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Brain injury
Also known as Acquired Brain Injury (ABI)
Key points about brain injury
A brain injury is damage to brain tissue. It differs from congenital disorders that you were born with.
A brain injury can be the result of trauma, eg, a blow to the head or impact that causes your brain to shake within your skull.
It can also result from a medical problem, eg, a stroke, brain tumour, lack of oxygen or infection, or by substance abuse or poisoning.
The effects of brain injury depend on which parts of your brain were injured and how seriously.
A brain injury can have a dramatic impact on your family, job, social and community life – support is available.
If someone is unconscious or unable to move all or some of their limbs or is complaining of neck pain call 111 immediately.
Don’t move the person (unless it’s dangerous to leave them where they are).
Get immediate medical help if you or someone you are caring for:
has received a hard bang on the head (say, from a major fall)
appears dazed or loses consciousness, even momentarily
seems unwell or vomits after the injury or shows any of thewarning signs of a brain injurybelow:
• Complaints of neck pain • Increasing confusion or irritability • Repeated vomiting • Seizure (fit) or convulsion • Double or blurred vision • Sleep difficulties • Lightheaded and dizziness
• Muscle weakness, tingling or burning in arms or legs • Fatigue or tiredness • Deteriorating conscious state • Severe or increasing headache • Unusual behaviour change • Difficulty remembering things.
Brain injury is damage caused to brain tissue that occurs after birth and is not related to a congenital disorder (a problem you are born with). A brain injury can be the result oftrauma (known as a traumatic brain injury)or amedical problem.
Traumatic brain injury (TBI)
A TBI is caused when an impact (bump or blow) to your head or body causes your brain to shake inside your skull.
Brain injury can also be caused by medical problems, such as:
brain tumours
bleeding in your brain
stroke
infection
lack of oxygen.
Ongoing alcohol and drug abuse can also cause brain injury, as can poisoning with toxic substances such as pesticides, gases and solvents.
A concussion is a type of mild traumatic brain injury (mTBI). It occurs when a bump, blow or shake to your head or body causes your brain to shake inside your skull, causing your brain to be bruised in a similar way to other parts of your body.
You don't have to get a blow directly to your head itself – impact anywhere on your body that causes your head to shake violently can lead to a concussion. You also don't have to be knocked out to get a concussion. In fact, loss of consciousness only happens with 10% of concussions.
Older people
The most common cause of brain injury in older people is a fall. If you or someone you care for has experienced a fall, see a doctor as soon as possible to check for the possibility of a brain injury. A brain injury can be possible even if you have a low-level or a same-level fall.
The consequences of a brain injury in older people can be serious and long term. This can include:
greater risk of cognitive decline
longer recovery
worse consequences, eg, fractures (broken bones).
More than two-thirds of older adults with mild brain injury recover fully. Older people who are most at risk of poor recovery from a mild brain injury include those who:
are frail
have been diagnosed with dementia
have a history of cancer
are taking or have taken blood-thinning medicines in the past.
The two Rs – recognise and refer is the principle.
Recognise
Recognise and be aware of the signs and symptoms of a brain injury (see above).
Refer
If you or someone you care for has experienced a fall, see a doctor as soon as possible to check for the possibility of a brain injury. You can also call Healthline free on 0800 611 116 if you are unsure what to do.
To assess the impact an injury has had on your brain, your doctor will use the Glasgow Coma Scale (GCS) to measure physical, verbal and eye-opening responses. Read more about theGlasgow Coma Scale(external link)(external link)
Brain injuries can range from mild to severe as determined by the GCS, with mild being GCS 14–15, moderate 9–13, and severe 8 or below.
Concussionis on the mild end of the traumatic brain injury spectrum.
The effects of brain injury are different for everyone. How you react depends on which parts of your brain were injured and how seriously.
About 5% of traumatic brain injuries in New Zealand are moderate to severe. If you have a moderate to severe brain injury, you are likely to have some level of physical, cognitive (thinking) or behavioural disability.
Some symptoms may appear right away, whereas others may not be present for days or weeks after the injury. Some symptoms may disappear after a few hours; some may continue for weeks or months.
Because the brain is so complicated, it is difficult to know exactly what the long-term outcome will be. Most people keep getting better slowly over time, but some people never recover to be exactly as they were before the injury.
