The Central Nervous System is made up of the encephalon, and the spinal cord. The encephalon is protected by the cranium and is made up of the brain, the cerebellum and the medulla oblongata. The brain is the most complex structure and the main nerve centre of the human body. Several brain areas are responsible for movement sensations and perceptions, emotions and behaviour. The brain is also the home of higher mental functions such as attention, memory, language and intelligence. Any damage to the brain can affect these functions to a greater or a lesser extent.
Brain damage may have several various causes: tumours, vascular diseases, infectious diseases, anoxia (if this occurs during labour it is called infantile cerebral palsy), etc. However, the most common cause of brain damage is trauma and it is called craniocerebral trauma -CCT-.
CCT is one of the most serious health problems in developed countries. This is due to the high number of deaths it causes and to the number of people consequently disabled of some kind, whether functional, cognitive or - commonly - both.
Brain damage after trauma is due to the primary injury (contusion). This is an impact on the cranium or the rapid movement of acceleration/deceleration. It also comes from the secondary injury (oedema, haemorrhage, cranial pressure increase, etc.). These secondary injuries result from primary injuries, occur in the first few days after an accident and may have a serious bearing on functional prognosis. The first consequence of post-traumatic injuries usually is an altered state of consciousness, a coma; The severity and duration of comas vary. In some cases they may last months, with serious long-term consequences.
Brain damage, regardless of its cause (either CCT or non-traumatic), leads to physical and cognitive deficits. These can bring about a disability which may be mild, moderate or severe.
Physical deficits may include disorders related to the senses (smell, sight, hearing, etc.), movement and walking (tetraparesis and hemiparesis), sensitivity, swallowing, motor coordination, muscle tone and spasticity, toileting disorders, etc.
Neuropsychological deficits (disorders of higher brain functions) imply a great many cognitive and behavioural defects varying in severity, always as a consequence of moderate or serious brain damage. The main cognitive functions which may be deranged are: concentration - attention, memory- - learning, reasoning - intelligence, language - speech etc. Behaviours - emotions may derange into: impulsiveness, uninhibition, lack of initiative, little awareness of the disability, mood changes, etc.
The occurrence of these alterations is usually varied and tends to change the patient's ability to acquire, store and retrieve new information and to make appropriate decisions. The result of cognitive dysfunction is loss of socialization and stress in the patient's family. In addition, cognitive dysfunction makes it difficult for patients to return to their pre-accident educational or work environment.
Despite advances in neurology and in the research of substances which may help nerve regeneration, complete recovery from brain damage is very difficult currently. However neurorehabilitation involves methods helping people with brain damage to maximize function recovery, strengthen their remaining abilities and adjust to their limitations for maximum self-support.
·INCIDENCE: In the countries in our region, the incidence of CCT is estimated at between 175 and 200 cases per 100,000 inhabitants per year. The mortality rate of CCT ranges from 14 to 30 % per 100,000 inhabitants per year. Severe disability from CCT has an incidence rate estimated at 2 % per 100,000 inhabitants per year, and moderate disability at 4 % per 100,000 inhabitants per year. The community at highest risk is young adults between the ages of 15 and 24. Incidence does prevail amongst males. The main cause is traffic accidents.