Brain Info
I am always looking for new information to pass on, so check back here often.
Some interesting stuff, click on the desired link.
ABI Questionaire
This questionnaire is not meant to be a formal "test" to see if you have a head injury. If you have multiple "YES" answers, bring this questionnaire to your doctor. Additional tests (medical and neuropsychological) maybe ordered.
HEADACHES
Yes or No - Do you have more headaches since the injury or accident?
Yes or No - Do you have pain in the temples or forehead?
Yes or No - Do you have pain in the back of the head (sometimes the pain will start at the back of the head and extend to the front of the head)?
Yes or No - Do you have episodes of very sharp pain (like being stabbed) in the head which lasts from several seconds to several minutes?
MEMORY
Yes or No - Does your memory seem worse following the accident or injury?
Yes or No - Do you seem to forget what people have told you 15 to 30 minutes ago?
Yes or No - Do family members or friends say that you have asked the same question over and over?
Yes or No - Do you have difficulty remembering what you have just read?
WORD-FINDING
Yes or No - Do you have difficulty coming up with the right word (you know the word that you want to say but can’t seem to "spit it out")?
FATIGUE
Yes or No - Do you get tired more easily (mentally and/or physically)?
Yes or No - Does the fatigue get worse the more you think or in very emotional situations?
CHANGES IN EMOTION
Yes or No - Are you more easily irritated or angered (seems to come on quickly)?
Yes or No - Since the injury, do you cry or become depressed more easily?
CHANGES IN SLEEP
Yes or No - Do you keep waking up throughout the night and early morning?
Yes or No - Do you wake up early in the morning (4 or 5 a.m.) and can’t get back to sleep?
ENVIRONMENTAL OVERLOAD
Yes or No - Do you find yourself easily overwhelmed in noisy or crowded places (feeling overwhelmed in a busy store or around noisy children)?
IMPULSIVENESS
Yes or No - Do you find yourself making poor or impulsive decisions (saying things "without thinking" that may hurt others feelings; increase in impulse buying?)
CONCENTRATION
Yes or No - Do you have difficulty concentrating (can’t seem to stay focused on what you are doing)?
DISTRACTION
Yes or No - Are you easily distracted (someone interrupts you while you are doing a task and you lose your place)?
ORGANIZATION
Yes or No - Do you have difficulty getting organized or completing a task (leave out a step in a recipe or started multiple projects but don’t complete them)?
Total Number of Yes Answers =
If you have 5 or more Yes answers, discuss the results of this questionnaire with your doctor.
TRAUMATIC BRAIN INJURY SURVIVAL GUIDE
By Dr. Glen Johnson, Clinical Neuropsychologist
Clinical Director of the Neuro-Recovery Head Injury Program
The information on this site is not intended as medical advice or a substitute for obtaining medical or other professional advice. If you have specific questions or concerns about your health, please consult a physician.
Fast Facts about traumatic brain injury
What is a traumatic brain injury?
A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI. The severity of such an injury may range from "mild," i.e., a brief change in mental status or consciousness to "severe," i.e., an extended period of unconsciousness or amnesia after the injury. A TBI can result in short or long-term problems with independent function.
How many people have TBI?
Of the 1.4 million who sustain a TBI each year in the United States:
50,000 die;
235,000 are hospitalized; and
1.1 million are treated and released from an emergency department.1
The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.
What causes TBI?
The leading causes of TBI are:
Falls (28%);
Motor vehicle-traffic crashes (20%);
Struck by/against (19%); and
Assaults (11%).1
Blasts are a leading cause of TBI for active duty military personnel in war zones.2
Who is at highest risk for TBI?
Males are about 1.5 times as likely as females to sustain a TBI.1
The two age groups at highest risk for TBI are 0 to 4 year olds and 15 to 19 year olds.1
Certain military duties (e.g., paratrooper) increase the risk of sustaining a TBI.3
African Americans have the highest death rate from TBI.1
What are the costs of TBI?
Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated $56.3 billion in the United States in 1995.4
What are the long-term consequences of TBI?
The Centers for Disease Control and Prevention estimates that at least 5.3 million Americans currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI.5
According to one study, about 40% of those hospitalized with a TBI had at least one unmet need for services one year after their injury. The most frequent unmet needs were:
Improving memory and problem solving;
Managing stress and emotional upsets;
Controlling one's temper; and
Improving one's job skills.6
TBI can cause a wide range of functional changes affecting thinking, sensation, language, and/or emotions. It can also cause epilepsy and increase the risk for conditions such as Alzheimer's disease, Parkinson's disease, and other brain disorders that become more prevalent with age.7
References
Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2004.
