In our waking hours, the brain generates enough electrical energy to power a light bulb. But when the organ is injured, when that light goes out, brain damage can throw a traumatic brain injury survivor’s life into total darkness.
Everything seems different after TBI. For many survivors, even the simplest pleasures become an ordeal. Recovering from any injury is difficult, but recovering from an injury to the most intricate, and poorly understood, organ in the human body can seem impossible.
What Happens After Traumatic Brain Injury?
No two brain injuries are the same, and every survivor’s treatment plan will be different. Some patients bounce back quickly, while others require years of therapy before approaching the level of physical and/or cognitive ability they enjoyed prior to their injury. But for all of these patients, there’s hope.
Acute Care: Staying Alive & Stopping Further Damage
Not all damage to the brain will cause immediate unconsciousness. Mild brain injuries can result only in temporary disorientation, although their effects may become pronounced as time passes.
Severe traumatic brain injuries, on the other hand, are defined in part by how much unconsciousness they cause.
Coma, Vegetative State & Minimal Consciousness
Serious trauma to the head can impede neurological function drastically. Physicians distinguish between three levels of low brain activity:
- Vegetative State
- Minimally Conscious State
At their longest, “comas” last around three to four weeks, according to the Brain Injury Association of America. In a coma, patients are unresponsive to their environment. Usually, their eyes remain closed and physicians will determine that they are unaware of their surroundings.
In what’s known as a “vegetative state,” patients appear unaware of their environment but exhibit low-level physical functions. Their bodies maintain the sleep-wake cycle, and their eyes might even open, but there’s no evidence that they understand what’s happening around them. Some patients never wake from a vegetative state, and the longer one lasts, the less likely it becomes that they will.
In “minimally conscious states,” survivors show small, but definite, signs of awareness. They may be able to nod yes or no to questions or speak intelligibly but can do so only intermittently.
Vitals & Monitoring
No matter where a patient is along this spectrum of unconsciousness, trauma specialists in the intensive care unit will be busy assessing vital signs. All of the patient’s physical needs must be met. Usually, trauma nurses will attend to nutritional needs by inserting a feeding tube, either through the patient’s nose or directly in their stomach.
Doctors will monitor neurological activity for signs of seizure, episodes of abnormal brain signalling. Patients who have been left physically disabled by their injury may not present any outward signs of seizure, so great attention will be paid to the readouts of an electroencephalogram (EEG).
Meanwhile, surgeons may take steps to prevent further injury to the brain.
Some TBI patients require surgery to survive. When the brain is damaged, it can swell with fluid, become inflamed or hemorrhage, leaking blood inside the skull. While significantly different from a medical perspective, all of these effects increase pressure on the brain itself, cutting off the organ’s oxygen supply and threatening further damage.
Open head injuries, in which a foreign object has pierced the skull, present similar challenges, with the added difficulty that fractured portions of the skull may need to be removed.
Intracranial pressure monitoring can become vital here. Doctors have various methods of inserting small devices inside the head to gauge skull pressure and track stress on the brain.
Intracranial bleeding can be drained or extracted surgically. Non-surgical techniques designed to lower pressure inside the skull also exist. In one method, doctors use a ventilator machine to artificially stimulate hyperventilation. This forces carbon dioxide out of the body. Blood vessels crossing through the brain contract in response, potentially lowering the pressure.
In cases of severe TBI, a portion of damaged brain tissue may need to be removed entirely, leaving space within the skull for tissue that is still alive. This procedure is known as “craniotomy.”
Awaking from an unconscious state isn’t usually a “linear” process, according to Patrick Hutzel at IntensiveCareHotline.com. He compares it to turning a light on using a dimmer switch; it’s gradual and slow.
Doctors determine that patients have exited a minimally conscious state once they can communicate (sometimes with great difficulty), use household objects appropriately or follow instructions.
Rehab: Working Towards Functional Independence
Once patients have regained consciousness, many will be moved to a special trauma unit in the hospital. But some won’t, and medical facilities have their own philosophies on transitioning patients between levels of care. Some patients will go to a rehabilitative care center, while others will be transferred to a nursing home.
