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Brain Injury - How Serious Is It?

CAUSES Brain injury is caused at least initially by an outside force, but includes the complications which can follow, such as damage caused by lack of oxygen, and rising pressure and swelling in the brain. A traumatic brain injury can be seen as a chain of events: THE FIRST INJURY occurs in the seconds after the occident THE SECOND INJURY happens in the minutes and hours after this, depending on when skilled medical intervention occurs. A THIRD INJURY can occur at any time after the first and second injuries, O and can cause further complications FIRST INJURY: There are 3 sorts of first injuries CLOSED HEAD OPEN OR PENETRATING WOUND CRUSHING These are the most common injury type with no break of the skin or open wound visible. These are not so common. In this type of injury the skull is opened and the brain exposed and damaged. This is the least common type of injury, and often damages the base of the skull and nerves of the brain stem rather than the brain itself. These often happen as a result of rapid acceleration or deceleration, for example a car hits a wall or is hit from behind at traffic lights, the head is rocked back and forth or rotated, and the brain must follow the movement of the skull. It can twist, and the billions of nerve fibres which make up the brain can be twisted, stretched and even torn in the process. This could be due to a bullet wound, or collision with a sharp object such as a motorcycle brake lever, or being hit by a pickaxe. If the damage is limited to one specific area, outcomes can be quite good, even though the accident may have however, In this type of injury, the head might be caught between two hard objects, such as the wheel of a car and the road. There may be no loss of consciousness. seemed horrific. In many cases, this type of injury may be combined with an acceleration type injury as well. Even mild injuries can produce widespread damage throughout the brain. This is defined as diffuse brain injury. The front of the skull has sharp bony ridges with which the brain can also collide, causing more damage. Arteries and veins running through the brain can be damaged, allowing blood to leak. SECOND INJURY This happens when the brain is starved of oxygen, which makes damage from the first injury worse. Understanding the relationship between the first injury and the effects of lack of oxygen has led to improvements in the kind of emergency treatment administered at the site of an accident by paramedics. t can happe Examples are choking on vomit after an accident, blood blocking a person's airway, or by the position which someone is lying in obstructing their airway. If other injuries are present, as they often are, serious blood loss can affect blood flow to the brain. n for several reasons. As a result, the amount of oxygen reaching the brain can be reduced. They will make sure breathing is maintained and blood pressure is brought back to normal levels by emergency transfusions. 3 THIRD INJURY This can take place at any time after the first and second injury, in the days and sometimes weeks which follow, and could be as a result of bleeding, bruising or swelling in the brain or because blood clots have developed. Measures to reduce the risk of raised pressure include putting the patient on a ventilator to ensure a good supply of oxygen, and controlling the amount of water and salts in the body to cut down on the flow of fluid into the brain. Blood leaking from tom blood vessels and other body fluids leaking into the area cause the brain to swell. This is a serious problem because the skull is a fixed space, and there is no room for expansion. It causes complications in two ways: Blood clots occur when blood has leaked from damaged veins / arteries and then pools into a clot. They can press on the surrounding brain tissue which can damage it, and they also raise pressure in the brain. 1. The walls of the skull are hard and unyielding, and damage the soft brain when it squeezes against them. Clots can occur in the brain itself (an intercerebral clot or in the space between the brain and the skull (a subdural or an extradural clot). 2. When the brain swells it can squeeze the blood vessels, limiting the brain's BLOOD blood circulation. This can be fatal, so intracranial pressure is monitored very carefully once the patient is in hospital. Blood clots (a.k.a haematomas), can occur after quite minor injuries; this is why patients are often kept under observation in hospital until the risk of a clot forming is likely to be over. SWELLING INJURY SEVERITY: After a traumatic brain injury Whether or not the person was actually unconscious, a state occurs where the person seems to be aware of things around them but is confused and disorientated. The table below gives a rough guide to how these measures affect the severity of the injury, although it is worth noting that everyone is different