How Severe Is The Brain Injury
After a traumatic brain injury, whether or not the person was actually unconscious, a state occurs where the person seems to be aware of things around them but is confused and disorientated. They are not able to remember everyday things or conversations, and often do or say bizarre things. This is called Post-Traumatic Amnesia , and is a stage through which the person will pass.
The length of PTA and/or loss of consciousness are important as they give an indication of the severity of the injury.
The term ‘Coma’ is often used to describe longer periods of unconsciousness.
The table below gives a rough guide to how these measures affect the severity of the injury, although it is worth noting that everyone is different and categorising injuries in this way doesn’t always give an accurate measure of the long-term effects.
S To Recovery After A Brain Injury
If youre a sports fan, it may seem like news reports about popular professional athletes sustaining concussions and brain injuries have become increasingly common in recent years. However, its important to remember that brain injuries dont just affect players in the NFL, NHL and other professional sports leagues.
Although playing a contact sport at the professional level certainly increases the risk, there are lots of ways people can sustain a brain injury while doing normal, everyday activities, says Christine Greiss, D.O., a physical medicine and rehabilitation specialist and director of the Concussion Program at JFK Johnson Rehabilitation Institute.
The good news is that whether a brain injury occurs during an NHL or NFL game or due to a slip, trip or fall, brain injury rehabilitation can help relieve symptoms and promote recovery.
What To Expect After Waking Up From Coma After Brain Injury
After an individual awakens from a coma, they may experience various states of consciousness. Below, well address 3 common states of consciousness: post-coma unresponsiveness, minimally conscious state, and post-traumatic amnesia.
Its important to note that a persons progression between these post-coma stages is not always linear. Recovery can cease at any of these stages, and sometimes the person will skip directly from a coma to post-traumatic amnesia.
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The Massey Family Foundation Gift
The Massey Foundation TBI Grand Challenge occurred thanks to a generous gift from the Joyce and Don Massey Family Foundation. The Massey family had their own experience with TBI after a car accident injured mother and wife Joyce Massey. TBIs effects seriously impaired her daily function, including difficulty with speaking, eating and breathing.
The Massey family gave their gift to U-M in early 2015 in hopes of sparing other families their experiences. It includes funding for clinical research, technology innovation, translational research, a patient-family support fund and the annual TBI Grand Challenge.
Thanks to gifts from generous donors, such as the Massey family, we are able to continue this important research, Neumar says. We hope these projects and presentations will accelerate additional research into TBI. We owe this growing patient group new technologies and treatments that will improve their ability to survive with this injury.
Investigators are welcome to attend the Massey Regional TBI Conference in October and to submit abstracts for posters and presentations. Additional information can be found on the conference website.
Treatment Course Upon Return To Ed
Of the 124 patients who returned to the ED within 72 hours, head CTs were performed in 47 patients, with 17 requiring a hospital stay. Eighty percent of patients were discharged from the ED after treatment, but one out of five was admitted to the hospital for further care. Five of these patients had intensive care unit stays , and four required neurosurgery. No in-hospital mortality was reported. One patient left the ED without treatment.
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What To Expect After Brain Injury: The Recovery Process
Because every traumatic event is different, it can be challenging to predict exactly what to expect after brain injury. The effects of TBI that survivors may experience depend on the severity and the areas of the brain affected. Damage to various locations of the brain may cause a range of physical, cognitive, emotional, and behavioral effects.
Common effects of traumatic brain injury include:
- Dizziness and balance problems
Understanding the various secondary effects that may occur can help you anticipate what to expect after brain injury. Many may still wonder, can survivors make a full TBI recovery? The answer lies in the brains ability to heal and rewire itself through neuroplasticity.
After a brain injury, many of the brains neural pathways used to communicate with the rest of the body may become damaged. However, with neuroplasticity, existing pathways are strengthened and new ones are created. This helps survivors restore any impaired or lost functions and promote recovery.
The best way to stimulate the brain and activate neuroplasticity is through high repetition exercises, or massed practice. During the first 3-6 months following a TBI the brain enters a heightened state of neuroplasticity. Survivors may see huge strides in this time frame but may feel progress has slowed after this stage. This is a normal part of recovery, referred to as a plateau.
Concussion Treatment And Home Remedies
If you donât need hospitalization, the doctor will give you instructions to follow. Experts recommend follow-up medical attention within 24 to 72 hours if symptoms worsen. To recover at home, you should:
- Take a break. If your concussion was sustained during athletic activity, stop play and sit it out. Your brain needs time to properly heal, so rest is key. Definitely do not resume play the same day. Athletes and children should be closely monitored by coaches upon resuming play. If you resume play too soon, you risk a greater chance of having a second concussion, which can compound the damage. The American Academy of Neurology has issued guidelines about resuming activities after a concussion.
