The Bridge To Better Healthcare

About Brain Injury

What is a Brian Injury?

Definition
An acquired brain injury (ABI) is damage to the brain caused by either:

  • A medical problem or disease, such as the brain not getting enough oxygen (also known as anoxia), a tumour, brain aneurysm, infection, or a stroke (with diffuse cognitive deficits). This is also known as a non-traumatic brain injury.

OR

  • A traumatic injury, such as a car crash, fall, assault (or sports-related injury. Learn about traumatic brain injury in other languages.

An ABI happens after birth and is not related to:

  • a congenital disorder or developmental disability, such as cerebral palsy, muscular dystrophy, autism, spina bifida with hydrocephalus, or
  • a process that gradually damages the brain, such as dementia, multiple sclerosis, Alzheimer’s Disease, Parkinson’s Disease.


Videos about ABI:

 

Physical Changes

A brain injury can cause physical changes that may be temporary or permanent.

Some people will experience a number of these changes. Some people may not experience any. It depends on the type of injury, where it is in the brain, and how serious it is.

A person with a brain injury may have difficulty with:

Alertness

In the early stages of recovery, the person may not be very alert, or their level of alertness may change throughout the day. This usually improves as the person recovers, allowing them to better participate in rehabilitation.

Movement/mobility

A person with an ABI may experience:

  • Paralysis or weakness in one or both sides of the body
  • Poor balance
  • Poor coordination
  • Low endurance (becomes easily tired with activity)
  • Difficulty planning movements
  • Muscle stiffness or trembling
  • Contractures (Muscles or tendons become permanently shortened and cause a limb to be deformed. Surgery or splints can help.)
  • Slow reaction time.


Speech and language

Some people have difficulties communicating after a brain injury. Sometimes the problem can be physical in nature (e.g., not being able to make sounds). Sometimes the problem can appear more cognitive in nature. For example, someone can make sounds and words but cannot find the right words to say what they want to say, or they cannot understand what is being said to them.

Swallowing

A person may not be able to chew or swallow regular foods or drink liquids after a brain injury. Sometimes they will require a change in diet (e.g., pureed food or thickened fluids). Sometimes a person may not be able to eat enough to meet their needs. They will have a tube put in their nose or stomach to give them proper nutrition. These difficulties are usually temporary (in the early stages of recovery) but can continue for someone with a more severe brain injury.

Bladder/bowel control

Following a brain injury, the person may not be able to control their bladder or bowel. The bladder or bowel may be overactive or underactive. Or, the person may not feel the urge to go to the bathroom or know how to respond if they do. People are often at increased risk for bladder infections because the bladder is not emptied regularly and completely.

Pain

Pain and headaches are common after a brain injury. Sometimes they go away as the person improves physically. Sometimes they can be more chronic and require ongoing pain management. Pain can make it difficult for people to concentrate and it can also affect the person’s mood and sleep.

Sleep

Sleep patterns can be changed after a brain injury. Sometimes people have trouble getting to sleep, staying asleep or getting the right level of sleep. A referral to a sleep clinic may be necessary if the issue is ongoing.

Fatigue

Fatigue is common. Recovering from a serious injury takes a lot of energy. Rehabilitation is hard work and can drain a person physically and mentally. If the person has difficulty paying attention, remembering or thinking, doing simple things will take more work.

The person may only be able to do activities for short periods of time and may need to be reminded to rest if they don’t realize they are getting tired. Fatigue often gets better as someone improves, but for some people it will be an ongoing problem. They will have to schedule their activities and appointments accordingly.

Seizures

Seizures can occur after brain injury. They can cause a part of the body or the whole body to shake, or they can cause the person to appear to black-out (be non-responsive for a few seconds). Seizures can occur soon after the injury or not until months or years later. Doctors may prescribe anti-seizure medication to help control the seizures. Sometimes doctors do this as a precaution after a brain injury. If a person has had seizures, it is unsafe to drive a car and the doctor may recommend that their driver’s license be taken away.

