	May 1999

Understanding Traumatic Brain Injury

by Pete Moore
Peter Moore is Tapping Technology's occasional correspondent from Frederick. He has written on topics ranging from baseball to military history… Please address your comments to mdtap@clark.net
Head Trauma Rehabilitation is the newest focus of intense interest and development as more federal funding services focus on this difficult rehabilitation population and more hospitals develop in/out patient programs designed for head trauma rehab.
Most recent statistics and literature place TBI as third ranking cause of death and disability under the age of 35. Between 400,000 - 600,000 sustain head injuries annually of which 100,000 die and between 50,000-100,000 survive with severe impairments that prevent independent living. Additional 200,000 head traumatized persons are left with sequela that interfere with independent living skills.
Annual medical and rehabilitation costs place the tab at $3.9 billion dollars (1980 dollars) yearly to accommodate and rehabilitate severely head injured persons.
The sequela which often accompanies traumatic brain injury includes Cerebral Vascular accident (CVA), or stroke. Stroke is considered a closed head trauma, defined as a sudden onset of weakness of neurological systems as a result of injury to a blood vessel in the brain (Cerebrum, Cerebellum, or Brain stem) Causes of CVA may include: Thrombosis (Blood clot), Hemorrhage (blood vessel rupture resulting in bleeding in the brain tissue), damage from pressure produced by blood leakage, and Embolism (blockage of blood in vessel).
One rehabilitation advantage of CVA over TBI is the tendency of residual effects to be focal rather than diffused. Residual effects of CVA are specific to the affected brain hemisphere. Ex., damage to left cerebral hemisphere result in communication (Language, speech, reading, writing) impairment as well as right side hemiplegia. It is not uncommon to note auditory comprehension deficiencies as well.
Key weaknesses revealing right cerebral insult might be seen in the individual's inability to orient himself/herself with respect to the environment. Perceptual deficits are prevalent as well as visual-spatial deficits. Other deficiencies include: motor sensory paralysis of the left side, depth perception, ability to appreciate a concept of wholeness from incomplete fragmentary cues and critical imagination.
Some persons who have had strokes may respond in slow, scattered, disorganized and anxious fashion to new activity. Depression is common since these people are over-sensitive to their disability.
Persons with right side damage may completely deny any deficits; or ignore or be unaware of them. Such individuals are satisfied with their performance regardless of its quality. Thus, right side damaged persons are unable to learn from their mistakes or profit from experience. They are usually insensitive to the needs and desires of others, eventually causing rejection by their peers. Complication from CVA vary and are numerous. Most frequently listed are depression, joint contractures, spasticity, bowel and bladder dysfunction, urinary tract infection, pneumonia, seizures, subluxation of shoulder, and other shoulder syndromes. General deficits resulting from CVA include
1) Quality Control: Display lack of ability in guiding and checking ones own behavior (doing the right thing at the right time).
2) Memory - tendency for information to be remembered and processed selectively, whether it involves new information or old information. Individual's retention may have greatly decreased since the individual can no longer process high volumes of information Finally, individuals experience difficulty with generalization, and or applying what has been learned in one setting to another setting.
Anyway you look at it, TBI is no day in the park, but knowing what to expect can decrease our awkwardness and fear of dealing with persons experiencing these symptoms and conditions.

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