- Guard against repeat concussions. Repeat concussions cause cumulative effects on the brain. Successive concussions can have devastating consequences, including brain swelling, permanent brain damage, long-term disabilities, or even death. Don’t return to normal activities if you still have symptoms. Get a doctor’s clearance so you can return to work or play with confidence.
- Treat pain with aspirin-free medications. Your doctor will prescribe a medication to relieve pain or recommend an over-the-counter option.
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Determinants Of Unplanned 72
A return ED visit was significantly more common in males , who accounted for 66.9% of this subpopulation. Additionally, patients with an intracranial bleed on head CT were significantly more likely to return to the ED within 72 hours of discharge 74.5% with 72-hour ED return had intracranial bleed on head CT. Black patients were more likely to return to the ED . Other predictors included mechanism of MVC , and a lower prehospital GCS. Among signs and symptoms related to traumatic brain injury, the only symptom that was significant was LOC > 30 min , of which there were 29 . In contrast, vomiting, seizure, alteration of consciousness and posttraumatic amnesia were not associated with increased risk of ED return visit. A finding of fracture on head CT was not predictive of a patients likelihood to return to the ED, nor was the patients age.
Taking Care Of Yourself And Other Family Members
Family members of a person in the VS or the MCS often feel a sense of loss or grief for the relationship they had before the injury. You can cope with these feelings in a few ways. A person in the VS or the MCS may make slow progress or go for long periods with no progress. Keeping a journal of the changes you have seen may be comforting. This may let you see how your loved one is more able to respond than he or she was at an earlier point in time.
Having a loved one who is in the VS or the MCS can be physically and emotionally draining. Dealing with this alone can be too much for one person. Its important to rely on support from others. You can look to existing supports, such as family, friends, and religious groups. You can also find new supports.
Other resources to consider include support groups and agencies, and the internet. You can contact the Brain Injury Association of Americas National Brain Injury Information Center . The BIAA can give you contact information for the closest chapter of your state brain injury association. Health care providers such as doctors, therapists, and social workers may also be good sources of information about supports available to you
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Types Of Traumatic Brain Injuries
Although described as individual injuries, a person who has suffered a TBI is more likely to have a combination of injuries, each of which may have a different level of severity. This makes answering questions like âwhat part of the brain is hurt?â difficult, as more than one area is usually involved.
Secondary brain injury occurs as a result of the body’s inflammatory response to the primary injury. Extra fluid and nutrients accumulate in an attempt to heal the injury. In other areas of the body, this is a good and expected result that helps the body heal. However, brain inflammation can be dangerous because the rigid skull limits the space available for the extra fluid and nutrients. Brain swelling increases pressure within the head, which causes injury to parts of the brain that were not initially injured. The swelling happens gradually and can occur up to 5 days after the injury.
Reasons For Ed Return
Patients most commonly returned to the ED for symptoms of post-concussion syndrome , including headache, altered mental status, and vomiting. Twenty-three patients reported pain and 14.6% were recalled to the ED after discharge for further evaluation, while 9.76% returned for evaluation of a repeat head injury.
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How Long Will It Take For Someone To Awaken From Coma After Brain Injury
Every brain injury is unique and as a result, every individual will regain consciousness from a coma at a different rate. Generally, the more severe the brain damage, the longer it will take for the individual to recover.
Sometimes, a patient may suddenly lose consciousness after being fully alert. Other times, unconscious individuals may gradually regain consciousness. Due to the unpredictable nature of consciousness in the early stages of traumatic brain injury, it is nearly impossible to predict when a patient will awaken from a coma in the first 24 hours after a traumatic brain injury.
However, a coma rarely lasts over a month. Instead, individuals who remain unconscious for prolonged periods typically progress to a wakeful but unconscious state called post-coma unresponsiveness. In the next section, we will discuss post-coma unresponsiveness and additional states of consciousness that may occur after a coma.
Cerebral Microbleeds May Be Less Detectable By Susceptibility Weighted Imaging Mri From 24 To 72 Hours After Traumatic Brain Injury
- 1Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
- 2Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
- 3MTA-PTE Clinical Neuroscience MR Research Group, Pécs Diagnostic Center, Pécs, Hungary
- 4Neurobiology of Stress Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- 5Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
- 6MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
Purpose: A former rodent study showed that cerebral traumatic microbleeds may temporarily become invisible shortly after injury when detected by susceptibility weighted imaging . The present study aims to validate this phenomenon in human SWI.
Results: The KruskalWallis ANOVA with Conover post hoc analysis showed significant median TMB number differences in the subacute period: 024 h = 4.00 2448 h = 1 4872 h = 1 and 72 h 7.5 . Neither clinical parameters nor FLAIR lesions depicted significant differences among the groups.
Our results demonstrate that TMBs on SWI MRI may temporarily become less detectable at 2472 h following TBI.
