Dementia
Abstract
Brain injury
is a widespread problem, affecting millions of people in different countries
worldwide. Damage on the brain can result to brain split which is the separation
of the right and left parts of the brain. There are two types of brain injury
that are discussed: Traumatic Brain
Injury (TBI) and Acquired Brain
Injury (ABI). Various causes of brain injury such as brain tumors, cerebrovascular
disorders, closed-head injuries, infections of the brain, neurotoxins and genetic
factors are discussed in the paper. Statistics of brain damage in the US are
given as well as the diagnosis and different types of treatment. Both physical
and psychological symptoms of brain damage are discussed in details.
Brain Damage
What is the brain?
People are living
in an age in which individuals are more and more accepting the idea that the
emotional, intellectual and even biological processes are controlled uniquely
by the brain. The question then is what is the brain? Tramo et al (1995)
defines it as center of the nervous system. The human brain has a structure
similar to the structure of the brains of all mammals. The location of the
brain is in the head, normally near to primary sensory functionality like
hearing, vision, taste, smell and balance. The brain is the most complex body
organ in vertebrates (Funnell, Colvin and Gazzaniga, 2007).
Split
Brain
Split brain is the term that describes the
result of severing to some degree of the corpus callosum that connects the
right and the left hemispheres of the brain. The surgical procedure that
produces this condition is referred to as corpus callosotomy and is considered
as the last result in the treatment of some of the brain disorders such as intractable
epilepsy. The two hemispheres of the brain are connected by the corpus callosum
which is the means by which their coordinate and communicate (Gazzaniga, 2005).
Right
hemisphere
This is the right side
of the brain that is the seat of language and processes information logically
and sequentially. The side stands out in nonverbal and spatial functions (Gazzaniga,
2005).
Left
hemisphere
This is the left
part of brain that is more visual and processes information holistically,
intuitively and randomly. This side is more dominant in verbal functions such
as speaking and writing (Gazzaniga, 2005).
Functions of the brain
The brain has very
many functions some of which will be discussed in this section of the paper. From
an evolutionary biological point of view, the function of this organ is
providing coherent control over all the actions of a human being. One of the
specific functions of the brain is information processing. The brain receives
input and processes it to information just like a computer system. The other
function of the brain is perception. The brain extracts biologically relevant information
from the inputs (Champion, Holcomb and Young,
2009). The brain is fed with the information concerning sound, light,
the chemical makeup of the atmosphere, head orientation, temperature, limb
positioning, and the chemical makeup of the bloodstream and the like. Motor
control is another function of the brain. These are the areas of the brain that
are concerned with the body movement. Arousal is the other function of the
human brain. This is involved with the daily cycle between waking and sleeping.
Homeostasis which is the maintenance of balance in the bodily states is
controlled by the brain. Motivation in human beings is a process that is
controlled by the brain. Learning and memory is also a function of the brain
(Funnell, Corballis and Gazzaniga, 2000).
Types of brain damage
All traumatic
brain injuries are injuries on the head. However, head injury is not
necessarily brain injury. There are two main types of brain injury: traumatic
brain injury and acquired brain injury. The two types of brain injury affect
the normal functioning of the brain (Zink, 2001).
Traumatic brain injury (TBI)
This is a kind of
brain injury that results from an external force like a blow to the head. Such
a blow can cause damages to the skull or brain movement inside the skull. The
major causes of traumatic brain injury are falls, violence and accidents. It
can be as a result of direct impact or acceleration. The impact can result to
immediate traumatic brain injury or secondary brain injury, which are the
events that happen sometime after the initial injury. The secondary processes
including cerebral blood flow as well as the pressure within the skull can
result to considerable damage to the brain from the initial injury. Traumatic
brain injury can be classified on the basis of severity and mechanism (closed
or penetrating) among other features, such as taking place in a particular
location or over a wide-spread area of the brain (Champion,
Holcomb and Young, 2009). Head injury normally refers to traumatic head
injury; however, it is a general category as it can refer to damage on other
structures in the head such as scalp or skull. Traumatic head injury is known
to be a major cause of death and disability in the entire world. This is
particularly in children as well as young adults. Traumatic brain injury can
result in a host of cognitive, emotional, social, behavioral and physical
effects. The result can be complete recovery, permanent disability or death (McIntosh and McCrory, 2005).