and categorising injuries in this way doesn't always give an accurate measure of the long-term effects. They are not able to remember everyday things or conversations, and often do or say bizarre things. This is called Post-Traumatic Amnesia (PTA), and is a stage through which the person will pass. The term 'Coma' is often used to describe longer periods of unconsciousness. LOSS OF CONSCIOUSNESS POST TRAUMATIC AMNESIA BRAIN INJURY MORE TIME = MORE SEVERE < 15 minutes <1 hour 1-24 hours 24 hours -7 days >7 days Minor Moderate 15 minutes - 6 hours The length of PTA and/or loss of consciousness are important as they give an indication of the severity of the injury Severe 6- 48 hours Very Severe > 48 hours CAUSES DO TO TOP HOW SERIOUS IS IT? BRAIN INJURY Traumatic Brain Injury (TBI) is an injury to the brain caused by a trauma to the head. There are many possible causes, including road traffic accidents, assaults, falls and accidents at home or at work. The effects of a traumatic brain injury can be wide ranging, and depend on a number of factors such as the type, location and severity of injury. You can read more about the symptoms in the "Effects of brain injury' section, using the links on the left or right. EFFECTS EFFECTS All brain injuries are different and people may be affected to a varying degree by any number of these problems depending on the severity of their injury and the area the brain which is affected. Main effects of brain injury: COGNITIVE PHYSICAL EMOTIONAL BEHAVIOURAL The cognitive effects of a brain injury affect the way a person thinks, learns and remembers. Different mental abilities are located in different parts of the brain, so a brain injury can damage some, but not necessarily all, skills such as speed of thought, memory, understanding, concentration, solving problems and using language. Most people make an excellent physical recovery after a brain injury, which can mean there are few, or no, outward signs that an injury has occurred. Everyone who has had a brain injury can be left with some changes in emotional reaction and behaviour. These are more difficult to see than the There are often physical problems present that are not always so apparent, but can have a real impact on daily life. more obvious problems such as those which affect movement and speech, for example, but can be the most difficult for the individual concerned and their family to deal with. Memory Problems Some people may be unable to remember faces or names, what they have read or what they have heard. New leaming may be affected, whilst previously learned skills may still be intact. Fatigue Excessive tiredness is common to all severities of brain injury. Tasks that we take for granted, such as getting dressed or waking around can require much more effort after brain injury. It is important to allow for rest periods at regular intervals during the day, and not to feel that everything has to be done Loss of Confidence This is very common after brain injury and a person can need a lot of encouragement and reassurance. Mood Swings The person may have a tendency to laugh or cry very easily, and to move from one emotional state to another quite suddenly. Reduced Initiation and Problems with Motivation Problems with getting started on tasks are common, and can often be mistaken for laziness. These problems may also be a symplom of depression. at once. Mobility Movement can become very slow and balance can be affected. Having a brain injury can sometimes feel like living life in the slow lane'. Some people may need a wheelchair other mobility aids, because Depression or Sense of Loss Reduced Concentration Span Completing tasks can be a problem and the task may be abandoned before reaching the end. The person may initially appear eager to start a task, but then lose interest very quickly. or their poor balance and co-ordination means they cannot wak without support. The fact that they use a wheelchair does not necessarily mean that the person cannot stand or walk for short distances. Caused by injury to the areas of the brain that control emolion, but can also be associated with the person gaining an insight into the other effects of their injury. After brain injury, many things that are precious to the individual may be lost forever and there may great sadness, anger, guilt and confusion, surrounding this. Reduced Speed of Information Processing People can take longer to think things through or work out what has been said to them. "Information overload' can be quickly reached, and can cause frustration and anger. Anxiety Life has been changed forever in a matter of seconds, and the future can look frightening. Anxiety can quickly lead to frustration and anger and needs to be identified and alleviated as early as possible. Sensory Impairment Sensation of touch on the skin may be reduced, lost exaggerated. It may also be difficult for the person to know where their limbs are positioned without looking at