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New Insights May Bring New Promise
In the recent study published in the New England Journal of Medicine, neurointensive care physicians doctors who take care of patients with brain injury in intensive care and researchers took brain wave analysis to the next level. They connected unresponsive patients with acute brain injury to continuous EEG, and asked them to perform simple commands while their brain waves were being recorded. The EEG data then were fed into a machine-learning algorithm derived from healthy volunteers, which compared the change in brain activity from the state while at rest to the activity recorded following the commands.
Of 104 patients studied, 15% showed activation of brain activity corresponding to the command, even though bedside examiners did not see any visible response a phenomenon termed cognitive-motor dissociation.
In a particularly striking finding, the researchers found that patients who showed brain activation were more than three times as likely, compared to those who showed no brain activation, to make strides in recovery and gain at least partial independence over the year following the brain injury. They were also nearly twice as likely to be able to demonstrate visible response and actually follow commands by the end of their hospital stay.
Learning About Financial Resources
You may feel overwhelmed as you learn about the financial resources that may or may not be available to your loved one. But with patience, persistence, and help from others, you will figure out which programs apply and find your way through the application processes.
Some programs that you will want to learn about include:
- Health care programs such as Medicare and Medicaid.
- Income replacement or financial assistance programs such as Social Security Disability Insurance or Supplemental Security Income . You may also want to find out if your loved one had disability insurance through work.
- Services to help with community living such as state and community agencies that assist people in these areas. For instance, some states have Medicaid waiver programs that provide funding for in-home care to allow people to stay at home.
You may not find someone who knows all there is to know about how to access these services and programs. The key is to ask questions and follow up to make sure that you and your loved one get all the benefits available. Social workers, therapists, case managers, and your local social security office may be helpful. Others who may be able to help include your state brain injury association chapter, family members or friends who are disabled or who have family who are disabled, or the human resources department at your loved ones work.
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How To Interact With A Loved One Who Is Unconscious Or At A Low Level Of Responsiveness
The most natural way of interacting is to talk to your loved one, even though he or she may not respond or understand. Telling him or her about recent events in your life, whats going on in your family or neighborhood, or the latest news may make you feel connected. Talking with your loved one about what you are doing as you provide care can increase your comfort with caregiving. For example, telling your loved one that you are going to move his or her arms and legs to help prevent joint tightness might make you feel more comfortable with this task. Only do these range of motion exercises if you have been instructed to do so by a doctor, nurse, or therapist.
Touch is another way to feel connected. Some family members have said that giving a massage or putting lotion on the hands or face of their loved one helps them to feel close to them. Its also important to give your loved one time for quiet and rest, such as by turning the TV off. You should also avoid overstimulation as this may cause rapid breathing, muscle tightening, teeth grinding, restlessness, and fatigue.
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There are several reasons for wanting to make these decisions as soon as possible. First and foremost is the well-being of the family. If there is confidence that the patient will never regain a quality of life that the patient would find acceptable, then early decisions spare the patient and family the suffering of a prolonged and ultimately futile hospital stay.
Second is the desire to avoid what may be the worst outcome: prolonged survival without meaningful recovery. Some patients who never recover consciousness regain the ability to breathe without a ventilator over the first few weeks of treatment. Disconnecting the ventilator before such recovery always leads to death in a short time. If this window has closed, families often feel compelled to continue treatment, usually with transfer to a long-term care facility. While it is possible to limit future treatments by withdrawing nutrition and fluids, these decisions are often fraught and put the family through even more emotional suffering.
Third is the fact that ICU beds are a limited medical resource: most ICUs run at or near capacity. Early decision-making for patients who are not going to survive with an outcome that is satisfactory to the patient and family makes it possible to treat more of those who can truly be helped by ICU care.
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Things To Look For When Considering A Setting To Care For Your Loved One:
Here are some things to look for when choosing a place for care:
- Your family members current treatment team has received good feedback about the programs quality of care when they have referred others there.
- The staff make you feel comfortable. They are available to talk about your concerns, and they answer your questions.
- The program has a multidisciplinary treatment team that, at a minimum, includes a rehabilitation physician, nurse, speech pathologist, physical therapist, occupational therapist, psychologist, and social worker.
- The treatment team meets together to identify treatment goals and review progress.
- The program and treatment staff have worked with the same kinds of problems that your family member has.
- The facility knows about the specific care your loved one needs and can meet those needs. You can help to make sure that a detailed nursing care plan is created.
- The program includes case management to help plan for the next level of care, whether its moving to a rehabilitation program, an LTACH, a SNF, or home.
- The program provides education and training for future caregivers.
- The program has a systematic approach to measure progress in all patients.
- The program is guided by recommendations for rehab programs from the American Congress of Rehabilitation Medicine and the NIDILRRs Traumatic Brain Injury Model System.
- The program receives good grades in state and/or federal quality ratings