Acquired brain injury

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Acquired brain injury
Brain injury with herniation MRI.jpg
Brain injury with herniation MRI
Specialty Neurology

Acquired brain injury (ABI) is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder such as fetal alcohol syndrome, perinatal illness or perinatal hypoxia. [1] ABI can result in cognitive, physical, emotional, or behavioural impairments that lead to permanent or temporary changes in functioning. [1] These impairments result from either traumatic brain injury (e.g. physical trauma due to accidents, assaults, neurosurgery, head injury etc.) or nontraumatic injury derived from either an internal or external source (e.g. stroke, brain tumours, infection, poisoning, hypoxia, ischemia, encephalopathy or substance abuse). [1] ABI does not include damage to the brain resulting from neurodegenerative disorders. [1]

Contents

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. [2] No two persons can expect the same outcome or resulting difficulties. [2] 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. [2]

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. [2] 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: [3]

Behavioral manifestations: [3]

Emotional

ABI has been associated with a number of emotional difficulties such as depression, issues with self-control, managing anger impulses and challenges with problem-solving, [4] these challenges also contribute to psychosocial concerns involving social anxiety, loneliness and lower levels of self esteem. [4] 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. [4]

How the patient copes with the injury has been found to influence the level at which they experience the emotional complications correlated with ABI. [5] Three coping strategies for emotions related to ABI have presented themselves in the research, approach-oriented coping, passive coping and avoidant coping. [5] Approach-oriented coping has been found to be the most effective strategy, as it has been negatively correlated with rates of apathy and depression in ABI patients; [5] this coping style is present in individuals who consciously work to minimize the emotional challenges of ABI. [5] 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. [5] Increased levels of depression have been correlated to avoidance coping methods in patients with ABI; [5] this strategy is represented in people who actively evade coping with emotions. [5] These challenges and coping strategies should be kept in consideration when seeking to understand individuals with ABI. [5]

Memory

Following acquired brain injury it is common for people to experience memory loss; [6] memory disorders are one of the most prevalent cognitive deficits experienced in affected people. [6] However, because some aspects of memory 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. [7] There is often partial recovery of memory functioning following the initial recovery phase; however, permanent handicaps are often reported [8] with ABI patients reporting significantly more memory difficulties when compared people without an acquired brain injury. [6]

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. [8] 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. [8] 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. [6]

Causes

Relations to Acquired Brain injury can occur in a variety of ways. [9] In adults aged 65 plus, 82.9% of hospitalizations were related to falls, about 13% experienced death shortly after. Furthermore, transportation related accidents were around 9% in correlation to brain injury. The number of hospitalizations related to brain injury is only increasing as well. Tripping, slipping, or stumbling is one of the biggest ways of experiencing these brain related injuries.

Additionally, an acquired brain injury can happen due to anoxia. This is often caused by carbon monoxide poisoning or drowning, as the lack of oxygen in these situations causes cell death. [10]

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. [11] The rehabilitation team may include but is not limited to nurses, neurologists, physiotherapists, psychiatrists (particularly those specialized in Brain Injury Medicine), occupational therapists, 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, [12] regain normal movement patterns, and maximize functional independence. [13] Rehabilitation should be patient-centered and guided by the individual's needs and goals. [14]

There is some evidence that rhythmic auditory stimulation is beneficial in gait rehabilitation following a brain injury. Music therapy may assist patients to improve gait, arm swing while walking, communication, and quality of life after experiencing a stroke. [13] 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. [15]

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. [15]

For more information on therapeutic interventions for acquired brain injury, see stroke and traumatic brain injury.

