Telephone:  (09) 575 5432        Email:  dr.lamont@xtra.co.nz

 

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Auckland Memory Clinic

Brain Injury

The human brain is a complex organ regulating every aspect of human behaviour. Everything you experience and all the information about the environment is experienced through your brain. This happens because of your brain’s ability to receive, process, store, retrieve and use sensory information.  The ability to think, see, feel, remember, smell, speak, and knowing how to behave appropriately all depend on a well-functioning brain. Even a relatively minor brain injury can interfere with these everyday abilities. Although not always visible brain injury is a complex matter. It can cause physical, mental, social, and occupation changes affecting the person, and those around them, for a short time, or permanently.  It causes a process of adjustments for everyone.

Common impairments after brain injury are difficulties with memory, mood, focus, tiredness and concentration and there may also be deficits in reasoning skills, learning, organisational skills, and cognitive functioning in general. Personality changes are very common and rapid mood swings can be difficult for others to cope with. Often many of the brain’s systems are disrupted and the combined overall effect can be profoundly disabling. One of the difficulties of recovery is the ‘stop-start’ nature of improvements. A plateau can be reached that seems as if this ‘is it’ and then this plateau will typically be followed by gains – a pattern of gains and setbacks.

 

 

Damage to the brain, whether caused by surgery, tumours, disease, toxins, or head injuries, can rob a person of their sense of self and compromise the quality of life.  While the damage is to one person, the entire family will be affected by the destructive impact of an injury to the brain.

Types of Brain Injury

Traumatic Brain Injury (TBI) is always the result of damage to brain tissue caused externally. Motor vehicle accidents, violence, sports injuries, blows to the head etc sometimes leave little outward physical evidence of injury, but the impact to the brain is likely to create on-going issues.  Most people seem to associate the term ‘head injury’ to TBI. Remember – many TBIs are superficial, temporary, and cause difficulties for only a short length of time.

 

Acquired Brain Injury (ABI) is caused by damage to the brain through strokes, tumours, toxins, degenerative diseases, brain haemorrhages and aneurysms not necessarily caused by external force.

 

Concussion. Concussion results from the braining being battered or shaken violently and is often followed by a change of consciousness. A person may be unconscious for a time, but also may remain conscious but in a dazed, disorientated state. Early on, the person is likely to have a headache, dizziness or vertigo, be unaware of surroundings, and may experience nausea and vomiting. Later on lack of concentration, memory dysfunction, difficulty finding words, tiredness, frustration, irritability, anxiety, depression, and sleep disturbances may occur.

It is essential that concussion be recognised and treated. During the time immediately after the concussion injury, brain cells exist in a vulnerable state. Always err on the side of caution if concussion is suspected.

 

 

Severe Head Injury. Very severe head injuries are usually caused by crushing blows or penetrating wounds to the head itself. These injuries rip, crush and tear delicate brain tissues. These are the most intractable type of brain injury and are usually life-threatening when they occur.  Often severe head injury results in an open head injury requiring prolonged hospitalisation and rehabilitation with little chance of a return to pre-injury functioning. It is important to note that closed head injuries can also result in severe brain injury.

 

Moderate and Minor Head Injuries. Many people sustain minor or moderate head injuries with few consequences, though for others similar injuries can result in lifelong impairments. These injuries are usually caused by a non-penetrating blow to the head, or by violent shaking.

 

The brain is quite mobile within the skull. The brain is protected from contact with the skull by cerebrospinal fluid which surrounds and cushions the brain during normal movement. However, when there is violence to the head such as in car accidents, falls, shaking, and so on the delicate brain can be forcibly rotated and battered within the spiny skull. When the brain tissue is battered, bruised, stretched and torn, it causes bleeding, bruising, and swelling of the brain tissue itself.

The resulting brain damage can result in impairments which substantially interfere with the return to a normal lifestyle. Functional impairments (which can interfere with the everyday functions of thinking, remember, walking, talking) may be short-lived or create on-going, life-long difficulties. Brain damage makes it difficult to store, process, accumulate, and retrieve information. It also interferes with the ability to control emotions, to learn new information, to be sensitive to other people, and to benefit from experience.   