Acquired brain injury (ABI)
This type of brain
injury happens at the cellular level. This is in most cases connected with
pressure to the brain. This pressure can be caused by a tumor or can be as a
result of neurological disorder such as stroke. ABI is caused by events that
happen after birth. It is not as a result of congenital or genetic disorder
like perinatal illness, perinatal hypoxia or fetal alcohol syndrome. Acquired
brain injury can cause cognitive, emotional, behavioral or physical disorders
that can result in temporary or permanent changes in brain functioning. The
injury can be caused by TBI or nontraumatic injury resulting from either
internal or external source like brain tumors, stroke, poisoning, infection,
ischemia, hypoxia or substance abuse. Acquired brain injury does not include
brain damage that result from neurodegenerative illness. When the brain is
damaged, there are obvious effects on the person’s life. Results of acquired
brain injury normally necessitate major life adjustments around the
individual’s new condition. Making such adjustments is important in the
recovery and rehabilitation of the affected person (McIntosh and McCrory, 2005).
Causes of Brain Damage
Brain tumors
Cancer is one of
the major non-infectious diseases and more recognized over the past decade,
more causes of brain tumors are detected with the current medical technologies
and more sophisticated medical techniques. Cancerous cells are known to
continue growing after the onset. This ongoing growth of the cells can exert
pressure on the brain. This pressure can in turn cause blood to clot or
directly result in brain damage as a result of the pressure the tumor exerts
against it. Tumors can also cause brain damage through invasion of the brain
spaces. Surgical procedures that are performed to remove tumors can also cause
brain damage (Majdan et al, 2011).
Cerebrovascular disorders
One of the common
cerebrovascular disorders is stroke. Such disorders block the flow of blood.
Incase a cerebrovascular accident such as stroke blocks the flow of blood, the
result is normally death of cells in the areas where the blood is not reaching.
Incase of hemorrhage in or over the blood because of such a cerebrovascular
accident there will be loss of flow of blood. Such loss of blood flow or injury
to tissues in the brain can result in brain damage. This is a common cause of
brain damage (Zink, 2001).
Closed-head injuries
These are the
types of injuries that case brain movement back and forth inside the skull.
Closed-head injuries can result from slip and fall, or from car accidents.
Shaken Body Syndrome is another kind of closed-head injury that can cause brain
injury. They include the injuries that result fast deceleration or acceleration
of the head. In this case, there is no penetration to the skull. The movement
of the brain within the skull results in nerve fibers within the separating and
damaging the brain tissue. This causes focal damage as well as diffuse damage
to axons. Diffuse damage is when the effects are broad (Majdan et al,
2011).
Infections of the brain
The brain can be
infected by different agents and in different ways. The brain as well as the
membranes that surround it is prone to various infections. This infection
particularly happens incase the unique blood-brain protective system is
violated. Some of the agents that cause these infections are viruses and
bacteria. These agents are known to cause severe and life-threatening illness
of the brain (Zink, 2001).
Neurotoxins
These are the
toxins that act particularly on nerve cells (neurons) normally through
interaction with membrane proteins like ion channels. Some sources of
neurotoxins are more general and describe the effects of neurotoxins that occur
at nerve tissue. Brain damage caused by the neurotoxins happens when the
harmful agents damage the nerve cells (Zink, 2001).
Genetic factors
There are some
dysfunctional genes that are hereditary. Because they are genetic or
hereditary, they can be passed from a parent to an offspring. Such genes have
been known to prevent complete development of a normal brain. The genes can be
said to cause damage to the brain (Majdan at al, 2011).
Statistics
Brain damage is a
serious problem not only in the United
States, but in all other countries. Each
year, brain damage in the United
States contributes to a number of deaths and
many cases of permanent disability (Majdan et al, 2011).
Incidence and prevalence
Statistics from
Centers for Disease Control and Prevention (CDC) approximate that 1.4 million
individuals suffer brain injury every years in the United States. The same report
suggests that about 50,000 individuals dies every year from brain injury. From
the Centers for Disease Control and Prevention, approximations of the number of
individuals who have survived a brain injury are ranging from 2.5 million to
6.5 million. This range is big due to the fact that most of the minor injuries
are never reported. The current number of people living with brain injury in
the United States
is estimated to 3.17 million individuals. About 475,000 brain injury cases take
place among children between the ages of 0 and 14 years. Falls are the main
cases of these injuries with the rates being highest for children between the
ages of 0 and 4 years and for the elderly 75 years and above (Majdan et al,
2011).