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. [16] 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. [16] Awareness of memory strategies, motivation and dedication to increasing memory have been related to successful increases in memory capability among patients [16] 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. [7] These have been shown to increase memory functioning in patients based on self-report measures. [7]

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. [17] Self-imagining has been found to improve recognition memory by coding the event in a manner that is more individually salient to the subject. [17] This effect has been found to improve recall in individuals with and without memory disorders. [17]

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. [4]

More research is necessary in order to draw conclusions on how to improve memory among individuals with ABI that experience memory loss. [18]

Special population

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, [19] participation in structured events has been found to be especially hindered under these circumstances. [19] 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. [19] Furthermore, young people with ABI are often reported as having insufficient problem solving skills. [20] This has the potential to hinder their performance in various academic and social settings further. [20] 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. [19]

Notable cases

Phineas Gage's accident Phineas gage - 1868 skull diagram.jpg
Phineas Gage's accident

There have been many popularized cases of various forms of ABI such as:

See also

Related Research Articles

<span class="mw-page-title-main">Aphasia</span> Inability to comprehend or formulate language

In aphasia, a person may be unable to comprehend or unable to 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 the Global North. Aphasia can also be the result of brain tumors, epilepsy, autoimmune neurological diseases, brain infections, or neurodegenerative diseases.

Source amnesia is the inability to remember where, when or how previously learned information has been acquired, while retaining the factual knowledge. This branch of amnesia is associated with the malfunctioning of one's explicit memory. It is likely that the disconnect between having the knowledge and remembering the context in which the knowledge was acquired is due to a dissociation between semantic and episodic memory – an individual retains the semantic knowledge, but lacks the episodic knowledge to indicate the context in which the knowledge was gained.

<span class="mw-page-title-main">Brain injury</span> Destruction or degeneration of brain cells

Brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage.

Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance. Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), concussion, and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

In neurology, anterograde amnesia is the inability to create new memories after an 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. This is in contrast to retrograde amnesia, where memories created prior to the event are lost while new memories can still be created. Both can occur together in the same patient. To a large degree, anterograde amnesia remains a mysterious ailment because the precise mechanism of storing memories is not yet well understood, although it is known that the regions of the brain involved are certain sites in the temporal cortex, especially in the hippocampus and nearby subcortical regions.

In neurology, retrograde amnesia (RA) is the inability to access memories or information from before an injury or disease occurred. RA differs from a similar condition called anterograde amnesia (AA), which is the inability to form new memories following injury or disease onset. Although an individual can have both RA and AA at the same time, RA can also occur on its own; this 'pure' form of RA can be further divided into three types: focal, isolated, and pure RA. RA negatively affects an individual's episodic, autobiographical, and declarative memory, but they can still form new memories because RA leaves procedural memory intact. Depending on its severity, RA can result in either temporally graded or more permanent memory loss. However, memory loss usually follows Ribot's law, which states that individuals are more likely to lose recent memories than older memories. Diagnosing RA generally requires using an Autobiographical Memory Interview (AMI) and observing brain structure through magnetic resonance imaging (MRI), a computed tomography scan (CT), or electroencephalography (EEG).

<span class="mw-page-title-main">Traumatic brain injury</span> Injury of the brain from an external source

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 (mTBI/concussion) to severe traumatic brain injury. TBI can also be characterized based on mechanism or other features. Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to permanent disability or death.

Closed-head injury is a type of traumatic brain injury in which the skull and dura mater remain intact. Closed-head injuries are the leading cause of death in children under 4 years old and the most common cause of physical disability and cognitive impairment in young people. Overall, closed-head injuries and other forms of mild traumatic brain injury account for about 75% of the estimated 1.7 million brain injuries that occur annually in the United States. Brain injuries such as closed-head injuries may result in lifelong physical, cognitive, or psychological impairment and, thus, are of utmost concern with regards to public health.

Memory disorders are the result of damage to neuroanatomical structures that hinders the storage, retention and recollection of memories. Memory disorders can be progressive, including Alzheimer's disease, or they can be immediate including disorders resulting from head injury.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, or years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.

The Rivermead Post-Concussion Symptoms Questionnaire, abbreviated RPQ, is a questionnaire that can be administered to someone who sustains a concussion or other form of traumatic brain injury to measure the severity of symptoms. The RPQ is used to determine the presence and severity of post-concussion syndrome (PCS), a set of somatic, cognitive, and emotional symptoms following traumatic brain injury that may persist anywhere from a week, to months, or even more than six months.

In psychology and neuroscience, executive dysfunction, or executive function deficit is a disruption to the efficacy of the executive functions, which is a group of cognitive processes that regulate, control, and manage other cognitive processes. Executive dysfunction can refer to both neurocognitive deficits and behavioural symptoms. It is implicated in numerous psychopathologies and mental disorders, as well as short-term and long-term changes in non-clinical executive control. Executive dysfunction is the mechanism underlying ADHD paralysis, and in a broader context, it can encompass other cognitive difficulties like planning, organizing, initiating tasks and regulating emotions. It is a core characteristic of ADHD and can elucidate numerous other recognized symptoms.

