Traumatic Brain Injury

When a patient takes a violent, hard hit to his or her head, the brain may experience changes in chemical and energy use as a way to compensate for the injury. These changes can result in headaches, light / sound sensitivity, and confusion. In mild traumatic brain injuries, these changes are short and do not permanently damage the brain.

However, with more severe injuries, these changes can last much longer and result in damage to the brain cells. These effects can cause the brain to swell and expand inside the skull. In severe cases, the swelling can lead to even more brain damage. Signs and symptoms can appear all at once, within 24 hours before the injury.

Although, they may emerge days or weeks after the injury. Sometimes the symptoms are subtle. Therefore, the patient may notice a problem but not relate it to the injury. Some people will appear to have no symptoms after a traumatic brain injury, but their conditions may worsen later. Here are a few known symptoms that are associated with traumatic brain injury:

• Difficulty sleeping

• Dizziness

• Fatigue / drowsiness

• Nausea or vomiting

• Problems with speech

• Oversleeping

• Depression

• Memory or concentration problems

• Mood changes

In addition, there are several different types and grades of traumatic brain injury, such as the following:

Concussion

A concussion is a mild head injury that can cause a brief loss of consciousness and usually does not cause permanent brain injury.

Contusion

This is a bruise to a specific area of the brain caused by an impact to the head; also called coup or contrecoup injuries.

Hematoma

Hematoma is a blood clot that forms when a blood vessel ruptures. Blood that escapes the normal bloodstream starts to thicken and clot. Clotting is the body’s natural way to stop the bleeding. A hematoma may be small, or it may grow large and compress the brain. Symptoms vary depending on the location of the clot. A clot that forms between the skull and the dura lining of the brain is called an epidural hematoma. A clot that forms between the brain and the dura is called a subdural hematoma. Lastly, a clot that forms deep within the brain tissue itself is called an intracerebral hematoma.

Diffuse Axonal Injury (DAI)

This is a shearing and stretching of the nerve cells at the cellular level. It occurs when the brain quickly moves back and forth inside the skull, tearing and damaging the nerve axons.

Traumatic Subarachnoid Hemorrhage

This is bleeding into the space that surrounds the brain. This space is normally filled with a specific fluid called cerebrospinal fluid (CSF), which acts as a floating cushion to protect the brain. Traumatic Subarachnoid Hemorrhage occurs when small arteries tear during the initial injury – the blood then spreads over the surface of the brain causing widespread effects.

Certain risk factors linked to traumatic brain injury include:

• Age – Elders aged 60 and older are more prone to experience moderate to severe symptoms caused by a traumatic brain injury. In addition, children (especially newborns to 4-years old), are also likely to experience severe brain injuries.

• Gender – Both women and men carry the same likelihood of developing complications linked to TBI.

• Sports – Traumatic brains injuries can be caused by injuries from a number of sports, including soccer, boxing, football, baseball, lacrosse, hockey, and other high-impact sports.

• Vehicle-related trauma – Collisions involving cars, motorcycles, or by circles are a common cause of traumatic brain injury.

• Falls – Falls from a bed or ladder, in the bath, and other falls are some of the most common causes of TBI, particularly in older adults and young children.

• Violence – Gunshot wounds, domestic violence, and other assaults are common causes of traumatic brain injury. Shaken baby syndrome is a similar condition that is caused in infants caused by constant violent shaking.

Some complications are a direct result of injury to the brain. Others come from being bedridden for many days or weeks. Here are some common complications that occur in the days or weeks after the injury:

• Edema – Swelling that occurs when the brain contains more fluid than normal. When swelling happens within the brain, there isn’t a place for the tissue to expand, therefore, this is because the brain is encased in the skull. Swelling can also cause pressure to build up which results in damage to brain cells.

• Coma – A patient in a coma is unconscious, unaware of anything, and unable to respond to any stimulus. This results from widespread damage to all parts of the brain. After a few days to a few weeks, a person may emerge from a coma or enter a vegetative state.

• Seizures – Some patients with traumatic brain injury will develop seizures. The seizures may occur only in the early stages, or years after the injury. Recurrent seizures are called post-traumatic epilepsy.

