“The human brain has 100 billion neurons, each neuron connected to 10 thousand other neurons. Sitting on your shoulders is the most complicated object in the known universe” (Kaku, 2014). This opening quote was from a well-known physicist and co-founder of the string field theory, Michio Kaku. We can’t really argue with the fact that the brain is one of the most complicated object in the known universe, yet it is inside all of us. Assumingly, we all know what the brain is and what is its’ function, which is to control everything that we do ranging from our movements to regulating our internal organs. But there is a lot more to it than just that, which begs the question, what is the brain? And why is it so complicated? To start with, we have to trace back from where it all started, in the womb. After some rigorous courtship and a successful conception, the brain is one of the earliest organ to develop during the development of the embryo. By the 6th week of conception, 3 swellings will be visible at the anterior end of the human neural tube which will later develop into the prosencephalon (forebrain), mesencephalon (midbrain) and rhombencephalon (hindbrain) (Pinel & Barnes, 2017). These are the main sections of the brain. The brain is a jelly like mass of fat and protein which weighs around 1.4 kilograms, consisting of some 100 billion nerve cells that not only put together thoughts and highly coordinated physical actions but regulate our unconscious body processes, such as digestion and breathing (National Geographic, 2017). Ever wondered why our organs are surrounded by bones? According to the same source, the brain is extremely sensitive and delicate, and so requires maximum protection. It is not only the skull that provides protection for the brain, but there are also three tough membranes, called meninges. The spaces between these membranes are filled with fluid that cushions the brain and keeps it from being damaged by contact with the inside of the skull. But even with all that protection, the brain is still vulnerable to damage.
There are two main types of brain injury which will be discussed in this paper, traumatic brain injury (TBI) and non-traumatic brain injury, or commonly referred to as acquired brain injury (ABI) (SpinalCord.com, n.d.). According to the same source, traumatic brain injuries is classified as when a pressure is implicated upon a person. These can range from road accidents, falling, contact sports such as boxing and many others. And if the brain hits the skull hard enough it could cause bleeding, swelling or bruising. Non-traumatic brain injuries, on the other hand, are instances of damage to the brain internally. These can be caused by infections, tumours, stroke, and loss of oxygen.
What caused the disorder/what happens when the structure does not function normally?
TBI is an issue around the world, due to some extent to the high percentage of street accidents and the nearness of brutality. Motor-vehicle accidents is the top contributor for the high number in traumatic brain injury cases. To add on, TBI consists of two types, which are primary and secondary injuries. Primary injuries occur at the instant of the impact directly caused by the particular trauma. As a result, the injuries that occur include a contusion or bruises of the brain itself, lacerations or tears in the lining of the brain itself and along with rupture of blood vessels leading to hemorrhages and cranial nerve injuries. The primary injury which is associated with the natural forces acting on the brain results in combination of acceleration, deceleration, and rotation forces (Crooks et al. 2007). There are two mechanisms of TBI which are closed or blunt injury and open or penetrating injuries. When the head strikes and object such as a windscreen or the ground, a traumatic brain injury may occur to the skull. This is called a closed or blunt injury because the barrier between the brain and the environment has been maintained. When it is a fracture resulting from a head strike it may result in a piece of bone being pushed into the brain tissue or an object such as a bullet entering the skull. These injuries where the intracranial vault is exposed to outside environment are termed open or penetrating objects. When this happens, the patient is exposed to a higher risk of infection.
In a common closed traumatic brain injury, the skull makes contact with an external object leading to an abrupt stop. Immediately the area of the brain may sustain a cerebral injury as the brain collides with the inside of the skull, further shearing damage. The tissue of the brain has very little structural support meaning it does not have the capability to bear with these forces well and in result, the blood vessels are damaged and small haemorrhages are formed (Crooks et al. 2007).
Secondary injuries takes place as a result of the primary injury and can happen anywhere from hours to days after the initial injury. The process of the secondary injury includes hypoxia meaning lack of oxygen to the brain, compression of the brain structures, cerebral edema, swelling and metabolic cellular damage. Intracranial hypertension, fluid collection, vasospasm, infection, anemia, and seizures are the problems that will originate from these injuries.
Diffuse axonal injury (DAI) contributes in cutting off forces on the brain from acceleration-deceleration and move forces that are usually related to high-speed impact, such as those occurring in a very car accident or blast injury. These cutting off forces disrupt nerve cells within the brain, particularly wherever the additional freely moving portion meets the additional mounted portion of the brain. DAI could be a common underlying reason for the abrupt onset of neurologic deficits in a very vital proportions of patients with traumatic brain injury.
Intracranial hemorrhage or hematomas are due to the bleeding under the skull from the ruptured blood vessels. The bleeding happens in the layer of the brain within and those three layers are the dura mater, pia mater and the arachnoid mater (Williams, 2018).
How it affects a person’s daily life/what problems would the person encounter?
Postconcussive syndrome is defined as a condition that refers to symptoms and/or signs of concussions that persist for weeks/months after the concussion. For mild traumatic brain injury (mTBI), the clinical consequences that will affect a person’s daily life can be classified into two multidimensional disorders. The first one can be themed as the early stages of post-traumatic disorders. The person will have often have headaches and suffer from dizziness. Extreme cases of dizziness would lead to vertigo, where one would feel as if the whole room is spinning and they would often feel like throwing up.