There’s no “right” way to do this. Human brain function is radically complex, and numerous theories have been proposed to explain how the organ works and how we can help people who have suffered brain damage. If you’re ever uncertain why something is happening, ask questions. Get answers. Be involved in your or your loved one’s care and don’t fear your own opinion. Be heard in the room.
Regardless of where a patient is monitored, they’ll be closely watched for changes, while psychologists and social workers help families and loved ones prepare for the possibility of disability, whether physical, cognitive or both.
Most patients will now experience what’s called the “confusional state.” Technically, this is a form of delirium, a spectrum of mental disorders affecting primarily the elderly.
Disorientation is common. Patients may appear to drift in time and space, unable to remember where they are or when it is. Their attention may lag, or seem non-existent. Short-term memory is usually impaired to some degree. Patients may be able to remember things that happened 10 years ago, but unable to recall what their loved one said 2 minutes ago.
Some patients will be extremely tired and sleep through the day. Sleep-wake cycles are often disrupted by traumatic brain injury. Some people will wake at regular hourly intervals during the night, while formerly deep sleepers will find themselves roused by the slightest noise. A patient’s level of awareness may change during the day, fairly suddenly. They may not respond as cogently as they did before.
Agitation and outbursts of anger are common. Families should try to preserve a calm environment for their loved one. If a particular topic seems distressing, let the conversation flow somewhere else.
At some point, most patients are transferred to a facility dedicated to rehabilitative care. Professionals in rehab have similar goals to those in the ICU, including basic stabilization of the patient’s physical condition, but expand the scope of treatment to include on-going therapies.
Rehab should begin as soon as possible. Most patients start working on regaining the ability to perform activities of daily living, like eating and dressing, before they’re transferred to an inpatient rehab center. At the rehab center, these efforts will be intensified if possible.
Physical, linguistic, cognitive and neuropsychological: each mode of impairment will be tackled by a different specialist. These experts have a common goal, however – recovering function to the highest level possible. This is sometimes called “remediation,” and contrasted to “compensation,” in which specialists focus on designing ways to adapt to new limitations that are unlikely to improve.
Therapy and rehabilitation are expensive and medical bills can quickly pile up causing added stress to an already stressful situation. Many TBI patients and their families consider filing a personal injury lawsuit when insurance companies fail to meet their needs. Several TBI injuries occur due to the negligence of another person, and when insurance fails to meet their financial needs, families are left with a huge burden of medical bills in addition to caring for an injured loved one.
TBI Is Complex. So Are Its Symptoms.
The brain plays a fundamental role in every move we take, every thought we think and every sensation we feel. While no part of the human body can function on its own, the brain serves as the gatekeeper of every other organ. Electrical impulses that start in the brain keep our heart’s pumping, our lungs breathing and our legs walking.
As you would expect, injury to the brain can result in numerous long-term symptoms, both localized impairments and systemic effects with far-reaching consequences.
Speech & Language
Patients with TBI often struggle with communication problems.
Aphasia is a broad category of symptoms associated with damage to the portion of the brain that controls language skills.
Anomia, when you can’t come up with the word you want to use, is particularly common after a traumatic brain injury. This is frustrating, both for patients and their loved ones, but many people with a TBI are unaware of the changes in their behavior, even those most glaring to their families.
Thought is often affected by traumatic brain injury. Remembering information, using it critically and understanding the consequences of knowledge can be difficult. Planning for future events, or making decisions in the present, may prove challenging, as can tasks involving multiple steps, like doing the laundry.
After sustaining a TBI, most patients experience some level of cognitive fatigue. Thinking becomes tiring.
Family members may observe various changes in mood or personality. Depression and anxiety are common. Some patients also have trouble regulating their emotions and may be prone to fits of rage or uncontrollable sadness. They often lose the ability to empathize with others and have difficulty understanding the emotions that their loved ones express.
Steps Toward Recovery
One of the most crucial steps in recovering from TBI is acknowledging that the patient may never recover fully. Only by internalizing the loss, possibly permanent, of some capabilities, can we learn to compensate for new limitations by using those skills that remain.
The attorneys of Banville Law understand the difficulties that your family is facing and want to help ease the pain of the situation. You have enough to worry about, without dealing with the added burden of financial stress. Our New York based firm has helped many families gain compensation for their injuries so that their loved one can focus on recovering.