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Brain Injury

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A brain injury can change your life in an instant. It may affect how you think, how you feel, how you behave, how you move, and what you remember. However, remarkable progress has been made in the treatment and rehabilitation of patients who have had a brain injury.

The multidisciplinary team at the Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center is dedicated to providing exceptional care to patients with brain injury.

In addition to the personalized care that you receive at the institute, please refer to this page to help you and your loved one navigate the journey to recovery. Along with learning about key milestones and expectations of brain injury patients, you will find important resources, clinical details and helpful suggestions for rehabilitation. We aim to be your partner as together we help you and your loved one recover from a brain injury.

What is a Brain Injury?

A brain injury occurs when there is damage to the brain. A traumatic brain injury (TBI) can be the result of a physical or head trauma resulting from a car accident, assault or fall that causes the brain to collide with the inside of the skull.

According to the Centers for Disease Control and Prevention (CDC), 1.7 million persons sustain a traumatic brain injury annually. Of those, around 120,000 people will have long-term, substantial loss of function. For this reason, it is important to understand the risk factors and causes of brain injury.

Types of Brain Injury

To understand the types of brain injury, it is important to know the different functions of the brain.

Cerebral CortexLobes of the Cerebral Cortex

  • The brain stem is responsible for basic life functions such as breathing, arousal and consciousness, attention and concentration, heart rate, and sleep and wake cycles.
  • The frontal lobes are responsible for problem-solving, judgment and motor function.
  • The parietal lobes manage sensation, handwriting and body position.
  • The temporal lobes are involved with memory and hearing.
  • The occipital lobes contain the brain’s visual processing system.

Skull Fracture

A break in one or more bones that surround the brain. Many times theses fractures heal on their own.

Contusion

A mild bruise to the brain. Side effects of a contusion may include headaches, nausea, vomiting, dizziness, and problems with memory and concentration. Surgery is usually not indicated.

Epidural Hematoma

A collection of blood that forms between the dura (outer covering of the brain) and the skull. Due to possible increases in pressure inside the brain, surgery may be needed.

Subdural Hematoma

A collection of blood outside of the brain. An acute subdural hematoma occurs when there is rapid bleeding in the brain. A chronic subdural hematoma may occur days or weeks after a minor injury to the brain. Due to possible increases in intracranial pressure, surgery may be needed.

Anoxic Brain Injury

Occurs when there is a lack of oxygen supplied to the brain.

What to Expect—Initial Evaluation

When arriving at the Mischer Neuroscience Institute, the healthcare team will measure a patient’s temperature, pulse and blood pressure, and generally performs urine and blood tests. A physician also will perform a physical examination of the patient, which may include testing the reflexes, eye movements, speech, muscle strength and tone, and coordination. A physician also may test attention and concentration, memory and cognitive reasoning.

Common Diagnostic Tests for Brain Injury Patients

While physical examination helps physicians determine the type of brain injury suffered by a patient, other tests can provide more detailed information regarding treatment. Some common treatments include:

Computed Tomography (CAT Scan)

A CAT , or CT, scan uses a computer system to give a detailed picture of brain tissue to determine where the brain was injured. During the test, the patient lies on a table with his or her head in a large, donut-shaped machine that takes pictures of the brain. The scan generally takes approximately 15 minutes to complete and is painless.

Magnetic Resonance Imaging (MRI)

An MRI is a test that uses a strong magnetic field and radio waves to give physicians a 3-D picture of the brain. During an MRI, which is painless, a patient must lie still within the MRI scanner for approximately 30 minutes. An MRI can be used for a more in-depth look of the brain than other imaging methods.

Electroencephalography (EEG)

An EEG measures and records the electrical activity in the brain. An EEG is painless and can be helpful in diagnosing seizures.

During the Hospital Stay…

Upon admission to the hospital, a patient may be admitted to the Neuroscience Intensive Care Unit (NSICU), Neuroscience Intermediate Care Unit (NIMU), or the Neuroscience Acute Care Unit depending on their current condition. All units are located in the Jones Pavilion.

Signs and Symptoms After a Brain Injury

Many brain injury patients may continue to experience neurological or physical symptoms following hospitalization. These may include cognitive, physical, personality and behavioral changes. Below is a list of possible changes that may occur, depending on the severity and location of the brain injury.

Confusion following brain injury can be very common. This may cause some agitation which may be treated with medications. Supervision by family may be recommended.

Cognitive deficits that may occur after a brain injury include memory loss, impaired decision-making skills, impaired communication, lack of safety awareness, and attention deficits.