Defense and Veterans Brain Injury Center (DVBIC). [unpublished]. Washington (DC): U.S. Department of Defense; 2005.
Ivins BJ, Schwab K, Warden D, Harvey S, Hoilien M, Powell J, et al. Traumatic brain injury in U.S. army paratroopers: prevalence and character. Journal of Trauma Injury, Infection and Critical Care 2003;55(4): 617-21.
Thurman D. The epidemiology and economics of head trauma. In: Miller L, Hayes R, editors. Head trauma: basic, preclinical, and clinical directions. New York (NY): Wiley and Sons; 2001.
Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury in the United States: a public health perspective. Journal of Head Trauma Rehabilitation 1999;14(6):602-15.
Corrigan JD, Whiteneck G, Mellick D. Perceived needs following traumatic brain injury. Journal of Head Trauma Rehabilitation 2004;19(3):205-16.
National Institute of Neurological Disorders and Stroke. Traumatic brain injury: hope through research. Bethesda (MD): National Institutes of Health; 2002 Feb. NIH Publication No. 02-158. Available from: www.ninds.nih.gov/disorders/tbi/detail_tbi.htm.
How doctors rate a brain injury
Here I hope to offer articles that can help you understand and start coping with your injury. Remember this information is for reference only and is not intended to replace professional medical help.
Injury severity
After a traumatic brain injury, whether or not the person was actually unconscious, a state occurs where the person seems to be aware of things around them but is confused and disorientated. They are not able to remember everyday things or conversations, and often do or say bizarre things. This is called Post-Traumatic Amnesia (PTA), and is a stage through which the person will pass.
The length of PTA is important as it gives an indication of the severity of the injury. Used in combination with length of time in coma, these two give the best measure of eventual outcome. You can find out more about PTA in our factsheet, which you can download using the link at the bottom of this page.
The table below gives a rough guide to how these measures affect the severity of the injury, although it is worth noting that everyone is different and categorising injuries in this way doesn't always give an accurate measure of the long-term effects.
MINOR BRAIN INJURY
Time in coma, < 15 min
Time in Post-Traumatic Amnesia (PTA), < 1 hour
MODERATE BRAIN INJURY
Time in coma, 15 min to 1 hour
Time in Post-Traumatic Amnesia (PTA), 1 hour to 24 hours
SEVERE BRAIN INJURY
Time in coma, 6 to 48 hours
Time in Post-Traumatic Amnesia (PTA), 24 hours to 7 days
VERY SEVERE BRAIN INJURY
Time in coma, > 48 hours
Time in Post-Traumatic Amnesia (PTA), > 7 days
Minor Brain Injury
A brief period of unconsciousness, or just feeling sick and dizzy, may result from a person banging their head getting into the car, walking into the top of a low door way, or slipping over in the street. It is estimated that 75% of all head injuries fall into this category.
The effects of a minor head injury can be anything but minor to the person concerned. They can include nausea, headaches, dizziness, impaired concentration, memory problems, extreme tiredness, intolerance to light and noise, and can lead to anxiety and depression. When problems like this persist, they are often called post-concussion syndrome.
A common problem is that either no scans were done at the time of the accident, or subsequent scans show no damage. This frequently gives rise to the impression that there is nothing medically wrong. The persistent problems can be misunderstood by GP's, sometimes being considered as almost hypochondria on the part of the patient. Although it is true that in some cases where the symptoms persist for months a psychological element such as depression can come into play. Whilst this may make existing conditions even more difficult to live with, it is not on the whole true or helpful to say that 'it is all in the mind'. A second opinion should be sought from a neurologist or neuro-psychologist.
It is important that relatives and employers are warned about the possible effects of a minor head injury, and for plans to be made accordingly. These might include not rushing to return to work, keeping stress to a minimum in the short term, and abstaining from alcohol. One study showed that almost one third of people with a minor head injury were not working full-time three months after receiving the injury, although other studies have been much more optimistic. Difficulties are certainly made much worse if the person has a mentally demanding job where there is a low margin for error.
The general conclusion seems to be that the vast majority of people who experience a minor head injury make a full recovery, usually after 3-4 months. However there is a very small sub-group whose recovery is not so good.
Moderate Brain Injury
A moderate head injury is defined as loss of consciousness for between 15 minutes and 6 hours, and a period of post-traumatic amnesia of up to 24 hours. The patient can be kept in hospital overnight for observation, and then discharged if there are no further obvious medical injuries. Like those with a minor head injury, patients with moderate head injury are likely to suffer from a number of residual symptoms.
