Traumatic Brain Injury
Injury to the brain can result from several things, including traumatic brain injury, stroke, bleeding in the brain, lack of oxygen to the brain for a period of time, toxic exposure, tumors, or disease processes. Sometimes the brain injury can result in few if any problems and sometimes the brain injury results in considerable dysfunction and impairment. The severity of impairment depends on the region of the brain affected and the amount of tissue that is damaged.
Modern medical technology allows doctors to look at the brain following brain injury to determine if there is damage to the structure of the brain. This technology includes CT scans, MRI scans, PET/SPECT scans, fMRI, and other techniques. It is also possible to look at the electrical activity of the brain through EEG. As helpful as these techniques are for looking at brain structure they are not sufficient to determine how the brain is working. Sometimes people with a lot of structural damage function quite fine and sometimes people with little or no damage to the structure of the brain function very poorly. This is because there are other factors involved in brain injury in addition to structural integrity of the brain, such as changes in neurotransmitters in the brain, emotional factors, neurodevelopmental factors, and behavioral factors. It is important to assess the functional sequelae of brain injury to determine how brain injury affects the person’s life. This is accomplished through neuropsychological evaluation, a battery of tests that forms the basis of the assessment process in our Head Injury Rehabilitation program. From the assessment we are able to develop an individualized care plan that is tailored to a patient’s specific cognitive deficits.
The brain does not heal following brain injury like other parts of the body might heal. For example, a broken bone is frequently able to mend to the point that it works just as well as it did before the fracture; however, if there is damage to the structure of the brain, scar tissue gets in the way of regeneration of neurons and neuronal connections. Fortunately, people can learn new ways to do things that are difficult following a brain injury, and this is called cognitive rehabilitation.
Cognitive rehabilitation in the Head Injury Rehabilitation program is aimed at developing compensatory strategies for areas of deficit. For example, brain injured individuals are instructed on the use of a schedule, timing device, digital voice recorder, and other strategies to compensate for memory impairment. Compensatory strategies are applied in functional settings such as those required for daily living. Individuals learn how to plan, organize, and execute activities of daily living, vocational and recreational/leisure activities, transportation, and social activities. Individuals with brain injuries also learn to use residual abilities as effectively as possible and engage in memory, problem solving, multi-tasking, and other activities.
In addition to addressing cognitive deficits, emotional and psychological problems are addressed in cognitive rehabilitation. Cognitive and behavioral strategies are used to manage depression, anxiety, irritability, dyscontrol, and other problems.
Current research regarding neurobehavioral rehabilitation supports the use of compensatory training and appropriate psychotherapy to address the problems commonly found in individuals with traumatic brain injury.