Physical deficits could include inability to walk, decreased balance, impaired speech, weakness, impaired hearing or vision, and increased fatigue. Sometimes the most difficult effects of a brain injury are the changes to the personality of the individual who may experience more stress, irritability, agitation, and may feel denial, lack of motivation, depression and anxiety. There may be a loss of emotional control accompanied by mood swings. Please be aware of these changes and talk to a physician with any concerns.

Please keep in mind that recovery from a brain injury continues after hospitalization.

Coping and Adjustment to Brain Injury

Brain injury not only impacts the individual with the brain injury but also the family and friends who surround them. Below is a list of helpful tips for caregivers, family and friends of patients on how to cope and adjust to changes
following a brain injury.

Acknowledge Your Feelings About the Brain Injury

A brain injury may bring about emotional, physical and financial stress for the caregiver. Other emotions that may arise are denial, anger, depression, guilt or responsibility. These feelings are normal and are expected.

Remember to Take Care of Yourself

It can be physically and emotionally exhausting caring for a loved one. It is important for caregivers to take moments out of the day to focus on other things and do things that are part of their daily routine (e.g., read a book, call a friend, exercise, take a bath, etc.).

Rely on Your Support Network

Prior to leaving the hospital, caregivers should think about family and friends who may be able to assist the patient with the brain injury. Rely on the support system to help with the patient’s care, and also to assist with everyday tasks such as grocery shopping, running errands, cooking meals, doing laundry or cleaning the house. Some brain injury patients may require some type of supervision after discharge, so it is important to work with family, friends or community resources to work out a supervision plan for the patient.

Educate Yourself

It is important to speak with the medical team, nursing staff and therapists about the needs of the patient following brain injury. Take time to read articles and attend support groups if possible.

Distraction Techniques

Some brain injury patients may experience increased agitation following their injury. If the patient becomes agitated or refuses to follow instructions, please try the following:

  • Re-direct: Change the topic or task by discussing topics of interest to the individual.
  • Give the individual time to calm down: Move away and give them time to calm down.
  • Notice any type of stimulation that might cause the agitation (lights, outside noises, etc.): Try to reduce the amount of stimulation by closing the door, go to a quiet room, etc.

Discharge, Care and Rehabilitation Following Brain Injury

The road to recovery following a brain injury will vary depending on the extent of the brain injury. During the hospital stay, patients may be evaluated by physical, occupational and speech therapists to determine their rehabilitation needs.

A physiatrist (physical medicine and rehabilitation physician) may also be consulted by the attending team to determine a patient’s rehabilitation needs. Some patients may be able to return home with home health or outpatient therapy while others may require a long-term, acute-care hospital stay (LTAC H), inpatient rehabilitation or a skilled nursing facility (SNF). A case manager or social worker will be available to review the discharge plan prior to discharge from the hospital.

Discharge Recommendations

Upon a patient’s discharge from the hospital, a physician will provide a list of specific discharge instructions that will include medications, follow-up instructions and follow-up appointments needed. Below is a list of helpful tips upon discharge for brain injury patients. Please always refer to the discharge instructions for specific instructions as the needs of each brain injury patient can be different.

  • Do not operate any power tools, such as saws or electrical appliances, due to slower reaction times and reduced attention.
  • Avoid environments with loud noises, flashing lights or strobe lights as these environments may be distracting and make it difficult to focus attention adequately.
  • Follow a structured and consistent routine at home.
  • Do not drink alcoholic beverages until cleared by a physician.
  • Do not drive until cleared by a physician.
  • Follow the medication schedule as instructed by the medical team.
  • Do not climb ladders or step-stools due to reduced balance and slow reaction times.
  • Supervision may be required due to impaired safety awareness. Please build a network of family or friends who might be able to assist with supervision needs.

Resources

DARS (Department of Assistive and Rehab Service)
4900 North Lamar Blvd.
Austin, TX 78751
Toll Free 1 (800) 628-5115
www.dars.state.tx.us/index.shtml

Brain Injury Association of Texas
316 W. 12th Street, Suite 405
Austin, TX 78701
Telephone: (512) 326-1212
Toll Free 1 (800) 392-0040
Fax: (512) 478-3370
Email: info@biatx.org

Social Security Administration
Toll Free 1 (800) 772-1213

Crime Victims Compensation
P.O. Box 12198
Austin, TX 78711-2198
Toll Free 1 (800) 983-9933

Texas Department of Aging and Disability Services
701 W. 51st St.
Austin, TX 78751
Telephone: (512) 438-3011
Toll Free 1 (888) 834-7406