Brain injury

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 of trauma (known as a traumatic brain injury) or a medical 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.  

In New Zealand, the most common causes of TBI are:(external link)(external link) 

• falls – find out more about fall prevention
• sports injuries
• motor vehicle accidents.

Medical brain injury

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 the Glasgow 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.

Concussion is 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
• personality changes, eg, irritability, intolerance, depression, anxiety, socially inappropriate behaviour and mood swings
• loss of contact with friends and associates.

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.
• Coping with financial and legal problems.
• Stress related to caring for the person.

Read about Coping with brain injury for family and friends(external link)(external link) Brain Injury NZ

Maintain core strength and balance

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. 

There are also community group or in-home strength and balance classes that are fun and can help improve strength and coordination. Find a community group strength and balance class near you(external link).

Read more about community group and balance classes(external link) and in-home strength and balance classes(external link).

Make it safer in and around the home

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).