Senses

A person’s ability to hear, see, smell, touch or taste may be affected by a brain injury. Someone may experience:

  • Oversensitivity to touch
  • Inability to feel pain, touch, hot or cold
  • Loss of vision, double vision or blurry vision
  • Visual neglect (seem unable to see things on one side of their body or room)
  • Changes in sense of smell or taste
  • Ringing in ears
  • Oversensitivity to noise.

Cognitive Changes

Brain injury can affect the way a person thinks, learns and remembers. Different abilities are located in different parts of the brain, so some may be affected, while others are not.

Some of these issues are more significant at the early stages of recovery when the person is distracted with medical issues and the high level of activity in the hospital. However, in some cases the changes can be permanent.

The following are some common challenges:

Attention

Difficulties with attention can include:

  • Directing attention
    The person may have difficulty focusing on a specific task or the important parts of the task. He or she may appear uninterested in or unaware of what they are being asked to do.
  • Sustaining attention
    The person may not be able to concentrate on a task for very long. He or she may be easily distracted. The complexity of the task and the person’s fatigue level can affect how long they can focus on a given task. Internal stimuli (e.g., thoughts about lunchtime) or external stimuli (e.g., outside construction noise) may interfere.
  • Shifting attention
    The person may be able to concentrate on one task but can’t switch from one activity to another. They may get stuck on a task and may not be able to stop doing it.
  • Divided attention
    Some people have difficulty coping with multiple tasks. For example, a student may not be able to listen to a teacher and take notes. Or the person may not be able to concentrate on cooking dinner while the radio is on. Problems with attention tend to get worse when the person is tired, stressed or worried. Working in a place with as few distractions as possible can help.


Speed of processing

After a brain injury, some people process information or think at a slower rate. Sometimes it looks as if the person does not understand or is not going to respond to what is said to them. However, they may be able to respond if they are given time to process the information.

Memory and learning

Memory is easily damaged by brain injury because there are several parts of the brain that are involved in processing, storing and retrieving information.

Although the degree and nature of memory impairments vary in each situation, there are common patterns.

Often the person with a brain injury has a good memory for past events or previously-learned material (e.g., family members, where they worked, the family pet’s name).

Short-term memory loss is the most common and troublesome type of memory problem. Examples of this are: forgetting what has just been said; having difficulty in learning a new skill; repeating the same question over and over; forgetting people’s names; getting details mixed up; forgetting a change in routine; and forgetting where things have been placed.

There is no magic answer to improve this type of memory problem, but rehabilitation can help a person cope by teaching strategies to make up for the memory loss (e.g., written reminders, logbooks, established routines).

Planning, organizing and sequencing

People with brain injuries can experience difficulties with planning, organizing information or sequencing things to get a task done.

A person sometimes has difficulty breaking down a task into the individual steps that are needed. As a result, the task can be overwhelming. For example, the person might want to phone a friend to arrange a visit, but the steps of finding a phone book, looking up the number, and deciding on the time and place to visit may be too much for them.

Strategies can help. For example, breaking the task into individual steps and providing cues to the person on how to complete each part of the task.

Communication

Brain injuries can affect a person’s ability to communicate. Communication is not just speaking. It is also communicating through gestures, body language and written language.

Language problems following a brain injury vary and may include:

  • Dysarthria
    Speech is slow, slurred or difficult to understand because the areas of the brain that control speech muscles are damaged.
  • Apraxia
    The person has difficulty saying words correctly.
  • Aphasia
    Some people with aphasia have problems with expressive language (what is said). Others have problems with receptive language (what is understood). Often a person may have more problems with reading and writing than with speaking and understanding.  Additional information about aphasia is available here.


Sometimes people experience difficulties with the social aspects of conversation such as taking turns, generating ideas, reading social cues, and recognizing facial expressions in themselves or others.