Acquired Brain Injury
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Acquired brain injury (ABI) is brain damage caused by events after
birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mammals, the process is initiated by hormones which cause the muscular walls of the uterus to contract, expelling the f ...
, rather than as part of a genetic or congenital disorder such as fetal alcohol syndrome,
perinatal Prenatal development () includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal devel ...
illness or perinatal hypoxia. ABI can result in cognitive, physical,
emotion Emotions are mental states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or suffering, displeasure. There is currently no scientific ...
al, or behavioural impairments that lead to permanent or temporary changes in functioning. These impairments result from either
traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic br ...
(e.g. physical trauma due to
accident An accident is an unintended, normally unwanted event that was not directly caused by humans. The term ''accident'' implies that nobody should be blamed, but the event may have been caused by unrecognized or unaddressed risks. Most researche ...
s, assaults,
neurosurgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and pe ...
,
head injury A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inju ...
etc.) or nontraumatic injury derived from either an internal or external source (e.g. stroke, brain tumours,
infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
, poisoning, hypoxia, ischemia,
encephalopathy Encephalopathy (; from grc, ἐνκέφαλος "brain" + πάθος "suffering") means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but r ...
or substance abuse). ABI does not include damage to the brain resulting from
neurodegenerative disorder A neurodegenerative disease is caused by the progressive loss of structure or function of neurons, in the process known as neurodegeneration. Such neuronal damage may ultimately involve cell death. Neurodegenerative diseases include amyotrophic ...
s. While research has demonstrated that thinking and behavior may be altered in virtually all forms of ABI, brain injury is itself a very complex phenomenon having dramatically varied effects. No two persons can expect the same outcome or resulting difficulties. The brain controls every part of human life: physical, intellectual, behavioral, social and emotional. When the brain is damaged, some part of a person's life will be adversely affected. Consequences of ABI often require a major life adjustment around the person's new circumstances, and making that adjustment is a critical factor in recovery and rehabilitation.''The ABI Handbook, Serving Students with Acquired Brain Injuries in Higher Education'', The Consortium for the Study of Programs for the Brain Injured in the California Community Colleges, 1997, California Community Colleges While the outcome of a given injury depends largely upon the nature and severity of the injury itself, appropriate treatment plays a vital role in determining the level of recovery.


Signs and symptoms

Symptoms: *
Anhedonia Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers t ...
*
Apraxia Apraxia is a motor disorder caused by damage to the brain (specifically the posterior parietal cortex or corpus callosum), which causes difficulty with motor planning to perform tasks or movements. The nature of the damage determines the disorde ...
*
Aphasia Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in t ...
* Amnesia Behavioral manifestations: *
Adynamia Adynamia means lack of strength or vigor due to a pathological condition. It is often associated with a range of neurological diseases such as multiple sclerosis and medial-frontal lobe The frontal lobe is the largest of the four major lobes ...
*
Disinhibition In psychology, disinhibition is a lack of restraint manifested in disregard of social conventions, impulsivity, and poor risk assessment. Disinhibition affects motor, instinctual, emotional, cognitive, and perceptual aspects with signs and sympto ...
*
Emotional flooding Emotional flooding is a form of psychotherapy that involves attacking the unconscious and/or subconscious mind to release repressed feelings and fears. Many of the techniques used in modern emotional flooding practice have roots in history, some ...
*
Perseveration Perseveration, in the fields of psychology, psychiatry, and speech-language pathology, is the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus. It is usually caused by a ...


