What is Brain Injury (BI)?

Acquired Brain Injury (ABI)
An Acquired Brain Injury is the term given to an injury to the brain sustained during a person’s life, as opposed to being born with a problem. There are two types of acquired brain injury – traumatic, which may be the result of a motor vehicle accident, violent assault, gunshot wound or fall, and non-traumatic which may be the result of a stroke, a brain tumour, an aneurysm or an illness such as encephalitis. Injury can also occur when there is lack of oxygen to the brain (hypoxia).

Traumatic Brain Injury (TBI)
Although the brain may look like a damp, frequently used sponge, don’t let appearances fool you. The brain consists of a complex network of billions of nerve cells, called neurons. It has very specific areas, with each one responsible for a particular function. It can store tremendous amounts of information, and, when it is working properly, there is nothing in our manmade world that can compare to it – not even the most sophisticated computer.

On the outside your skull is completely smooth, but if you were to run your hands along its interior, you would notice “innards” that are rough, bony and ridged – especially near your forehead and ears where your frontal and temporal lobes reside. Under normal conditions your brain is safely bobbing in its sea of cerebrospinal fluid. But if your head hits the steering wheel, for example, your brain would bounce and jiggle within its skull home, hitting and re-hitting those bony ridges around your forehead. And which areas of the brain would most likely hit and re-hit this ridged skull zone? None other than the higher functioning frontal and temporal lobes – which hold those thoughts, actions and motivations that make you human and unique.

This stop-start movement of your brain is called an acceleration-deceleration injury resulting in bruising, haemorrhaging and even stretching or tearing of the axons (nerve fibres) in the brain. Sometimes the impact causes the brain to move in the opposite direction, so that a blow to the front of the head causes a bruise in the back of the brain. This “backhand” phenomenon is called a coup-contrecoup injury.
Adding insult to injury in addition to the bouncing ball of the brain hitting the “concrete” wall of the skull, stretching and tearing can occur – with serious repercussions. Axons within the brain are pushed and pulled in all directions and will be stretched causing wide spread damage throughout the brain. This is called diffuse axonal injury and may cause coma, especially if the brainstem nerve fibres are traumatised. An injury to the brainstem affects your very survival – from breathing to staying awake. Damage here can be long lasting and devastating.

A bruised brain can also become swollen and because it is encased in a finite amount of space, it has no room to expand within the confines of its rigid skull. Intracranial pressure builds, damaging even more nerves. It is crucial that this swelling be treated as quickly as possible either with medication or surgical intervention.

There are two types of traumatic brain injury

  • A bullet wound, a shard of glass, a forceful blow with a heavy instrument …. any of these can penetrate the brain, damaging both it, and the surrounding skull, causing both a skull fracture and brain injury. Any accident involving an outside force that penetrates the head is called an open head injury. As well as bruising, bleeding and swelling, foreign matter that has entered the brain can cause infection which can be an added risk in this type of injury.
  • Damage from a closed head injury is seemingly invisible. Because the skull is not penetrated, everything appears intact. However it is vulnerable to diffuse anoxal injury and swelling.

Consequences of Brain Injury:
Injury to the brain may result in physical difficulties which may include walking and balance problems and in severe cases paralysis; swallowing, and speech and language difficulties; cognitive impairments; memory loss and emotional changes such as mood swings and aggression.

Recovery After Brain Injury:
There are two important points about recovery after brain injury. The first is that how soon and how much improvement takes place is affected by the frequency and type of rehabilitation. The other important point is that there is always a limit to how much recovery can take place. This limit is set by the kind of injury, the amount of damage, and the age and lifestyle of the brain injured person.

Recommended Reading:
Headway Gauteng has a small library of books and videos from educational through to inspirational, which may be ‘borrowed’ by members on a monthly basis. The following books are recommended

  • Living with Brain Injury. A Guide for Families by Richard C Senelick, and Cathy E Ryan
  • Head Injury – The Facts by D Gronwall, P Wrightson and P Waddell
  • The Catastrophe of Coma – A Way Back by EA Freeman
  • Where is the Mango Princess? A Journey Back from Brain Injury by Cathy Crimmins

Printed articles about brain injury are also available on request.

The following poignant comments were written by a brain injured person for her family:
Accept me for who I am today. Don’t hold me to being the person I was before the accident. I have a different brain now.
I am not stupid, I am wounded. Please respect me.
Focus on what I can do rather than what I cannot do.
Approach me with an open heart and slow your energy down.
Celebrate all of my little successes. They are my inspiration.

Please spread the word :)