themselves or their surroundings. A coma is a deep state of unconsciousness. The patient cannot be aroused, does not respond to stimuli, and cannot make voluntary actions. A patient in this state may be referred to as comatose. Comas can be medically-induced to give the brain time to heal. >> DR. DAVID W. WRIGHT: Sympathetic storming is an elevated stress response that occurs in roughly a third of traumatic brain injury patients. It can occur anytime from 24 hours to a week after injury, and is thought to be a sign of returning activity of the sympathetic, or protective nervous system. A tumor is an abnormal growth or tissue that may be benign or malignant, or in other words, cancerous. >> DR. SUSAN CONNORS: During the early weeks after injury, treatment focuses on stabilizing the patient’s physical condition, preventing complications such as pneumonia and blood clots, and addressing medical issues that arise from a brain injury.

Because brain injuries run the gamut from mild to severe, some people will only need regular follow-up appointments with a health care provider after discharge from the hospital or trauma care center. Others receive therapy, tests and monitoring on an outpatient basis. Still others may be transferred to a rehabilitation unit, or a specialized rehabilitation center. After they leave the rehabilitation facility, outpatient therapy may continue for either a short or long-term period. Medical professionals help you determine when your loved one is ready for the next step. Through rehabilitation, he or she tries to relearn basic skills like speaking, dressing and walking. The goal is to improve function so the patient can become as independent as possible. Rehabilitation encourages the body’s natural healing process through stimulating and enhancing physical and cognitive abilities, and teaching new techniques to compensate for lost skills.

Early on, rehabilitation therapy strives to keep the person safe and increase awareness of his or her surroundings. Next steps may be stretching, strengthening, balance and range of motion exercises. At first, the health care team may focus on helping your loved one relearn the basics, such as the date, time and location, as well as what happened to them. As cognitive, language and physical abilities progress, the focus shifts to improving their attention span and mobility, their memory and language skills and increasing their self-care skills. Community outings to practice skills learned in the hospital or rehabilitation facility may be included. >> JUDY FORTIN: At this time, we’ll continue on to the last chapter of the video. Chapter Five provides advice for how to deal with the injury and its consequences to your loved ones and your family. Lee Woodruff starts off the chapter. She has some great advice because she and her family have been through and survived a catastrophic brain injury themselves. It’s an important part of the video.

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