• Vegetative state – Widespread damage to the brain can result in a complication known as a ‘vegetative state’. Although the person may be unaware of his or her surroundings, he or she may open his / her eyes, make sounds, respond to reflexes, or move.

• Brain death – When there is no measurable activity in the brain and the brain stem, this is called ‘brain death’. In a person who has been declared brain dead, removal of breathing devices will result in cessation of breathing and eventual heart failure.

During a diagnosis of traumatic brain injury, a healthcare provider will examine you and ask about your symptoms. They will also want to learn more about what caused the injury. Depending on the severity of the injury and symptoms, your doctor may use neurological evaluation, imaging tests, and an additional blood test.

First, a neurologist checks your memory, thinking, motor function (balance, reflexes, and coordination), and sensory functions (hearing and vision). Afterward, a computed tomography (CT) scan or MRI will be used to check for brain bleeding and swelling. Finally, a blood test (such as a brain trauma indicator) will be ordered to look for proteins in your blood that indicate concussion or mild traumatic brain injury.

Once physiotherapy begins to process, a physiotherapist will work with you to develop goals and an individualized treatment plan to address the challenges and functional limitations associated with traumatic brain injury. Depending on the severity of the injury, the patient’s level of consciousness, and the problems the patient has, the treatment plan will widely vary.

When a patient is said to be in a vegetative state, some basic brain functions resume, such as eye-opening on a regular sleep / wake cycle, breathing, and digestive functions, but they are unaware of surrounding activity. During this phase, the physiotherapist will help with positioning and equipment that will ensure proper posture and flexibility, reduce the likelihood of any problems, such as bedsores, and encourage the patient’s responsiveness to the environment.

However, when the patient is said to be in a minimally conscious state, the physiotherapist will help with stretching, positioning, and equipment use while working with the individual to increase consistent responses to commands for movement and communication.

As the person becomes more conscious and is able to more actively participate in exercises, the following examples will help ease most symptoms linked to mild TBI:

Hip Rotation (internal / external)

Begin in a seated position and place a towel under your foot to make it easier to move. Then, slide your foot towards your midline on top of a towel. Next, push your legs outward to the side, using your hands to assist if necessary. Repeat this method 10 times a day while switching sides each time.

Hip abduction

For this exercise, sit in a chair and hold one leg slightly above the floor. Then, kick your leg outward as if you are kicking a ball out of the way. Lastly, kick your leg inward toward your midline before repeating 10 times a day.

Seated trunk extension

For this exercise, you begin by sitting on a chair. Afterwards, lean forward as far as you can safely without falling over. Finally, use your back muscles to push yourself back up. Repeat this with 3 sets of 15 repetitions a day.

Forward punches

While seated, clasp your hands together. Then, keeping your hands clasped, punch forward while keeping your arms parallel to the floor. Lean forward as far as you can while you use your back muscles to pull your trunk back to an upright position. Repeat 10 times a day.

Natural remedies for brain injury provide a gentle alternative to pharmaceutical drugs and their potentially harmful side effects. Therefore, below is a list of a few natural home remedies to use after a mild traumatic brain injury:

Aromatherapy

Some studies have shown that essential oils can reduce nausea and symptoms of anxiety and depression, which are common secondary effects of traumatic brain injury.

Massage therapy

Many of the symptoms associated with mild traumatic brain injury are identical to the symptoms of whiplash. Massage therapy is a great way to relieve tension in your neck and finally get rid of those symptoms.

Acupuncture

An additional natural remedy for traumatic brain injury you can try is acupuncture. Not only can an acupuncture session help relieve many TBI side effects, but several studies have also shown that it promotes the production of BDNF, a neurotrophic factor that aids in the production of new brain cells.

Healthy foods and vitamins

It is recommended to consume foods rich in Omega-3 fatty acids and antioxidants, such as those found in a diet meal. These will help reduce inflammation and stimulate your brain’s production of new nerve cells. If you have trouble eating or getting the right amount of nutrients through your food, you can try supplementing your diet with vitamins for brain injury.