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28 Apr

Acquired Brain Injury

Brain injuries come in many forms. Some are present from birth: these can be congenital, meaning a person is born with them; inherited, meaning they are passed on from one or both parents; or can happen from complications in pregnancy, or during or around the time of birth. Acquired brain injury (ABI) is a brain injury that is not present at birth, but which happens at a later stage in a person’s life.

Acquired brain injury is not uncommon, with around 350,000 people admitted to hospital in the UK every year with an ABI, usually related to a traumatic head injury or stroke.

What is an Acquired Brain Injury? 

An ‘acquired brain injury’ refers to any injury to the brain that happens after birth. They are ‘acquired’ – meaning that they happen to a person, usually with a clear specific cause. The effects of an ABI can range from extremely mild to completely debilitating, and the experience of an ABI varies from one person to another.

The brain is the part of the body that interprets signals and sends instructions to the rest of the body. Every sense we have – sight, smell, touch, taste, hearing, pain, our thoughts and emotions, knowing when we need to go to the toilet or recoil from a hot surface – relies completely on the brain functioning well. Every way we have of understanding the world is controlled by the brain. This means that damage to the brain can affect any part of the rest of the body, and can affect the body functions we aren’t aware of as well as those we are.

Different parts of the brain control and respond to different parts of the body, so the placement and amount of damage has a big impact on the way a brain injury presents and the effect it has on a person. Injuries to the front, back, left or right of the brain all have very different effects, and within the brain are lots of complex, subtle parts which can be damaged and cause problems.

For example, people with certain kinds of damage to the hypothalamus – a part of the brain which regulates lots of hormones and body processes – can experience feelings of constant hunger which is never satisfied, no matter how much someone eats; this can lead to depression, obesity and related diseases[i].

Hypothalamus

Changes in behaviour and personality are common in people with certain sorts of brain injury, and there are even a few examples of people who, after injury to part of their brain, develop unsuspected talents[ii].

Brain injuries commonly result in some degree of cognitive impairment, affecting memory function, thought processes, attention, understanding and communication. In some cases, this may resolve partly or fully. Sometimes, changes in creative thinking or memory function aren’t always obvious at first, but become more noticeable when someone goes back to their normal environment and activities after the injury.

Causes and Types of Acquired Brain Injury

The causes of acquired brain injury are very varied, but may be broadly grouped into traumatic[iii] – i.e. resulting from an accident or injury inflicted on the head and brain, or atraumatic – i.e. resulting from something internal. Some of the causes of ABI can include:

  • Stroke – a bleed, blockage, or narrowing in a blood vessel in the brain can cause serious and extensive damage to the brain. A narrowing in a blood vessel supplying the brain restricts blood flow and oxygen perfusion. Any tissues in the body very quickly become damaged and cells die without adequate perfusion, which is why time is of the essence when someone has a suspected stroke.
  • Traumatic head injury – the brain is well-protected within the skull from many forms of injury or accident, but the kind of accident where the brain is effectively thrown against the inside of the skull can cause bruising, bleeding, and swelling to the brain. This in itself can constitute a serious injury, but the effects of a bleed or significant swelling within the encased skull can put pressure on the whole brain and even damage parts of it which weren’t immediately impacted by the injury.

Close,Up,Hand,Doctor,Point,Mra,Brian,Scan,Image,Of

Road traffic accidents are the most common cause of traumatic head injuries, followed by sporting accidents. Injuries to the head do not necessarily mean that the brain has been affected at all.

  • Toxicity – i.e. poisoning, which could be through drugs, alcohol, or even occupational exposure.
  • Cancer or other diseases – brain tumours or cancers which metastasize (spread) to the brain can cause ABI. Other diseases which affect the brain, such as forms of dementia, can be considered a form of ABI, although they’re usually grouped separately as the management and trajectory is so different from acute acquired brain injury.
  • Hypoxic or anoxic brain injury – this is a brain injury caused by lack of blood supply to the brain. Hypoxic means there has been too little oxygen supplied to the brain; anoxic means there has been no oxygen supplied to the brain. A stroke is a hypoxic brain injury, but the term may be used more broadly to describe an ABI caused by a circulation problem that is external to the brain itself. This usually causes more universal damage, whereas a stroke is generally more regional within the brain. A cardiac arrest – where a person’s heart stops pumping blood around the body, drowning, or carbon monoxide poisoning are some of the most common causes of hypoxic brain injury.

Treating Acquired Brain Injury

The initial treatment of a brain injury depends on the cause and nature of the injury itself. Depending on the nature and extent of the injury, and the extent of the effect on the rest of a person’s function, an ABI may require an extended stay in hospital and a long period of rehabilitation. The prognosis varies from full recovery or minimal impact on a person’s abilities, to being almost entirely debilitating, affecting almost all voluntary and much involuntary brain function.

Diagnosis

Diagnosing a brain injury takes a combination of medical assessments and investigations. Medical imaging like computed tomography (CT) or magnetic resonance imaging (MRI) scans are used to create a picture of the brain and visualise areas of damage or abnormalities. Experienced radiologists using MRI scanners are able to detect even very subtle changes in the tissues of the brain, but the delicate brain tissues can be affected even by microscopic damage.

Sometimes, someone with a brain injury might have to have a series of scans at set intervals to look for ongoing changes. Doctors attending someone with a suspected brain injury will need to know about the history of the injury and the person’s symptoms, and will do a physical examination which will include shining a torch in their patient’s eyes, assessing their consciousness, cognition, and control over movement and sensation in different areas of the body.