Some ongoing problems include:
cognitive problems, eg, difficulties with thinking clearly, maintaining concentration, problem-solving and completing projects
memory problems particularly with learning and remembering new information
physical problems, eg, with sense of balance, fatigue causing reduced mental and physical stamina, slower reflexes and headaches
sensory problems, eg, lower tolerance to light and noise, or problems with taste, smell and touch
communication difficulties making it difficult to express yourself and understand others
A brain injury can have a dramatic impact on family, job, social and community life.Brain Injury NZ(external link)(external link)has a range of resources for living with brain injury.
When someone in your family has a brain injury, the whole family/whānau is affected.
This could involve the following:
The initial shock of the initial brain injury. This can include coping with intensive care treatment.
Dealing with ACC, hospitals, WINZ and other agencies.
Adjusting to the changes in the person with the brain injury and how these may affect other family members and friends.
Keeping active and exercising regularly is important for older people to maintain core strength and balance. This helps to keep you steady on your feet and reduce the risk of a fall and prevent a possible brain injury, as well as other consequences such as fractures. Lack of exercise can lead to weak legs, which increases the chances of falling.
Any increased exercise is helpful. Start with 5 minutes a day and build up.
Making your home safer by reducing tripping hazards and clutter, adding hand-rails and improving lighting can help reduce the chances of a fall. Read more about the home safety checklist(external link).
Videos from the 'Broken' Attitude Live series, where you hear from people who have have experienced a traumatic brain injury and the rehabilitation they went through.
Video: Broken: Part 1
Imagine waking up and not knowing who you are. Every 15 minutes a New Zealander suffers a traumatic brain injury. Follow three people in the fascinating phases of brain rehab. This video may take a few moments to load.
(Attitude Live, NZ)
Video: Broken: Part 2
Traumatic brain injury can happen to anyone. But it’s often a hidden disability. In this series we journey into a world not seen before, where people grapple with the profound challenge that is rehabilitation from a brain injury. This video may take a few moments to load.
(Attitude Live, NZ)
Video: Broken: Part 3
In New Zealand 36,000 people suffer a traumatic brain injury every year. The most severe go to ABI Rehabilitation where a team of experts support people with brain injuries back into the community. This video may take a few moments to load.
O'Connor sustained a traumatic brain injury in a motorbike accident. His mother thought he'd never gain independence, but 13 years on he's flatting and working. This video may take a few moments to load.
(Attitude Live and ACC, NZ)
Video: Changed in a moment with Casey
It was just over a year ago that Casey broke her neck while training for an upcoming motocross event. She is doing everything she can to give herself the best chance of getting back on her feet. This video may take a few moments to load.
(Attitude Live and ACC, NZ)
Video: Changed in a moment with Nafi
Nafi Tefono was ‘young and bulletproof’ and a talented rugby player, but one day a misplaced tackle resulted in a broken neck – and some tough decisions about his future. This video may take a few moments to load.
Discover more about how your brain works, describing the different parts of the brain and what they do. A clear and easy to understand resource.Download pdf(external link)(external link)
What is brain injury?
Understand the different types of brain injury, their effects and the medical definitions. Thesymptoms and effects of brain injury are also explored.Download pdf(external link)(external link)
Coping with brain injury – for family and friends This leaflet is about how you can help in the recovery of a person who has sustained a brain injury, and how to look after yourself at the same time.Download pdf(external link)(external link)
Work and study This leaflet will help you start the process of returning to work or study, including what support services you may need, and what to expect while rehabilitating.Download pdf(external link)(external link)
Key information about post-traumatic headache provided by Dr Pyari Bose, neurologist, Auckland
Post-traumatic headache (PTH)is the most frequent symptom after mild traumatic brain injury (mTBI). It is estimated that annually 69 million suffer from TBI worldwide, mostly attributable tomTBI.InNew Zealand it is estimated that up to 36,000 people suffer TBIs each year, of which 95% are mild.
The leading causes of TBI in New Zealand are falls,mechanical forces, driving-related accidents andassaults.Just over 20% of all TBIs in New Zealand are sustained through sport-related activity.(7)
The underlying cause of PTH is not fully known. It is thought thatmechanisms related toboth migraine and traumatic brain injury (TBI) are implicated. These include impaired descending paincontrol networks in thebrain,neurochemicalchanges, neuroinflammation, cortical spreading depression, and release of thepain protein-calcitonin gene-related peptide (CGRP).
The treatment would be determined by evaluation of the underlying headache phenotype. Common patterns of PTH include migraine type and tension type headache patterns. Part of the management also includes addressing if patients are overusing pain medications.
Headachesmay resolve within 3 months of the traumatic brain injury but in some patients this may last longer.
