Brain Injury: FAQ

What is a brain injury?
Brain injuries can occur suddenly and without warning. In the United States, more than two million traumatic brain injuries occur each year. It is estimated that approximately 70,000 to 90,000 people survive a serious traumatic brain injury every year but are left with significant physical, intellectual, emotional, behavioral, social and vocational impairments.

Traumatic Brain Injuries (TBI) occur when a sudden movement, such as a blow to the head, shakes the brain. Brain tissue is composed of billions of neural circuits that transmit information necessary for human behavior. When the brain is injured, there is a disruption of the transmission of information caused by a stretching and shearing of these neural circuits. Traumatic brain injuries can range from mild (commonly referred to as concussions) to severe. The most common cause of traumatic brain injuries is automobile accidents. People can also sustain brain injuries through sporting accidents, falls and physical assaults. Injury to the brain can also be caused in non-traumatic ways, including problems with blood supply (ischemia, hemorrhage and aneurysm), tumors and anoxia (lack of oxygen to the brain).

Recovery from brain injury can be a long-term process. Support from family, friends and employers improves the chances of recovery. It's important that a person with a brain injury choose a program or facility that can handle not only their treatment but also their return home.

Are all TBIs the same?
Because each person's brain is slightly different, brain injuries will affect each person in a different way. The recovery process after a brain injury depends upon a person's age, the severity of their injury, their pre-injury personality and their level of adjustment. The Rancho Levels of Cognitive/Behavioral Functioning monitor a patient's recovery process. These levels were developed by the Head Injury Treatment Team at Ranchos Los Amigos Hospital in Downey, California. There are eight levels of recovery beginning with Level I, during which the patient is most impaired (unconscious), to Level VIII, in which the patient is able to make logical decisions and function independently.

How does a brain injury affect communication?
Speech is the combination of sounds that are used to form words. Changes in speech may occur in the following ways: 

• Dysarthria (slurred speech)
• Changes in voice
• Slow or fast rate of speech
• Paralysis of the vocal cords or parts of the throat
• Apraxia (poor motor planning of speech muscles)

Language is the use of words/sentences to convey ideas. Changes in language may occur in the following ways:

• Nonstop talking 
• Tangential speech (talking off topic) 
• Word-finding problems, word substitutions, sound substitutions, jargon 
• Inappropriate language skills (e.g., interrupting, standing too close when speaking, talking instead of listening) 
• Difficulty understanding what is said or written 

A speech-language pathologist can provide speech and language therapy for these deficits.  Learn more about Good Shepherd’s Speech and Communication Program.

What is “cognition” and how is it affected by a brain injury?
Cognition refers to the thinking skills that you use in your activities of daily living. These include skills in the areas of attention, concentration, processing, initiation, long-term memory (recall of past events), short-term memory (recall of recent events and new information), problem solving and organization. When an individual sustains a brain injury, any or all of the above areas may be affected. 

What is “dysphagia”?
After a brain injury, an individual suffering from dysphagia may exhibit drooling and/or difficulty in chewing or swallowing and be at risk for aspiration. These individuals may then need an NPO (nothing by mouth) or modified (pureed or ground foods, thick liquids) diet. Good Shepherd's dysphagia program is available to help adults and children suffering from any of these symptoms.

What happens when it's time for person with a brain injury to go home?
At Good Shepherd, patients are assigned a care manager who will follow them from the moment they are admitted to the hospital to the time they leave. The care manager also works with the patient, family and rehabilitation team to coordinate plans for discharge. These plans may include outpatient rehabilitation and referrals to community agencies such as home care.

Families can assist with this process by being available to the rehabilitation team and care managers to discuss needs for discharge. When the patient goes home it is important that the family sticks to the rehabilitation instructions. For example, it may seem like a good idea to force a person with a TBI to remember appointments, dates, etc., but generally this will lead to frustration and agitation and, eventually, failure. A better way to assist in memory is to use logs, date books and lists of things to do. These tools are often taught and initiated in the rehabilitation hospital and should be followed through at home to ensure continued success with the rehabilitation process. It is important to establish and keep a routine as much as possible in the home.  

Keeping consistent mealtimes, bedtimes and chores are some ways to maintain such a routine. Avoid trying to make up for lost time with overwhelming day trips to relatives, shopping trips or activities. The person with a TBI may need minimal stimulation as he or she re-enters a home and community setting. It will also help to take up offers from close friends to provide relief for family caregivers. If possible, use a few different friends who understand the patient's needs. 

How is sexuality affected by a brain injury?
Sexuality is a concept that deals with more than sexual activity. It also includes how someone feels about themselves as a man or woman and their ability to form and maintain intimate relationships. People with TBI want to work productively, live independently and feel a part of their family and community. Sexuality is an important aspect of these goals.

When a person has a TBI, the concept of sexuality is often brushed aside, in part because health-care providers may be uncomfortable addressing sexuality issues. Caregivers are often providing care that involves intimate activities such as bathing and the patient has little or no privacy. 

Individuals with TBI may have impaired judgment and may be impulsive. It is common that in an environment with impaired cognition, inappropriate sexual comments or behavior occurs. Caregivers should recognize that these actions are an expression of a basic need and should not take these comments personally. 

After a person with a TBI leaves the rehabilitation facility, it is important to establish leisure time and social time. Social problems are at the top of the list of problems for individuals with TBI five years after the injury. Friends and family may have drifted away after the injury and through the hospitalizations. It is important for the person with the TBI to re-establish relationships or form a new circle of friends. Relationships are easier to establish in leisure settings.

How will my child's educational program change?
This will be dependent on the severity of the TBI and the student's cognitive, communicative, physical and behavioral needs. Some students return to a regular classroom with or without accommodations. Other students may require a service agreement or an individualized educational program to meet their learning needs. In more severe situations, a student may be transitioned to a more specialized school where their physical, behavioral and cognitive needs can be met. 

What's the difference between physical therapy and occupational therapy for TBI patients?
Physical therapy revolves around helping a patient regain physical mobility, strength and endurance. Physical therapists use modalities (specific treatment methods) as well as patient education so a person knows, understands and operates within his or her physical limitations. Specific modalities can include hot packs, ultrasound and whirlpool baths. Activities that physical therapists can focus on include moving in bed, walking, getting in and out of a chair or gaining wheelchair efficiency.

Occupational therapy helps patients regain the skills needed for daily life and work. An occupational therapist evaluates a patient's ability to perform tasks such as dressing, grooming, bathing and home and management skills such as shopping, cooking, budgeting and leisure activities. Occupational therapists also assess how the individual perceives and interacts with their environment.

Will the patient be able to walk again?
Although every patient is different and outcomes vary from patient to patient, most people are able to ambulate (walk) at some level after a TBI. Some TBI patients will require an assistive device of some sort to improve their balance and aid in ambulation.

For more information on the Good Shepherd Brain Injury Rehabilitation Program, contact us, call 610-776-3100 or Request an Appointment.