Emotional

ABI has been associated with a number of emotional difficulties such as depression, issues with self-control, managing
anger Anger, also known as wrath or rage, is an intense emotional state involving a strong uncomfortable and non-cooperative response to a perceived provocation, hurt or threat. A person experiencing anger will often experience physical effects, su ...
impulses and challenges with
problem-solving Problem solving is the process of achieving a goal by overcoming obstacles, a frequent part of most activities. Problems in need of solutions range from simple personal tasks (e.g. how to turn on an appliance) to complex issues in business an ...
, these challenges also contribute to psychosocial concerns involving
social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disor ...
, loneliness and lower levels of
self esteem Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
. These psychosocial problems have been found to contribute to other dilemmas such as reduced frequency of social contact and leisure activities, unemployment, family problems and marital difficulties. How the patient copes with the injury has been found to influence the level at which they experience the emotional complications correlated with ABI. Three
coping strategies Coping refers to conscious strategies used to reduce unpleasant emotions. Coping strategies can be cognitions or behaviours and can be individual or social. Theories of coping Hundreds of coping strategies have been proposed in an attempt to ...
for emotions related to ABI have presented themselves in the research, approach-oriented coping, passive coping and avoidant coping. Approach-oriented coping has been found to be the most effective strategy, as it has been negatively correlated with rates of
apathy Apathy is a lack of feeling, emotion, interest, or concern about something. It is a state of indifference, or the suppression of emotions such as concern, excitement, motivation, or passion. An apathetic individual has an absence of intere ...
and depression in ABI patients; this coping style is present in individuals who consciously work to minimize the emotional challenges of ABI. Passive coping has been characterized by the person choosing not to express emotions and a lack of motivation which can lead to poor outcomes for the individual. Increased levels of depression have been correlated to avoidance coping methods in patients with ABI; this strategy is represented in people who actively evade coping with emotions. These challenges and coping strategies should be kept in consideration when seeking to understand individuals with ABI.


Memory

Following acquired brain injury it is common for people to experience
memory loss Amnesia is a deficit in memory caused by brain damage or disease,Gazzaniga, M., Ivry, R., & Mangun, G. (2009) Cognitive Neuroscience: The biology of the mind. New York: W.W. Norton & Company. but it can also be caused temporarily by the use o ...
; memory disorders are one of the most prevalent cognitive deficits experienced in affected people. However, because some aspects of
memory Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered ...
are directly linked to attention, it can be challenging to assess what components of a deficit are caused by memory and which are fundamentally attention problems. There is often partial recovery of memory functioning following the initial recovery phase; however, permanent handicaps are often reported with ABI patients reporting significantly more memory difficulties when compared people without an acquired brain injury. In order to cope more efficiently with memory disorders many people with ABI use memory aids; these included external items such as diaries, notebooks and electronic organizers, internal strategies such as visual associations, and environmental adaptations such as labelling kitchen cupboards. Research has found that ABI patients use an increased number of memory aids after their injury than they did prior to it and these aids vary in their degree of effectiveness. One popular aid is the use of a diary. Studies have found that the use of a diary is more effective if it is paired with self-instructional training, as training leads to more frequent use of the diary over time and thus more successful use as a memory aid.


Children

In children and youth with pediatric acquired brain injury the cognitive and emotional difficulties that stem from their injury can negatively impact their level of participation in home, school and other social situations, participation in structured events has been found to be especially hindered under these circumstances. Involvement in social situations is important for the normal development of children as a means of gaining an understanding of how to effectively work together with others. Furthermore, young people with ABI are often reported as having insufficient problem solving skills. This has the potential to hinder their performance in various academic and social settings further. It is important for rehabilitation programs to deal with these challenges specific to children who have not fully developed at the time of their injury.


Management

Rehabilitation following an acquired brain injury does not follow a set protocol, due to the variety of mechanisms of injury and structures affected. Rather, rehabilitation is an individualized process that will often involve a multi-disciplinary approach. The rehabilitation team may include but is not limited to
nurses Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health c ...
,
neurologists Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...
,
physiotherapists Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...
,
psychiatrists A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
(particularly those specialized in Brain Injury Medicine),
occupational therapists Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's abili ...
, speech-language pathologists, music therapists, and rehabilitation psychologists. Physical therapy and other professions may be utilized post- brain injury in order to control muscle tone, regain normal movement patterns, and maximize functional independence. Rehabilitation should be patient-centered and guided by the individual's needs and goals. There is some evidence that rhythmic auditory stimulation is beneficial in gait rehabilitation following a brain injury.
Music therapy Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music t ...
may assist patients to improve gait, arm swing while walking, communication, and quality of life after experiencing a stroke. Newer treatment methods such as virtual reality and robotics remain under-researched; however, there is reason to believe that virtual reality in upper limb rehabilitation may be useful, following an acquired brain injury. Due to few random control trials and generally weak evidence, more research is needed to gain a complete understanding of the ideal type and parameters of therapeutic interventions for treatment of acquired brain injuries. For more information on therapeutic interventions for acquired brain injury, see stroke and
traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic br ...
.