Amnesia is a deficit in memory caused by brain damage or brain diseases, but it can also be temporarily caused by the use of various sedative and hypnotic drugs. The memory can be either wholly or partially lost due to the extent of damage that is caused.

<span class="mw-page-title-main">Cognitive rehabilitation therapy</span>

Cognitive rehabilitation refers to a wide range of evidence-based interventions designed to improve cognitive functioning in brain-injured or otherwise cognitively impaired individuals to restore normal functioning, or to compensate for cognitive deficits. It entails an individualized program of specific skills training and practice plus metacognitive strategies. Metacognitive strategies include helping the patient increase self-awareness regarding problem-solving skills by learning how to monitor the effectiveness of these skills and self-correct when necessary.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

<span class="mw-page-title-main">Childhood acquired brain injury</span> Medical condition

Childhood acquired brain injury (ABI) is the term given to any injury to the brain that occurs during childhood but after birth and the immediate neonatal period. It excludes injuries sustained as a result of genetic or congenital disorder. It also excludes those resulting from birth traumas such as hypoxia or conditions such as foetal alcohol syndrome. It encompasses both traumatic and non-traumatic injuries.

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 include the following areas: psychosocial, cognitive, behavioral, and functional status, self-esteem, coping skills, and quality of life. As the conditions experienced by patients vary widely, rehabilitation psychologists offer individualized treatment approaches. The discipline takes a holistic approach, considering individuals within their broader social context and assessing environmental and demographic factors that may facilitate or impede functioning. This approach, integrating both personal and environmental factors, is consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF).