Treatment

Treatment for an ABI includes treatment for the injury itself, and, where possible, treatment of the underlying cause. An atraumatic ABI is more likely to have an underlying cause that needs to be managed – a medical condition which has caused an injury to the brain.

Treatment for an ABI will usually involve assessment and treatment in an acute hospital setting. This may be in intensive care unit, stroke unit, or specialist brain injury department. Some brain injuries can be managed on more general medical wards. Some injuries may require a medical procedure or surgery, and some may be managed more conservatively with medications and monitoring; no two brain injuries are the same.

Rehabilitation

Rehabilitation is an incredibly important part of care after an ABI; the aim of rehabilitation is to help people get as independent and well as they can be after their injury, and then to ensure that any ongoing support they might need will be available to them.[iv] It isn’t always possible to anticipate the length of time it takes to rehabilitate to a stable condition and level of function; with a severe brain injury it can take many months. There can also be wide variances in the extent that the brain itself will recover – some kinds of tissue damage are irreversible, whereas some can resolve to some degree over time.

Female hand trying to connect a missing jigsaw puzzle of human brain on gray background. Creative idea for solving problem, memory loss, dementia or Alzheimer's disease concept. Mental health care.

Rehabilitation after an ABI may incorporate:

  • Physiotherapy, especially where movement or mobility has been affected.
  • Occupational therapy, with an aim to adapt or relearn functional living skills.
  • Speech and language therapy, to support changes in communication needs, and also when swallowing reflexes are affected.
  • Counselling or input from a clinical psychologist.
  • Consultant-led medical care for ongoing optimisation of treatment, or to manage and monitor related conditions.

Some people with ABI need to have long-term follow up with consultants or specialist brain injury support teams including nurses, doctors, and other healthcare professionals. Some rehabilitation activities can continue at home.

The Impact of an Acquired Brain Injury

Sustaining a severe acquired brain injury is likely to have a very large impact on a person’s life. It also affects the people closest to them, and can change everybody’s life in significant and important ways.

As a family member

Learning that a loved one has sustained a serious injury is always devastating, and when that injury involves the brain, it can be even more overwhelming. Injuries involving the brain can be unpredictable, they can impact on every aspect of a person’s life, abilities, and even personality.

When someone has a severe brain injury, the rest of their close family and household may have serious concerns over income, expenses, their home, future care of the affected person, the impact on children in the family, and more – all while their loved one is critically ill[v].

This combination of worries, both practical and uncontrollable, is acutely distressing. Having support from others, whether friends and family, the medical and rehabilitation teams, or specialist support organisations, can be invaluable.

As a person with an ABI

Someone with a serious ABI may fully understand the extent of their injuries and the impact it will have on their, and their loved ones’ lives. On the other hand, it may be difficult to comprehend – some severe brain injuries have a serious and permanent impact on a person’s ability to process and remember information.

When someone recovers enough from a serious brain injury to understand their condition and the potential consequences, it can be very distressing, even depressing[vi]. Any impact on brain function is an emotionally charged issue – to learn that you have sustained an injury that might affect your ability to communicate, interact with your family in the same way, to work, simply to go about your usual life independently is overwhelming.

Sometimes, brain injuries themselves can cause personality and mood changes – and sometimes living with brain injuries can cause these changes too. It’s important to know that even with the most severe brain injuries, you are important to your family and to society, and that there’s a reason that there is support available – it is because you are needed.

Living with Acquired Brain Injury

Rehabilitation following an ABI can continue for as long as it is helpful – being medically stable is only the beginning of life after an ABI. Input from healthcare professionals, social support and carers can help get people with ABIs back to their normal life.

Sometimes, someone might need a lot of adjustments in their living conditions when they leave hospital – a home that is adapted for access and safety, and they may need a package of care to ensure that someone is always with them to support physical or cognitive needs.

Depending on the extent of impact from the ABI, getting back to work, education, social or recreational activities may be possible with time and adaptation. Any recovery takes time, and the nature of an injury to the brain; an injury which can cause a range of cognitive as well as physical effects, can be particularly challenging. Organisations like The Brain and Spine Foundation and Headway, which provide practical advice as well as emotional support can be an essential resource. Everyone who is affected by an acquired brain injury – whether to themselves, a friend or family – might need support.

[i] Ahima, R. S., & Antwi, D. A. (2008). Brain regulation of appetite and satiety. Endocrinology and metabolism clinics of North America37(4), 811–823. https://doi.org/10.1016/j.ecl.2008.08.005

[ii] Afra, P., Funke, M., & Matsuo, F. (2009). Acquired auditory-visual synesthesia: A window to early cross-modal sensory interactions. Psychology research and behavior management2, 31–37. https://doi.org/10.2147/prbm.s4481

[iii] Greve, M. W., & Zink, B. J. (2009). Pathophysiology of traumatic brain injury. Mount Sinai Journal of Medicine. A Journal of Translational and Personalized Medicine. A Journal of Translational and Personalized Medicine, 76(2), 97-104. https://doi.org/10.1002/msj.20104

[iv] Turner‐Stokes, L., Pick, A., Nair, A., Disler, P. B., & Wade, D. T. (2015). Multi‐disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane database of systematic reviews, (12). https://doi.org/10.1002/14651858.CD004170.pub3

[v] Degeneffe, C. E. (2001). Family caregiving and traumatic brain injury. Health & social work, 26(4), 257-268. https://doi.org/10.1093/hsw/26.4.257

[vi] Juengst, S. B., Kumar, R. G., & Wagner, A. K. (2017). A narrative literature review of depression following traumatic brain injury: Prevalence, impact, and management challenges. Psychology Research and Behavior Management, 10, Article 175-186. https://doi.org/10.2147/PRBM.S113264