Memory

Some strategies for rehabilitating the memory of those affected by ABI have used repetitive tasks to attempt to increase the patients' ability to recall information. While this type of training increases performance on the task at hand, there is little evidence that the skills translate to improved performance on memory challenges outside of the laboratory. Awareness of memory strategies, motivation and dedication to increasing memory have been related to successful increases in memory capability among patients an example of this could be the use of attention process training and brain injury education in patients with memory disorders related to brain injury. These have been shown to increase memory functioning in patients based on self-report measures. Another strategy for improvement amongst individuals with poor memory functioning is the use of elaboration to improve encoding of items, one form of this strategy is called self-imagining whereby the patient imagines the event to be recalled from a more personal perspective. Self-imagining has been found to improve recognition memory by coding the event in a manner that is more individually salient to the subject. This effect has been found to improve recall in individuals with and without memory disorders. There is research evidence to suggest that rehabilitation programs that are geared toward the individual may have greater results than group-based interventions for improving memory in ABI patients because they are tailored to the symptoms experienced by the individual. More research is necessary in order to draw conclusions on how to improve memory among individuals with ABI that experience memory loss.


Notable cases

There have been many popularized cases of various forms of ABI such as: * Phineas Gage's case of traumatic brain injury that greatly stimulated discussion on brain function and physiology * Henry Molaison, formerly known as patient H.M., underwent neurosurgery to remove scar tissue in his brain that was causing debilitating
epileptic seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with los ...
s, neurosurgeon William Beecher Scoville performed the surgery which created bilateral lesions near the
hippocampus The hippocampus (via Latin from Greek , ' seahorse') is a major component of the brain of humans and other vertebrates. Humans and other mammals have two hippocampi, one in each side of the brain. The hippocampus is part of the limbic system, ...
. These lesions helped remove symptoms of the epilepsy in Molaison but resulted in
anterograde amnesia In neurology, anterograde amnesia is the inability to create new memories after the event that caused amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event remain intact ...
. Molaison has been studied by hundreds of researchers since this time, most notably
Brenda Milner Brenda Milner (née Langford; July 15, 1918) is a British-Canadian neuropsychologist who has contributed extensively to the research literature on various topics in the field of clinical neuropsychology. Milner is a professor in the Departme ...
, and has been greatly influential in the study of memory and the brain. * Zasetsky injured in the Battle of Smolensk, bullet entered his left parieto-occipital area and resulted in a long coma. Following this, he developed a form of
agnosia Agnosia is the inability to process sensory information. Often there is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss. It is usually ...
and became unable to perceive the right side of things.


See also

* Brain damage *
Chronic traumatic encephalopathy Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repeated trauma to the head. The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. The disease often gets worse ...
* Concussion *
Head injury A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inju ...
* Neurodegeneration *
Rehabilitation psychology Rehabilitation psychology is a specialty area of psychology aimed at maximizing the independence, functional status, health, and social participation of individuals with disabilities and chronic health conditions. Assessment and treatment may inclu ...
*
Traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic br ...


References


External links


World Federation of Neurorehabilitation

United Kingdom Acquired Brain Injury Forum

The Brain Injury Hub – information and practical advice to parents and family members of children with acquired brain injury
{{DEFAULTSORT:Acquired Brain Injury Brain disorders