The most commonly reported symptoms include tiredness, headaches and dizziness (physical effects) difficulties with thinking, attention, memory planning, organising, concentration and word-finding problems (cognitive effects) and irritability (an emotional and behavioural problem). These symptoms are accompanied by understandable worry and anxiety. This can be particularly pronounced if the patient has not been warned that these problems are likely to arise. If the patient expects to be perfectly well within a few days and symptoms are still prominent after a few weeks, they may worry or feel guilty. This has the effect of creating a vicious circle leading to more symptoms and so on.
A large proportion of people find that when they return to work they have difficulties and feel that they are not functioning at their highest level. For the majority of people these residual symptoms gradually improve, although this can sometimes take 6 to 9 months.
Severe Brain Injury
A severe head injury is usually 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. These patients are likely to be hospitalised and receive rehabilitation once the acute phase has passed. Depending on the length of time in coma, these patients tend to have more serious physical deficits.
Very Severe Brain Injury
A further category of very severe injury is defined by a period of unconsciousness of 48 hours or more, or a period of PTA of 7 days or more. The longer the length of coma and PTA, the poorer will be the outcome. However, there are exceptions to this rule and, just as there is a small group of people who have a mild head injury who make a poor recovery, so there is a small group of individuals who have a severe or very severe injury who do exceptionally well.
Areas of the Brain
The brain is the control center for all of the body's actions and functions. It receives messages and interprets them. The brain responds to messages by enabling a person to perform the vital processes of breathing and moving, as well as thinking, judgment and emotional reactions.
A fundamental awareness of the brain's structure may help in understanding what happens to the brain during head injury.
The brain is comprised of three areas:
Brain Stem - The brain stem connects the brain to the spinal cord. Structures in the brain stem control consciousness, arousal and vital functions such as breathing, blood pressure and pulse rate.
Cerebellum - The cerebellum controls muscle, coordination and balance.
Cortex - The cortex is the largest area of the brain and is where most thinking functions occur. The cortex is divided into four lobes. Each lobe has a specialized function as shown in the diagram on page 32. In addition, the cortex is divided into two halves (hemispheres). The dominant hemisphere, usually the left, controls verbal functions such as speaking, writing, reading and calculating. The right hemisphere controls functions that are more visual in nature such as memory, drawing or copying.
No two traumatic head injuries are the same, just as no two individuals are identical. This is because different areas of the brain are affected with each injury and the effects are multiple. Because of these multiple effects and the fact that the damage is often widespread, traumatic brain injury differs from other types of brain damage such as stroke, brain tumor, drug or alcohol-induced problems and degenerative disease.
Here is a list of possible functional deficits resulting from an Aquired Brain Injury.
- Debilitation, fatigue.
- Sleep dysfunction, i.e. insomnia, day and night confusion.
- Lack of stamina.
- Problems planning, organizing and initiating tasks.
- Difficulties with multitasking and sequencing, i.e. keeping track of two things at once.
- Need for structure and direction to accomplish tasks.
- Poor concentration, attention and memory.
- Problems retrieving information from memory.
- Although intelligence remains intact, there is slowness in processing information, particularly new information especially if fatigued or over stimulated.
- Problems with pacing activities.
- Difficulty with judgment and decision making.
- Irritability
- Impulsivity
- Difficulty dealing with change.
- Inability to cue, leading to socially inappropriate behavior.
- Isolating self as feeling different, and therefore treated differently
- Hard to “keep up” in social situations.
- Poor coping strategies which impact on interpersonal and vocational efforts.
- Vertigo (dizziness), light headed feeling.
- Tinnitus (ringing in the ears).
- Light or sound sensitivity.
- Smell and taste alterations.
- Visual, speech and hearing disturbances.
- Stress related disorders-depression-frustration.
- Emotional liability, i.e. crying for no apparent reason.
- Emotional / behavioral outbursts.
- Compulsive talkativeness.
- Balance and co-ordination problems (motor co-ordination).
- Personality change.
- Chronic pain, including headache.
- Inability to return to work, or, if able, at reduced capacity and with great effort.
- Family breakdown.
- Possible misdiagnosis as, for example, psychiatric illness or malingering.
Each head injury is different. A survivor may experience any combination of symptoms or none at all. Severities of symptoms vary with each individual and may change over time.
The information on this site is not intended as medical advice or a substitute for obtaining medical or other professional advice. If you have specific questions or concerns about your health, please consult a physician.