Frequently Asked Questions about Brain and Head Injuries
Here are a list of answers to the most frequently asked questions by victims of head injuries, their friends, family and professionals.
What is a Head or Brain Injury?
A person who has suffered an injury to the head or brain due to an accident, fall, gunshot wound, car accident or an assault is said to have a head or brain injury or sometimes (depending on the severity) a traumatic brain injury. The injury might have resulted from a lack of oxygen to the brain (a result of a drowning) or a lack of blood supply to the brain (a result of a heart attack) or in the case of a severe car accident, the brain injury might have been caused by several factors.
Many times the brain injury patient may not remember and may never remember what exactly happened to cause the injury.
Do people with head injuries recover?
Yes, people with brain injuries can and do recover. The timeline for such a recovery is calculated in weeks, months, and even years. Frequently, there is a quick recovery time after the injury but as time progresses, recovery slows down. Some people who have suffered severe head injuries exhibit no noticeable problems, while others need constant care for the remainder of their lives.
Many times a person with a brain injury remains unconscious and it is impossible to predict how long they will remain this way or when they will regain consciousness. The milder the injury the shorter the time frame for full recovery of consciousness and the more severe the injury, the longer the time frame is for a person to regain full consciousness.
How long will it take before we know how severe the head injury is?
The recovery of a patient from a severe head injury is often slower than the family and friends expect. Doctors who say we have to wait and see are NOT being inconsiderate but really providing the most accurate answer they are able to. Generally speaking, the longer a person remains in a coma, the less likely that person will recover completely.
Many family members want to know whether their loved one will die. Again, it is impossible to know for certain whether a person with a head injury will die. Because head injuries are serious injuries, they can lead to a person’s death. Basically there are two critical time periods for persons suffering from a head injury. The 24 to 48 hours after the injury has occurred is a critical time period. Patients, who have received the most intensive treatment, may not be able to survive the severity of their head injuries. Those patients who do survive the first critical time period, face the second critical time period—starting a few days later and lasting for up to two weeks or more. This second critical time period results from swelling of the injured brain.
What is Brain Swelling?
Brain swelling or cerebral edema is the result of many different kind of injuries to the brain. Often brain swelling is unavoidable and if it is not controlled can lead to death because of the excessive pressure in the head (intracranial pressure).
How can Brain Swelling be controlled?
Controlling brain swelling required around the clock care and usually means the patient is in a hospital’s intensive care unit (ICU). Doctors must control all bodily functions. For example, breathing for the patient is done by a machine called a ventilator or respirator. The patient is given strong medications that temporarily paralyze the injured person and deepen the level of unconsciousness. A person is placed in a coma-like state to help control his/her blood pressure, breathing and other bodily functions. Sometimes it becomes necessary to drain small amounts of fluid from the brain. Surgical procedures are another way to help control brain swelling.
If a patient’s brain swelling is not able to be controlled, it usually results in the death of the patient. Other injuries suffered in addition to the brain injury are factors that add to the risk of dying.
What is Brain Death?
According to California Law, “a person, who has suffered irreversible cessation of all functions of the entire brain, including the brain stem, is dead.”
The time of death is defined as the time the physician determined that there is no longer any remaining brain function.
What is a Coma?
A coma is a sleep-like state where the injured person does not open his/her eyes, does not speak and is unable to obey commands. Comas are divided into several layers based on the responsiveness of the patient to eye-opening, speaking, and movement of his/her extremities. If a patient is able to open his/her eyes, speak and respond to simple commands, they are no longer considered to be in a coma.
There are no current medications that can shorten the length of time a person remains in a coma. As mentioned before, there are medications that enable a doctor to deepen the level of a patient’s coma to help in the healing process.
Why do patients in a coma occasionally move?
Although persons in a coma are unable to obey commands, it is not uncommon for them to move in response to touch or pain. Comatose patients often exhibit signs of Extensor Posturing or marked stiffness in the legs, arms, and neck where the legs are pointed straight out and the feet are pointed downward while the patient’s arms are pointed straight out at the sides with the wrists bend down and hands clenched in a fist. The head injured patient might become so rigid they quiver due to the straining of their muscles. This is called Flexor Posturing and is only different from Extensor Posturing because a patient’s arms are bent at the elbow. Another type of movement is called Withdrawal which is a more complex movement where a patient may pull away from a painful stimulus or may try to push away a source of pain.
Do comatose patients feel pain?
Being in a coma is similar to being under anesthesia. Though patients in a coma may react to pain by moving or even making a noise, they oftentimes have no memory of any pain.
Are comatose patients able to hear?
Sometimes, patients in a coma show signs that they’re able to hear and even to understand. Most often, these are simply reflexes (squeezing of a hand in response to a touch). Many doctors advise family and friends to speak to comatose patients as if they can hear and understand what is being said.
What is a Brain Stem Injury?
The brain stem is the part of the brain that connects the rest of the body with the larger portion of the brain. The brain stem is responsible for many functions like breathing, consciousness, eye movements, heart beat, swallowing, facial movements and pupil reactions. All sensations that go to the brain as well as signals from the brain must pass through the brain stem. The brain stem is quite susceptible to injury, but it is almost never the only part of the brain which is injured when a person’s brain suffers an injury.
What causes a coma in head injured people?