Estimates
on the cost of treating brain injuries in the country are at 48.3 billion
dollars per year. This cost is categorized as 31.7 billion dollars for
hospitalization and another 16.6 billion dollars in the costs that are related
to fatalities. The Centers for Disease Control and Prevention approximates the
full cost of acute care as well as rehabilitation for traumatic brain injury
patients in the country ranges between 9 billion dollars to 10 billion dollars
per annum. This cost is excluding the
direct costs to members of the family and community (for example lost earnings,
productivity for members of the family, work time, employers, care givers, and
the costs that are associated with provision of social services). It is
approximated that over a lifetime, it costs between 600,000 dollars and 1.875
million dollars in caring for a senior of serious brain damage (Majdan et al,
2011).
For both males and
females native born, there are high rates of brain injury-associated
hospitalizations. This number is followed by the people born in other
English-speaking nations and then the non-English speaking nations. This
pattern was also evident in the brain-injury related disabilities in men,
though standard errors related with small samples reveal that it is not likely
to tell whether the difference in groups is significant. Females appear to have
lower rates of brain injuries when compared with men. The rates of
hospitalization due to brain injuries seem to be higher in men that in females,
particularly those born in the country. Demographic patterns of the incidence
of brain injury-related disability should not essentially be expected to
reflect demographic patterns of hospitalization for injury-related conditions.
As research reveals, whites may be fewer in terms of traumatic brain injuries,
but they are not immune to acquired brain injuries (Majdan et al, 2011).
Disease
Diagnosis
Neurological
examination
Diagnosis of head
damage is suspected on the basis of lesion circumstances as well as clinical
evidence. Neurological examination is one of the ways of getting clinical
evidence of brain injury or damage, for instance testing if the pupils
constrict in a normal way in response to light. Another way is assigning
Glasgow Coma Score. In determining diagnosis and prognosis and determining the
kind of treatment to give, particularly in traumatic brain injury, neuroimaging
is used. Neoroimaging is effective in detecting increased intracranial pressure
(Shaw, 2002).
Diagnostic
Tests
There are other specialized
radiologic tests used in the diagnosis of brain damage.
a) Magnetic resonance imaging (MRI)
This is a
diagnostic test that shows more details than others such as the CT scan. This
test is capable of adding information on the expected results in the long-term.
This test is effective in detecting the characteristics of injury such as
diffuse axonal injury in the long-term (Boake and
Diller, 2005).
b) Computerized tomography (CT)
This is the kind
of test that is more effective in the emergency situations because it is fast,
accurate as well as widely available. Once the first CT has been done, others can follow
later to see how the injury is progressing. This test is preferred in emergency
situations because of its ability to detect fractures and bleeds and its fast
acquisition of images (Boake and Diller, 2005).
c) Evoked potentials
These are
electrical potentials that are recorded from the nervous system of a person
after presentation of a stimulus. They are different from the spontaneous
potentials. The ability of the test to determine the time for the nervous
system to respond to stimulus is useful in the diagnosis of brain damage (Granacher, 2007).
Prognosis
Prognosis of brain
injury becomes worse with its severity. Most of the injuries are minor and do
not result in permanent disability. However, severe damages have the
possibility of causing permanent disability. Permanent disability is found to
happen in 10 percent of minor injuries, 66 percent of moderate injuries and a
100 percent of severe injuries. Minor cases can be solved within a few weeks
and the patient is able to return to his normal life, though a few have mild
social and cognitive impairment. Over 90 percent of those with moderate injury
are able to resume normal functioning though a few will require assistance
physical capabilities, employment and financial management. Most of those with
severe injuries will die or have permanent disability. Coma is closely
connected with severity. Prognosis also differs with severity and location of
the injury as well as the ability to seek timely medical care (Granacher, 2007).
Symptoms
Physical
Brain injuries normally
result in different impairments which can differ in severity. The symptoms also
depend on the cause of the brain injury. As already noted, in case of severe
injuries, the person can have permanent disabilities such as delusions,
neurocognitive deficits, speech and movement impairment, and mental disability.
Personality changes have also resulted in some cases of brain damage. The very
severe cases of brain damage result in coma or even vegetative state. Even
minor injuries can cause serious damage and have symptoms showing up later in
life. Brain damage disrupts the normal functioning of the brain. Some of the
physical symptoms that are caused by brain damage include: 1) slowed thinking
processes; 2) difficulty switching between tasks; 3) diminished libido; 4)
disturbed sleep; 5) emotional outbursts; 6) irritability; 7) depression;
8) faulty judgment; 9) impaired memory
(Some individuals with head damage engage in confabulations. This is the
incapability to tell daydream memory from the real memory. Some of the patients
suffer memory lapses and tend to fill the lapses with daydreams); 10)
difficulty concentrating; and 11) inattention and excessive sleepiness (Coles, 2007).