them. Eyesight may be affected and this may not be correctable with glasses. Odd postures or waking patterns may also be explained by sensory impairments. Taste or sense of smell may be impaired or lost, either in the short or long term. or Reduced Problem Solving Abilities It may be difficult for the person to work out what to do if they encounter an unexpected problem. Frustration / Anger Frustration can build up quickly, especially when things that were once so easy are now difficult or impossible. The resulting anger may be very difficult for the person to control. Repetition or Preservation The person may be unable to move on to another topic in the same conversation, and they may return to the same topic over and over again. They may also repeat the same action, appearing unable to break the cycle. REPEAT REPEAT REPEAT Speech Difficulties Slow, indistinct or rapid speech is common after a brain injury. It may be hard to understand the person's speech at first, but the listener may learn to tune in'. Some people may repeat what they have said many times over this is known as perseveration. Some people may lose the ability to speak altogether. Their inability to express themselves does not mean that they have lost their intelligence. Abusive / Obscene Language This may be spontaneous and uncontrollable, and may be an outlet for the person's anger and frustration. This behaviour can obviously be embarrassing and upsetting for those nearby. Impaired Judgement/ Reasoning This may affect a person's ability to think rules, or follow discussions. The person may easily become argumentative due to lack of understanding. It can cause difficulties in accurately perceiving and interpreting one's own and other people's behaviour and felings. Putting oneself 'in someone else's shoes can be almost impossible. Disinhibition There may be a loss of control over social behaviour, so that the person may behave in an over-familiar manner or may make sexual advances with the ?1?1?! ically, to understand Epilepsy Brain injury can make a person prone to epileptic seizures or "fts. Many people who have had a seizure after a brain wrong people at the wrong time. They may also be unable to inhibit what they are thinking and may make inappropriate and offensive outbursts. injury are given a drug for a number of years to reduce the chance of it recurring. The drug may have an overall 'dampening' effect on the person's level of arousal, and therefore on the performance of everyday tasks. Impulsiveness A person with a brain injury may tend to speak or act without thinking things through properly first. Aphasia (Language Loss) This may be 'receptive' (difficulty g sense of what is said or od or expressive' (difficulty finding the right words to say or write), or both. This can be very frustrating for the person and for others, and patience is needed on both sides. Remember - just because a person cannot express themselves, does not mean they do not need or want to be heard. Obsessive behaviour REPEAT REPEAT For example, a person may be afraid that their possessions will be stolen, and may check their belongings repeatedly. Weakness / Paralysis Often affects one side of the body more than the other. This could mean that help is needed during personal care and when getting dressed or undressed. Muscle weakness may affect continence, and continence aids may be needed. REPEAT Impairments in Visual-Perceptual Skills The person finds it diffcult to make sense out of ordinary pictures and shapes, finding the way around a building, or drawing / constructing objects. These problems can be particularly frustrating for a person who is quile competent in their language and social skils Occasionally, people may fail to respond to stimuli coming from one side of their visual field, or may ignore a particular side of their body, for example when shaving or dressing. This condition is known as visual neglect. Ataxia Irregular, uncontrolled movement or tremor affecting the coordination of movements. The person's hands may be shaky or clumsy, and handwriting may be difficult or impossible. Hormonal Imbalances Brain injury may cause damage to the hypothalamus / pituitary gland, which are small structures at the base of the brain responsible for regulating the body's hormones. Damage to these areas can lead to insufficient / increased release of hormones, causing disruption of the body's ability to maintain a stable internal environment (homeostasis). We are experts in dealing with brain injury compensation claims Access Legal from Shoosmiths Call us on 03333 559 617 shoosmiths Occesslegal www.access-legal.co.uk

Brain Injury - How Serious Is It?

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Brain injuries are generally misunderstood and their impact often underestimated. Here's a useful infographic guide to the causes, effects and clinical implications of a traumatic brain injury.

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