Coma in head injured people is usually the result of an injury to all parts of the brain and not just the brain stem. In the majority of cases, a person in a prolonged coma indicates a diffuse injury to all parts of the brain, including the brain stem and in most cases recovery is a slow process. Effects of brain stem injury may include prolonged difficulty with movements, vision, swallowing and other bodily functions controlled by the brain. Injuries to other parts of the brain can lead to problems with memory, movement, attention, ability to think rapidly, complex thinking, speech and language, behavior and personality.
What are seizures?
Seizures are the result of abnormal brain activity and are most often the result of a severe injury to the head. It is important to control them as they are in no way good for the brain. In order to control seizures, physicians often prescribe medications like
Dilantin (penytoin) and Phenobarbital. In some cases, a patient’s seizures are unable to be controlled with medication and physicians try to maintain the other bodily functions to minimize any further brain injury from the repeated seizures. Sometimes, the medicines used to control seizures will actually place the patient in a deeper state of unconsciousness and physicians use other medications that paralyze the body to prevent muscle contractions produced from seizures.
How long will patients need to take seizure medications?
It is not uncommon for head injury patients to continue taking seizure medications for several years after their head injury. This is done to prevent the seizures which sometimes come a long time after the initial injury. These seizures are called Post Traumatic Epilepsy and are most often found in patients who have suffered a penetrating injury to the brain, who have suffered blood clots (hematomas) in the brain and who have had seizures in the first week following their injury. Suddenly stopping seizure medications may cause seizures in people who would not otherwise have them. So, patients must take the medications as directed and follow a doctor’s instructions when reducing the doses.
What is Spasticity?
Spasticity is defined as an increased muscle tone of some muscles as a result of partial or complex disconnections of the muscles of the brain. Spastic muscles usually have very brisk reflexes and sometimes quiver on their own.
Are doctors able to tell how much brain damage a patient has suffered?
Certain tests such as the CT scan, EEG and BSER (Brain stem evoked response) can help to provide some information about the extent of a brain injury. But, the function of the brain in thinking, speaking and moving provides the most useful information about the extent of the damage. Because the function of the brain
can continue to improve for months and even years after a head injury, measurements of brain function must be repeated several times as a person’s recovery progresses.
Is the brain able to heal itself?
Injured brain tissue can recover over a short period of time, but once brain tissue is dead or destroyed, there is no evidence that new brain cells can regrow. Though new brain cells do not grow, the process of recovery will usually continue. Doctors believe this happens because other parts of the brain take over the function of the destroyed brain tissue. But, the more extensive the damage, the less likely that the remaining brain can take over the function of the destroyed areas.
What are the stages of recovery from a brain injury?
The more severe head injuries are followed by a period of coma lasting from seconds to months or longer.
What is post-traumatic amnesia?
The next stage of recovery from a brain injury is called post-traumatic amnesia. When people with a brain injury come out of a coma, they don’t just wake up instantly. Instead, it is a more gradual process of regaining contact with the
world. One of the most striking aspects of the recovery of consciousness is that
it takes a long time to begin to restore memory. The kind of memory most often affected is the ability to continuously remember the events of the day. A head injury person who is awake but unable to recall what happened a few hours or even minutes ago is said to be in a state of post-traumatic amnesia. People who are fully recovered from a head injury usually have no memory at all of this
stage of recovery.
When does rehabilitation begin?
Rehabilitation is the process of helping a person realize his/her maximum functional potential. Once a person’s memory of the day’s events begins to be restored, the rate of recovery often appears to be much more rapid, although many problems may remain for a long period of time. These problems can range from difficulties in movement, memory and attention to a slower process of thinking, difficulties in complex thinking, problems with speech and language, personality changes and even behavior problems. All of these problems are tackled in the rehabilitation of the head injured person. It must be remembered that some aspects of rehabilitation begin even while the patient is still in a coma.
What happens after the initial recovery phase?
It is important for people who have suffered a brain injury to continue rehabilitation even after they no longer are receiving acute hospital care. Sometimes, rehabilitation can occur in the person’s home or on an outpatient basis. Many times, the rehabilitation is best accomplished in a rehabilitation facility. This allows for the person to undergo several hours a day of specific therapy. Unfortunately for some because the nursing care requirements are too much and the rehabilitation potential is so limited, persons with brain injuries are best placed in a skilled nursing facility.
When does recovery stop?
As we’ve already mentioned, gradual recovery from a head injury may continue for many years. Fortunately some positive improvements have been made through the intensive retraining of people who have regained normal intelligence but are severely handicapped by specific problems in thinking, behavior and in both social and vocational skills. Recovery may stop at any age.
Does it mean that a patient is fine when they are able to leave the hospital and return home?
Many patients of head injuries still have continued problems when they are able to return to their home and families. This is especially true for patients who have sustained a severe head injury that produced a prolonged coma. Because problems with complex thinking, emotional instability, and personality changes are common, both the head injured person and his/her family may become frustrated and greatly affected by these continued difficulties. Setbacks may occur in the person’s ability to take care of him/her self as well as in the person’s independence. The rehabilitation team may suggest continued therapy as an outpatient or through a visiting therapist. Families will have to investigate other resources that exist to assist the head injured person and his/her family in overcoming the long-term problems which become visible only when the patient returns home.
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