Psychological
At times it is
hard to differentiate actual brain damage from other emotional disorders of
issues. However, after testing for brain damage in a person showing these
symptoms it is possible to tell. Specialists use tests to make it possible to
figure out the problem in a particular area of the brain. The frontal lobe of
the brain is responsible for controlling inhibition of unsuitable behavior,
attention, foresight, interpersonal behavior, personality, mood, judgment, and
drive. Sometimes, the symptoms lessen as the injury heals, but in a few cases,
they get worse. This causes psychological symptoms such as Depression, Cognitive/Intellectual
difficulties (effects on the Short Term Memory or the Long Term Memory,
impairment in information processing (Semantic Encoding, Verbal Abstraction,
and Implicit Learning) (Race, Keane and Verfaellie, 2011).
The symptoms vary
depending on the area of the brain that is injured. Incase the brain is injured
at the forehead or the frontal lobe, symptoms that are likely to occur include:
incapacity to express oneself, problems in solving problems, personality
change, social behavior change, mood changes, incapability to focus on tasks,
persisting on a single thought, lack of flexibility in thinking, problems in
interacting with other people, incapability to organize a series of complex movements,
and loss of body movement (Race, Keane and Verfaellie, 2011).
Incase the
parietal lobe is injured, possible symptoms include: problems in coordination,
loss of self-awareness of some parts of the body, difficulties in reading,
problems doing mathematics problems, problems in telling right from left,
problems with drawing, problems in naming objects, and problems in attending to
more than one object at the same time (Race, Keane and Verfaellie, 2011).
If it is the
occipital lobes that are injured, possible symptoms include: problems in
reading and writing, problems with recognizing objects’ movement, problems in
recognizing drawings, problem with seeing objects, problems with recognizing
words, problems with identifying color and hallucinations (Race, Keane and
Verfaellie, 2011).
Treatment
Brain treatment
helps patients with neurological impairments to manage their physical,
psychological and cognitive damages. While these symptoms can be effectively
managed, there is no cure for congenial brain injury. However, besides
medications, doctors prescribe therapies to help the patients in regaining some
of the lost functions and abilities such as communication skills. Treatment for
congenial traumatic brain injury differs from the treatment for acquired brain
injury (Tompkins, Blake, Wambaugh and Meigh, 2011). While treatment for
traumatic brain injury help the patient in managing impairments, treatment for
acquired brain injury tries to fix the injury as well as prevent more damage to
the brain. If it is untreated, other life-threatening conditions such as
swelling of the brain and raised intracranial pressure. Intracranial pressure
refers to the amount of pressure exerted on the skull by the brain blood as
well as cerebrospinal fluid. The brain can swell because of this pressure that
result from brain injury. In some cases, a hole is drilled into the skull by a
surgeon to relieve the pressure. Another treatment for increased intracranial
pressure is simply tilting the bed of the patient and straightening the head.
This is effective in flow of blood through the veins in the neck (Hamed, 2009).
Medication
Strong medication
is used instead of relieving the pressure by drilling the skull. Such
medications that are available include corticosteroids. Other medicines that
can be used are analgesics, sedatives and paralytic agents depending with the
kind of injury and the extent of the damage. Diuretics which are medicines that
increase the output of urine can remove excessive fluid in the body. Though useful
in treating ICPs, it can cause insufficient blood volume. Therefore it should
be used carefully. While traumatic brain injury can be treated with the use of
benzodiazepins, these medicines are used cautiously as they can lower blood
pressure by repressing breathing (Hamed, 2009).
Corticosteroids
This medicine is
used in reducing brain inflammation as well as swelling. Given the fact that
this medication is used in treatment of other conditions such as skin diseases,
allergic reactions, certain tumors, digestive problems, blood disorders
arthritis, eye problems, and for hormone replacement, it is important for it to
be prescribed by the doctor. This is because it is only a specialist who can
know the dosage of the medication required by the patient depending on the
brain injury (Hamed, 2009).
Physical therapy
Physical therapy
is one of the treatments that are recommended for people with brain injuries.
This program is aimed at promoting health of the brain damage patient by making
it possible for him or her to perform purposeful and meaningful activities.
