Acquired Brain Injury

According to the Brain Injury Association of America, 2.4 million Americans sustain a brain injury each year. The good news is that the prognosis for those suffering a severe injury are better today than ever before since more is known about the brain and how to mitigate the risks involved.

Brain injury typically involves both primary and secondary impacts. Primary acquired brain injury occurs as a direct result of impact—brain lacerations and contusions, diffuse axonal injury, skull fractures, etc.—and are considered primary injuries that result in mechanical cellular disruption and microvascular brain injuries.

Secondary brain injury can be more insidious and more difficult to diagnose and manage. Many ABI patients initially appear only mildly injured but deteriorate clinically hours or days after the injury. Secondary injuries occur as a result of a very complicated and complex series of neurochemical and neurophysiologic reactions in the brain’s cellular level. Brain injuries can cause brain swelling, difficulty breathing, and significantly elevated blood pressure, all of which can worsen the brain injury.

Acquired brain injury often results in long-term or lifelong medical complications that make it difficult or impossible for the injured person to return to work and other activities of daily living. The injured person may also have paralysis and other traumatic injuries that can impact function and delay recovery. Chronic pain is not uncommon and may complicate recovery, especially if the problem distracts the patient or results in dependency on chronic pain medications. However, high quality, systematically managed care throughout the recovery process often leads to more promising acquired brain injury treatment outcomes for patients.

Treatment and Complications

The most important thing to understand about brain injury is that it is a process, not an event. Within minutes of injury, one’s brain chemistry changes as the body releases chemicals. Inflammation can occur within hours and is one of the most dangerous complications post-injury. Intracranial pressure can compress brain tissue, cause herniation and restrict blood supply to the brain. One of the key interventions when this occurs is to release the building pressure; a process that may include draining blood or removing damaged tissue to allow room for healthy brain tissue.

The Glasgow Coma Scale and the Rancho Los Amigos Scale are two of the key tools used when diagnosing brain injury. The Glasgow Coma Scale is based on a 15 point scale for evaluating severity based on verbal, eye opening and motor responses. The Ranchos Los Amigos Scale is a scale that measures awareness, cognition, behavior and interaction with the environment. With both, lower scores represent greater severity.

Acquired brain injury treatment may occur in several stages depending upon the severity. Ideally, treatment begins upon arrival at the hospital with the emergency room medical team. Once stabilized, the patient will be transferred to a specialized trauma care unit where a team of specialists will engage in acute treatment and close monitoring. Following this, the patient will likely be transferred to a rehabilitation facility where another team of specialists will be involved. The possibility of post-acute treatment, often in a non-hospital environment, is common for the more severely injured.  With all these handoffs, it is important to play an active role in coordinating care and facilitating the transfer of information.

The ultimate goal is to help the injured person return to productive activity. Along the way, attention will be devoted to managing medical risks and assisting with the recovery of memory, concentration, decision making and communication. The process can take months or years depending on the severity of the injury.