People who have mTBI would often feel fatigue even if they are well rested. It is one of the most common problems people would encounter after having m TBI but 70% of the survivors of m TBI complained of mental fatigue. There are three types of fatigues ; physical fatigue, physiological fatigue and mental fatigue. For physical fatigue, one have to work their body extra hard as it comes from muscle weaknesses. If the person is stronger and active, this problem will lessen. For physiological fatigue, the person would get aggravated easily and have psychological problems like anxiety and depression. It worsens as it relates to stress. For mental fatigue, survivors of m TBI would find it harder to think as their brain is injured.They need to put in extra effort and concentration that they did before in everything they do. Due to the fact they have to work and focus extra hard, it will make them mentally tired (“Fatigue and Traumatic Brain Injury” , n.d.)
The second set would be themed as late post-traumatic disorders. It evolves from the early stages to some worse conditioned somatic, emotional and cognitive symptoms. Later phase disorder is said to be highly influenced by psychosocial factors even though concussions increase the duration of the symptom (Katz,Cohen & Alexander, 2015). It is understandable why patients have depression and anger issues. Following their brain injury, many of them have relationship problems, unemployment and have to deal with their caregivers’ frustration. Depression is identified as one of the most common symptoms in patients who suffers from TBI. It can affect patients’ motivation and takes a toll on their ability to engage in rehabilitation, slowing down their recovery. This is due to the injury that was inflicted on the brain itself especially parts of the brain where they control emotions.
Moye and Pradhan (2017) found that post traumatic headache (PTHA) is the most common and most persistent symptom following m TBI with the prevalence from 47 to 95%. People often associate amnesia as post- concussion symptoms, but TBI actually is in association with chronic pain When assessing TBI, one must also consider the presence of other diagnosis like an injured spinal cord.
TBI can leave terrible effects on consciousness like causing trouble on arousal, alertness and responsiveness. Brain death is one of the problems aroused resulting from severe TBI. Brain function will slowly decline and after a period of time, blood will stop flowing to the brain, leading it to die. When someone is in a coma, it doesn’t mean that their brain has died, it is when they are unconscious and unresponsive to any stimuli like sound and light. It can generally last from a few days till a few years, depending on the situation. People will either regain consciousness, move to a vegetative state or eventually die.
One of the dysfunction that happens to patients who suffer from TBI is that even though they suffer from memory problems, it isn’t due to a deficit in memory storage. Rather, TBI patients can generally retain the ability to recognise new material, just that they have difficulty organizing new information for successful encoding and retrieval (Dikmen et al., 2009). They are more likely to mistaken their source of information and get confused over certain things. With TBI, patients would often find planning a pain. This is because effective planning needs one to have the ability to keep things in mind using working memory and to keep track of available options. Therefore, they are more likely to experience difficulties in doing daily activities like driving and cooking.
It has a potential to increase the risk for early cognitive decline. With severe TBI, people tend to have deficits in self-awareness and self-monitoring. At its most severe stage, patients exhibit anosognosia where they fail to recognize the existence of injury and diseases (Giancino & Cicerone,1998). Impaired awareness tends to take place in many forms in patients suffering from TBI. They tend to not notice that there’s an injury at all. Since TBI tend to affect patients’ cognitive ability, Metacognitive Knowledge is used to describe their general awareness of cognitive abilities (Flavell,1981). Anticipatory metacognitive skill is the ability to predict future performance that allows one to forecast their performance.
Are there any solutions?
TBI can be treated depending on the size, severity and location of the injury. The severity of the injury is the biggest challenge, and although most cases of brain injury occurs at the moment of impact, it is often damaged by secondary injuries that happen after the incident. ( “National Institute of Neurological Disorders” , 2015)
Mild traumatic brain injuries are normally easier to treat as they only require rest and sometimes over-the-counter pain relievers to treat a headache. Patients with mild traumatic brain injury is encouraged to schedule a doctor’s appointment for follow-up,and only proceed with daily activities after getting a head’s up from the doctor. (Brainline, 2018)They should also pay attention to any new signs or symptoms to see if they are in someway related to the injury. Some symptoms might be related even though the injury happened a few weeks ago. Many people return to their normal routine gradually but they have to be aware to prevent future concussions. First time concussions are easier to recover while the second and third time will be harder.
For severe traumatic brain injury, emergency care is focused to prevent death and minimize risk due to inflammation or lack of oxygen in the brain. People with severe TBI normally require a breathing machine to ensure they are breathing properly. In the emergency room, doctors will monitor blood pressure, brain temperature and blood flow to the brain. ( Brainline, 2018) . If it is too severe, emergency surgery would be conducted to remove blood clot or stop bleeding in the brain.
After a significant brain injury, patients are required to attend rehabilitation to relearn basic skills. With this strategy, people can learn compensatory strategies to cope with deficiencies involving cognitive abilities,memory and thinking skills so that things can be done. Rehabilitation can be different for everyone as it depends on the severity of the brain injury and which part of the brain was the injury inflicted.
Traumatic brain injury damage does not only occur during the primary injury, but also in the period after which is the secondary injury. Pharmacological choices in the treatment of severe traumatic brain injury prevents the person from having a secondary injury such as brain ischaemia. The focus is on resuscitation fluids and treatments of intracranial pressure by means of using sedatives and osmotherapy. The aim of this treatment is to achieve and adequate circulating blood volume by restoration of blood vessels , to avoid hypertension and intracranial hypertension to maintain the cerebral blood flow and lastly it helps limit hypoxia.
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