Physical therapists work with the patient by using treatments that recover,
develop and maintain activities of day to day living. The physical therapist
not only helps the patient to improve their motor and reasoning skills, but
also to deal with any complete loss of function. The main aim of physical
therapy is helping the patient to have an independent, productive and
fulfilling life (Tompkins, Blake, Wambaugh and Meigh, 2011).
Psychological
Counseling
Counseling is important in helping
the patient deal with the problem and adapt to the disability. This is
therefore more effective where it is done by a professional counselor who
understands the problem (Tompkins, Blake, Wambaugh and Meigh, 2011).
Cognitive
rehabilitation
Cognitive
rehabilitation is the main treatment for acute and subacute stages of recovery.
It is a program that assists patients to restore their normal functioning or in
compensating for cognitive deficits. The aim of rehabilitation is to improve
independence at home and in the community. Rehabilitation is more effective in
cases where it is done by a group of professionals who are knowledgeable in
head trauma. As for any person with neuralgic disability, a multidisciplinary
approach is more effective for better results. Rehabilitation physicians are
possibly the major medical staff involved in the rehabilitation process, but
based on the patient, other doctors and physicians can be involved. In this
program, the patient is individually trained on particular skills as well as
metacognitive strategies. Metacognitive abilities entail assisting the patient
in increasing self-awareness concerning problem-solving abilities. This is done
through learning how to observe the success of these abilities as well as
self-correct where possible (Tompkins, Blake, Wambaugh and Meigh, 2011).
Conclusion
Analysis
It has emerged
from research that brain damage is a serious issues in the world, affecting
millions of people in different nations every year. Statistics reveal that in
the United States,
more that a million people suffer brain injury every year. It has also emerged
that treatment of brain injury costs the country more that 48 billion dollars
every year. This problem is not isolated to the United States because all the other
countries have reported cases of brain damage. The injuries range from minor to
severe. It has also emerged that most of the traumatic brain injuries result
from falls and this is the reason why majority of the affected are children
between the age of 0 and 4 and the elderly 75 years and above. Several ways
have been discussed of how people can snuffer brain injury. In the past decade,
technology has developed such that it is possible to effectively manage most
cases of brain injury. Diagnosis of brain injury is possible as there are
various tests that are available for brain specialists. There are also
non-based programs of behavioral, social, cognitive, vocational and educational
treatments that address the problem of brain damage.
Evaluation
With the current
development in medical technology, it is possible to manage cases of brain
damage effectively. Research reveals that most of the brain damage cases that
are treated effectively are the ones that are reported in time. It is thus
important to seek medical attention immediately one falls or has a blow on the
head that could result to brain injury. Patients who suffer brain injury are
not only at the risk of suffering primary injury, but also secondary injury. This
is the reason why immediate care is essential as some of the symptoms of brain
injury will emerge later as secondary injury. Majority of the minor injuries
are treated and the patient able to return his or her normal functioning. The
injuries that are likely to cause permanent disabilities are the severe
injuries, but the effects can also be effectively managed by seeking immediate
treatment and going through the entire treatment and rehabilitation process.
Many hospitals in the country are equipped with effective equipments for
identifying the kind of injury a patient has suffered and thus the doctors are
able to have the knowledge of what procedure to follow. Various cases of brain
injuries have been treated in the past and the technology continues to develop
such that it will be able to handle more complicated cases.
Interpretation
Forecasting
recovery in brain damage is a complicated but significant task. Important
information is important in order for such prediction to be made and the
treatment and rehabilitation program tailored to the needs of a particular
patient. The information is of value when dealing with the patient as well as
for policy makers in deciding the most effective ways of preventing brain
injury and designing treatment programs. They are also important when looking
at the wider issue of resource allocation, comparison of results in different
treatment and rehabilitation programs and looking at the effects of different
procedures on recovery. Brain damage is a serious issue and looking at the
statistics it is evident that it is one that requires immediate attention.
People require being educated on the ways of preventing brain damage for their
own health and to save the country on the increasing cost of treating these
injuries. It is important that children and the elderly are protected from
avoidable falls and for people engaging in sports and such activities to wear
protective gears. This way, such accidents that can be prevented will save the
country, families and the society a lot. Brain injury is a serious problem and
every person has a responsibility in preventing it where possible. More
research is necessary to develop more advanced technologies of dealing with
brain injuries such that more permanent disabilities can be avoided.
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