Surviving Brain Injury and the Road to Recovery

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Surviving a brain injury is a life changing event, it can be a frightening and confusing time, Maria Atkin (Legal Nurse Consultant) offers an overview of the road to recovery and provides key information on how to maximise rehabilitation potential with the support of medical and legal experts.

Understanding Brain Injury

The brain is the most complex organ in your body, it is the bedrock of your personality and has an estimated 100 billion nerve cells interconnected via trillions of synapses1 which provides more connections than there are stars in the galaxy! Understanding the brain, without injury, is a challenge in itself, therefore surviving a brain injury can prove to be the most perplexing time of your life. The brain weighs only three pounds but is unique to each individual, determined by varying levels of social development, education, lifestyle, intellect and physical health status, so when the brain becomes injured, the pre-existing characteristics and ‘pre-morbid status of the brain’ are important to take into account. Latest research by Dr Schneider (2014)2 discusses the "cognitive reserve theory." The hypothesis is that people with more education have a larger cognitive reserve which helps improve the outcome of surviving injury. Other type of factors used to help determine recovery potential are culture, personality backgrounds, work-life and psychological wellbeing.

Assessing Extent of Injury

Following primary / acute medical intervention, the road to recovery for a brain injury survivor is broadly arranged into three stages. These three stages are: inpatient care within a hospital setting, community reintegration, and either returning home for rehabilitation or attending a specialist centre and finally lifetime support. Although these stages reflect a general development in rehabilitation, each person’s process is unique based on his or her circumstances, therefore the stages may vary in exact order. During the acute admission, medical professionals, with the assistance of modern technology may use immediate neuro-radiological examinations such as head computerized tomographic (CT) scan or magnetic resonance imaging (MRI), to help initially assess the extent of damage caused. Modern technology is advancing and through latest research3 a new brain scanning technique named Positron Emission Tomography (PET) imaging, offers potential for predicting the fate of severely brain injured patients.

In addition to medical technology, the starting point for the recovery process is underpinning the location of damage caused to the brain. Injury can be either traumatic or acquired (please see examples in table 1) both with varying levels of severity. Recovery potential is furthermore assessed according to the location and extent of neurological damage (ranging from minor injuries to severe, please see table 2). In terms of the location of brain injury; this can be either focal (injury caused to one particular part of the brain) or global (injury affecting the majority of the brain).

However, from experience, the most crucial factor that helps determine one’s recovery potential is simply time. This allows the person’s brain to heal naturally and gradually whilst allowing professionals to monitor progress and help towards developing rehabilitative milestones.

Table 1

Traumatic Brain Injury Acquired Brain Injury
Assault to the brain caused by a blow to the head which has penetrated through to the brain by damaging and opening the skull (e.g. serious RTA, falls, sport injuries, assaults). Anoxia (complete starvation of oxygen to the brain), Hypoxia (partial loss of oxygen supply), viral/infections, drug and alcohol abuse, infarction (death of brain cells resulting from an interruption of their blood supply).

Table 2

The duration of coma and/or Post-Traumatic Amnesia (PTA) can also be used to make a judgement of how severe the injury is likely to be4.

MILD/MINOR Causes brief loss of consciousness for 15 minutes or less with a period of post-traumatic amnesia of less than 1 hour.
MODERATE Defined as being a condition where the patient has been in a coma for 6 hours, and a period of post-traumatic amnesia of up to 24 hours.
SEVERE Defined as being a condition where the patient has been in a coma for 6 hours or more, or a post-traumatic amnesia of 24 hours or more.

Road to recovery

As highlighted in the above, due to the complex structure of the brain and varying levels of injury and subsequent damage, there is no typical approach to recovery as each medical examination is based on the merit of individuality. Specialist brain injury professionals such as neuro-rehabilitation consultants, neuro-psychiatrists, neuro-psychologists and specialist brain injury nurses are imperative to provide the expertise you need to understand and anticipate the long term effects. Planning for the future will entail specific treatment options, often by developing bespoke and individualised rehabilitative packages of care to help maximise recovery potential. Such specialist support is not only helpful to families trying to rebuild lives but also to share knowledge, experience and help guide individuals throughout such uncertain and challenging times.

The Effects of Brain Injury

It is suggested that new brain connections are formed each time you create and store a memory. Therefore if the brain sustains injury, neuroplasticity works hard to help form new networks and pathways despite the injury often resulting in long term difficulties, most commonly to memory, cognitive functioning, psychological wellbeing, physical health and impacting on social behaviour. To name but a few, there are a range of common effects, however, all of which will depend, as previously mentioned, on the type, location and severity of the brain injury. An interesting condition and one which is not widely recognised is 'acquired savant syndrome' whereby people develop talents for maths, art or music. An extraordinary story and most worthy of a read, is seen within the Mail Online (26/04/14) How a brain injury turned an average Joe into a math genius who is among only 40 people in the WORLD to have released an 'inner Einstein' after trauma5.

On a final note, brain injury can be a bewildering prospect and the road to recovery is not one to travel alone, a range of legal and health professionals are available for support. For more details on how we can help, call us on 0800 195 8467 or complete our contact form to the right.

About the Author

Maria Atkin, Legal Nurse Consultant
Maria qualified as a registered nurse in 2005 and began her career in North Wales’ NHS. In 2010, she moved to South Wales and took up post as an NHS Senior Specialist Manager and developed a Brain Injury Case Management service. She has a wealth of clinical knowledge and experience and has achieved a Master of Laws (Legal Aspects of Medical Practice) degree at the prestigious Cardiff School of Law (2013). Maria has also actively volunteered for Headway Charity for the last two years and recently established Legal Nurse Consultant Ltd to help provide nursing expertise to assist legal firms and the public in relation to brain injury assessment and case management.

Footnotes

1 www.livescience.com
2 Dr Schneider, E.B (2014) Longer education linked to better recovery from traumatic brain injury, Johns Hopkins School of Medicine
sup>3 Stender, J et al (2014) Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study, The Lancet Early Online Publication
4 http://www.headway.org.uk
5 Available from:http://www.dailymail.co.uk/news/article-2608861/How-brain-injury-turned-average-Joe-math-genius-40-people-WORLD-released-inner-Einstein-trauma.html



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