 

 After brain injury, a person can find that things that were once achieved effortlessly become unfamiliar and difficult. Extraordinary mental effort is often needed to do things that were automatic prior to the injury. A child with a brain injury may become unmanageable, their school level drops, personality can change, and there is often regression to an earlier developmental stage.  In adults, there may be an inability to continue with the former occupation, behaviour can become unpredictable, unreliable and inappropriate, and violence can occur – the frustration level is immense.

How widespread is the problem? 

 

It is estimated that there are 90 new head injuries a day in New Zealand, while in the USA it is estimated that 5 million people annually sustain head injuries – and 2 million of those result in permanent impairment.

The Brain, Function, and Injury

 

The brain is a complex structure, and damage to any part of it can result in a wide range of impairments. For example, the hippocampus is vital to the processing of memory and damage is likely to affect all abilities dependent on memory: language, face recognition, counting, reasoning and so on.

The tables below show functions associated with the lobes of the brain, and the likely effects of injury in each of the lobes.  Keep in mind that the brain functions are all inter-related and are not as clear-cut as such a list can seem.  If you have further questions related to this, please email me at: Dr.Lamont@memoryclinic.co.nz and I will answer you individually.

Frontal Lobes

Functions of the Frontal Lobes

 

  • Executive functioning such as planning, working memory, attention, problem-solving, verbal reasoning, inhibition, mental flexibility, multi-tasking, initiation and monitoring of actions.

  • Emotional response and stability.

  • Personality

  • Judgement

  • Word meanings

  • Memory for habits

Associated Head Injury Impairments

 

  • Difficulty in planning sequences such as in making a cup of coffee

  • Little spontaneity when interacting with others

  • Loss of thinking flexibility (mental rigidity)

  • Difficulty focusing. Lack of attention

  • Mood swings

  • Personality changes

  • Abstract reasoning impaired

  • Loss of ease of language

  • Often repeating actions many times without awareness of doing so

Temporal Lobes

Functions of the Temporal Lobes

 

  • Hearing, memory, meaning, language

  • Play a role in emotions

  • Play a role in learning

  • Concerned with interpreting and processing auditory stimuli

  • Long-term memory

  • Contribute to visual perception

  • Categorising objects.​

Associated Head Injury Impairments

 

  • Prosopagnosia - difficulty recognising faces and names

  • Difficulty in understanding speech

  • Difficulty in identifying objects

  • Hard to verbalise information about objects

  • Short-term memory loss

  • Aggressive behaviours

  • Change in sexual interest

  • Concentration difficulties

  • Damage to right temporal lobe can result in incessant talking

  • Right side lesion may affect rhythm and musicality

  • Religiosity

  • Seizure disorders

  • Strange auras and reveries

  • Disorders of visual perception

  • Left side lesion - impaired verbal memory

  • Right side lesion - impaired non-verbal memory.​

Parietal Lobes

Functions of the Parietal Lobes

 

  • Visual perception

  • Touch perception

  • Manipulating objects

  • Integrates information from the senses into one single concept - including pain, pressure, and temperature

  • Goal-directed voluntary movement

  • Spatial sense and navigation

  • Knowledge of numbers and their relation to one another

  • Responsive to shape, size, and orientation of objects


 

Associated Head Injury Impairments

 

  • Agraphia - difficulty writing words

  • Anomia - difficulty naming objects

  • Unable to focus visual attention

  • Problems reading

  • Unable to focus on more than one object at a time

  • Poor hand-eye coordination

  • Difficulty with simple maths problems

  • Difficulty drawing

  • Confusing left and right

  • Visual perception poor

  • Self-care compromised because of lack of awareness of some body parts and surrounding space (Apraxia)

.​

Occipital Lobes

Functions of the Occipital Lobes

 

  • Visual perception

  • Colour discrimination

  • Movement perception

  • Creation of dreams

Associated Head Injury Impairments

 

  • Difficulty recognising colours

  • Visual defects such as 'field cuts'

  • Sight illusions - inaccurately seeing objects

  • Hallucination

  • Inability to recognise words

  • Difficulty recognising pictures or diagrams

  • Difficult to perceive movement

  • Loss of reading and writing fluency

  • Occipital lobe seizures may be triggered by flicker stimulation.​

Contact Allison at Dr.Lamont@xtra.co.nz

or telephone (09) 575 5432