Traumatic Brain Injury (TBI)
The brain, which together with the spinal cord forms the central nervous system, is protected by the skull and consists of the cerebrum, the cerebellum and medulla. The brain is the most complex structure of the human body and the central nervous system; its different areas are mainly responsible for movement, feelings and perceptions, emotions and behaviour, and within the brain, higher mental functions are performed: attention, memory, language and intelligence. Any brain injury may affect one level or another of these functions.
Brain injury may be due to different causes: tumours, vascular lesions, infectious diseases, anoxia (if it occurs during labour, it is called cerebral palsy), etc. However, the most common cause is from trauma and is called traumatic brain injury (TBI).
Injury to the brain after trauma is due, firstly, to the primary injury (contusion) directly related to the impact on the skull or the rapid acceleration/deceleration movement, and secondly, to the secondary injury (oedema, haemorrhage, increased pressure in the skull etc.), which develops as a result of the primary injury during the first days after the accident and can have serious consequences on the functional prognosis. The first consequence of the post-traumatic injury is usually an altered state of consciousness: the coma. The intensity and duration of which will vary and in some cases can last for months, causing significant long-term consequences.
Physical deficiencies may be disorders at the sensory level (touch, smell, sight etc.), movement and gait disorders (quadriplegia and hemiplegia), or swallowing, motor coordination, muscle tone or spasticity disorders, abnormal sphincter control, etc.
As regards neuropsychology (the effect on higher functions), we can objectify a great variability of cognitive and behavioural deficits that, with varying intensity, may occur as a result of moderate or severe brain injury. The main cognitive functions that can be altered are: attention and concentration, memory and learning, reasoning and intelligence, language and speaking, etc. With respect to behaviour and emotion, one may suffer disorders such as impulsiveness, lack of inhibition, lack of initiative, lack of awareness of the condition, change in personality, etc.
These changes tend to occur at different frequencies; however, they tend to alter the patient's ability to acquire, store and retrieve new information, as well as the ability to make correct decisions. The result of cognitive dysfunction is a loss of social relations and the emergence of trouble in the family, in addition to difficulty returning to the educational or work situation the patient was in before the accident.
Despite advances in the field of neurology and the research of substances that could help nerve regeneration, full recovery from injury is difficult at present. However, neurorehabilitation has methods available to help the person affected by brain injury to optimise the recovery of their individual functions, enhance their preserved capabilities and help them adapt to their limitations, in order to achieve the most autonomy possible.
References about TBI
- Intervenciones de rehabilitación en traumatismo craneoencefálico: consenso multidisciplinar. IN08/2010. Barcelona: Agència d’Informació, Avaluació i Qualitat en Salut. Pla director sociosanitari. Departament de Salut. Generalitat de Catalunya; 2010.
- Traumatic brain injury. Rehabilitation Medicine Quick Reference. David X. Cifu, MD and Deborah Caruso, MD. Demos Medical Publishing, New York. 2010