References

  1. 1 2 3 4 Ontario Brain Injury Association. "What is Acquired Brain Injury" . Retrieved 5 March 2011.
  2. 1 2 3 4 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
  3. 1 2 Osborn, Claudia L. (1998). "A Head Injury Primer". Over my head: A doctor's own story of head injury from the inside looking out. Kansas City MO: Andrews McMeel Publishing. ISBN   9780836254198.
  4. 1 2 3 4 Ownsworth, Tamara L.; McFarland, K.; Young, R. (2000). "Self-awareness and psychosocial functioning following acquired brain injury: An evaluation of a group support programme". Neuropsychological Rehabilitation. 10 (5): 465–484. doi:10.1080/09602010050143559. S2CID   143459268.
  5. 1 2 3 4 5 6 7 8 Finset, Arnstein; Andersson, S. (2000). "Coping strategies in patients with acquired brain injury: relationships between coping, apathy, depression and lesion location". Brain Injury. 14 (10): 887–905. doi:10.1080/026990500445718. PMID   11076135. S2CID   39961743.
  6. 1 2 3 4 Ownsworth, Tamara; McFarland, K. (1999). "Memory remediation in long-term acquired brain injury: two approaches in diary training". Brain Injury. 13 (8): 605–626. doi:10.1080/026990599121340. PMID   10901689.
  7. 1 2 3 Sohlberg, Mckay Moore; et al. (2000). "Evaluation of Attention Process Training and Brain Injury Education in Persons with Acquired Brain Injury". Journal of Clinical and Experimental Neuropsychology. 22 (5): 656–676. CiteSeerX   10.1.1.569.1591 . doi:10.1076/1380-3395(200010)22:5;1-9;FT656. PMID   11094401. S2CID   10206850.
  8. 1 2 3 Evans, Jonathan J.; et al. (2003). "Who makes good use of memory aids? Results of a survey of people with acquired brain injury". Journal of the International Neuropsychological Society. 9 (6): 925–935. doi:10.1017/S1355617703960127. PMID   14632251. S2CID   43359135.
  9. ↑ Harvey, Lara A.; Close, Jacqueline C. T. (2012-11-01). "Traumatic brain injury in older adults: characteristics, causes and consequences". Injury. 43 (11): 1821–1826. doi:10.1016/j.injury.2012.07.188. ISSN   0020-1383.
  10. ↑ Goldman, Liam; Siddiqui, Ehraz Mehmood; Khan, Andleeb; Jahan, Sadaf; Rehman, Muneeb U.; Mehan, Sidharth; Sharma, Rajat; Budkin, Stepan; Kumar, Shashi Nandar; Sahu, Ankita; Kumar, Manish; Vaibhav, Kumar (2022). "Understanding Acquired Brain Injury: A Review". Biomedicines. 10 (9): 2167. doi: 10.3390/biomedicines10092167 . ISSN   2227-9059. PMID   36140268.
  11. ↑ Turner-Stokes, Lynne; Pick, Anton; Nair, Ajoy; Disler, Peter B.; Wade, Derick T. (2015-12-22). "Multi-disciplinary rehabilitation for acquired brain injury in adults of working age" (PDF). The Cochrane Database of Systematic Reviews. 2015 (12): CD004170. doi:10.1002/14651858.CD004170.pub3. ISSN   1469-493X. PMC   8629646 . PMID   26694853.
  12. ↑ Singer, B; Dunne, Allison (2001). "Reflex and non-reflex elements of hypertonia in triceps surea muscles following acquired brain injury: implications for rehabilitation". Disability and Rehabilitation. 23 (17): 749–757. doi:10.1080/09638280110060466. PMID   11762877. S2CID   218876009.
  13. 1 2 Magee, Wendy L.; Clark, Imogen; Tamplin, Jeanette; Bradt, Joke (2017). "Music interventions for acquired brain injury". The Cochrane Database of Systematic Reviews. 1 (1): CD006787. doi:10.1002/14651858.CD006787.pub3. ISSN   1469-493X. PMC   6464962 . PMID   28103638.
  14. ↑ Dalton, Catherine; Farrell, De Souza; Wujanto, McKenna-Slade; Thompson, Liu Greenwood (2012). "Patient inclusion in goal setting during early inpatient rehabilitation after acquired brain injury". Clinical Rehabilitation. 26 (2): 165–173. doi:10.1177/0269215511405230. PMID   21937524. S2CID   206483988.
  15. 1 2 Mumford, Nick; Wilson (2009). "Peter". Brain Injury. 23 (3): 179–191. doi:10.1080/02699050802695566. PMID   19205954. S2CID   205525984.
  16. 1 2 3 Tate, Robyn, L. (1997). "Subject review Beyond one-bun, two-shoe: recent advances in the psychological rehabilitation of memory disorders after acquired brain injury". Brain Injury. 11 (12): 907–918. doi:10.1080/026990597122972. PMID   9413624.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. 1 2 3 Grilli, Matthew, D.; Glisky, Elizabeth L. (November 2010). "Self-imagining enhances recognition memory in memory-impaired individuals with neurological damage". Neuropsychology. 24 (6): 698–710. doi:10.1037/a0020318. PMC   2970672 . PMID   20873930.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ↑ Gopi, Yashoda; Wilding, Edward; Madan, Christopher R. (2022-07-05). "Memory rehabilitation: restorative, specific knowledge acquisition, compensatory, and holistic approaches". Cognitive Processing. 23 (4). Springer Science and Business Media LLC: 537–557. doi:10.1007/s10339-022-01099-w. ISSN   1612-4782. PMC   9553770 . PMID   35790619.
  19. 1 2 3 4 Bedell, Gary, M.; Helene M. Dumas (January 2004). "Social participation of children and youth with acquired brain injuries discharged from inpatient rehabilitation: a follow-up study". Brain Injury. 18 (1): 65–82. doi:10.1080/0269905031000110517. PMID   14660237. S2CID   26782607.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. 1 2 Suzman, Katherine B.; et al. (1997). "Cognitive-Behavioural Remediation of Problem Solving Deficits in Children with Acquired Brain Injury". J. Behav. Ther. Exp. Psychiatry. 28 (3): 203–212. doi:10.1016/S0005-7916(97)00023-2. PMID   9327299.
  21. 1 2 3 Corkin, Suzanne (February 2002). "What's new with the amnesic patient H.M.?". Nature Reviews Neuroscience. 3 (2): 153–160. doi:10.1038/nrn726. PMID   11836523. S2CID   5429133.
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