Brain injuries: impact and prevention

Traumatic brain injuries (TBI) impact more than 2.5 million people in the United States each year and have a wide range of severity, from mild concussions to coma. Some conditions have a widespread potential impact on function. Survivors of brain injury may be left to deal with significant changes to their physical, emotional and cognitive health and function. A Baylor College of Medicine expert outlines the effects of brain injuries.

Effects

The impact of severe brain injury can vary. Survivors often will have a significant alteration of consciousness, and in the most severe cases, there is complete loss of consciousness. Rarely, consciousness is never regained. Neurologic improvement tends to occur over weeks to months. The pace of this improvement is highly variable, but in general is fastest over the first three months post injury and will often continue for a full year or beyond.

Long-term effects of brain injury are myriad. Paralysis, changes in muscle tone and problems with coordination of movements can make basic mobility and self-care activities a challenge. Many people are left with a degree of cognitive impairment. Amnesia, impairment of attentional function and disorders of higher-level executive cognitive skills are all common.

“The memory loss following brain injury isn’t like what you see in TV soap operas where you forget who you are. Your old memories are usually preserved. What you lose is the ability to lay down new memories – to learn new information,” said Dr. James McDeavitt professor of physical medicine and rehabilitation and executive vice president and dean of clinical affairs at Baylor. “The ability to focus your attention may also be impaired, similar to people with ADHD.  This clearly can have implications as people attempt to return to work or school.”

Brain injuries may also result in:

• Behavioral changes
• Mood disturbances
• Depression
• Irritability
• Social disinhibition

So-called “mild” brain injuries, or concussions, may not result in the same level of physical impairment, but individuals with concussion may still be limited by decreased exercise tolerance, headache, dizziness and cognition. In rare cases, sustaining a second concussion can cause severe neurologic damage.

“If you have a blow to the head and experience any transient neurologic impairment (loss of consciousness, memory loss, dizziness, nausea, or headache), you should be evaluated by a physician knowledgeable in concussion assessment and treatment. It is important to have expert guidance as you look to resumption of school and sports participation,” McDeavitt said.

Neurologic impact

Much of the damage in traumatic brain injury is the result of torquing of individual nerve cells as the brain rapidly decelerates. This damage tends to be most severe in the lower portion of the frontal lobes and the inner portions of the temporal lobes, which explains some of typical cognitive and behavioral issues following TBI. The frontal lobe modulates behaviors while the temporal lobes are responsible for information processing and memory functions.

Prevention

Patients with TBI will experience a degree of spontaneous natural recovery over time, but they may experience issues such as vertigo, dizziness and balance problems. Therapists, including physical therapists, occupational therapists, psychologists and speech and language pathologists, can assist with maximizing return to prior activities. For injuries that do not resolve quickly, it is important to find a physiatrist specializing in rehabilitation medicine or neurologist with experience in working with people with TBI. In addition to therapy, physicians might also prescribe medications that help reduce some of TBI-related cognitive and behavioral impairment.

There is no effective treatment to actively repair the damage to the injured brain; at this point, prevention is the best treatment.

Many injuries are related to car crashes, so McDeavitt encourages everyone to stay safe on the road: wear a seatbelt, do not drink and drive, do not text and drive and maintain a safe speed. There also is a high incidence of concussion in sports where people run into each other at full speed, especially in football and soccer.

“Increasingly, concern in sports is not just about concussion, but the cumulative impact of small subclinical brain injuries. There is an increasing body of evidence that shows if you play football over a long period of time, you’re subject to hundreds if not thousands of microinjuries – all of which are asymptomatic – but add up over time. This produces a condition known as chronic traumatic encephalopathy, or CTE, which can be very disabling,” McDeavitt said.

Evidence shows that even playing high school or college football creates some of the microscopic structural changes in the brain that are consistent with CTE. If your child plays football or a high-contact sport, make sure the coaching staff is familiar with the risk of brain injury and appropriate application of concussion protocols. If a player gets a concussion, they should not return to play until fully recovered. Parents should make sure the coaching staff is emphasizing good technique and minimizing full speed contact drills.

“Brain injury is one of the few conditions in healthcare that affects such a wide variety of functions. TBI can impact your ability to perform basic tasks: to walk, dress, groom and bathe. It can impact your ability to return to your prior educational or vocational level of function. Changes in cognition and behavior can strain family relationships. However, there is help, and there is hope,” McDeavitt said.

Learn more about Baylor Medicine Physical Medicine and Rehabilitation. 

-By Homa Shalchi