Some Signs and Symptoms

An acquired brain injury is damage to the living brain tissue that has occurred since birth. About 75% of these are actually traumatic, in other words, a pressure wave has gone through the brain because of violent shaking or activity, or the brain has hit the inside of the skull. The other 25% of brain injuries would be things like having a stroke. Some of those strokes are because a piece of the clot has travelled to the brain from a different part of the body, got stuck in an artery in the brain and cut off blood supply, and therefore, oxygen.

Another type is a haemorrhagic stroke. Basically, there has been a bleed. An artery in the brain has burst - a blood vessel has burst - which causes this type of stroke.

Some people get an infection in the brain, such as the herpes simplex virus, which is like the common cold sore virus. It gets into the brain and causes swelling. This can cause quite a bit of damage.

Other forms might be that somebody has had a heart attack, or they have drowned and not been resuscitated quickly enough, and oxygen is cut off to the brain. Other forms might be a tumour, so somebody has had a tumour in the brain that has then been removed. These are not an exhaustive list of brain injury types, but some of the major ones.

The thing with traumatic brain injuries is, because of the brain's texture, which is quite soft, when a force comes on to it there is a kind of pressure wave that bounces backwards and forwards. If the force is sufficiently violent the brain kind of rotates inside the skull, and unfortunately on the inside of the skull there are some sharp bony ridges, some at the bottom and some just above the eye sockets on the inside, and the brain can actually rub up against those; be pushed against those.

And then there is what we call diffuse axonal injury, which is basically the brain connections, if you like, actually disrupted in a wide area of the brain, so there may be pressure. The original sort of insult to the brain may come at the front, but this kind of microscopic damage can take place across the entire brain. So, it gives a quite complicated picture rather than a focused cutting-off of oxygen to the brain, say, through a stroke, at a specific point.

We think about some aspects of brain injury being what we call the ‘hidden disability’. In the case of where the part of your brain that helps you make movement has been damaged, it is quite obvious that that person, say, would need to use a wheelchair because they have got paralysis or weakness. If you have damage to key areas of the brain, say, the frontal lobes, there may well be a mixture of what we call ‘cognitive’ or ‘thinking problems’ and also ‘behavioural problems’. So if you start thinking in a different way, if you are not able to control your impulses as well as you used to be able to (before you had a brain injury) because of damage to the frontal lobe, and you are less aware of yourself which is also a problem, and you are less aware of the things that you are doing and saying (which is a problem following, say, a frontal lobe brain injury), then you may present as offering behaviours that challenge.

They may just pass you off as ‘you are not being brought up well’, or you have been... Or you are being rude. And of course, a lot of people, service users that I know that have had brain injuries, were living perfectly well-functioning lives and were completely polite prior to the injuries. And part of what we help people with at Headway Essex is to help them socialise… re-socialise and re-learn. In many ways, some of the correct ways of being, if you want, by being around other people and getting some guidance from the staff, because people do forget how to behave properly.

They also have difficulty with basic functions, such as making plans. How do I plan to get from A to B? And we may just take that for granted, but if you have had, once again, damage to the frontal parts of your brain, you may have a lot of trouble with stuff like that. You may become easily frustrated as well, and not be able to suppress your anger and come out with quite angry outbursts. So there is... You may look at a person and say, "Well they look alright," because they have not got any damage to their motor functions and so you may misinterpret their behaviours, as I say, of being one of just being very rude.

Now, it is kind of about helping people to understand that a particularly traumatic brain injury often results in changes in behaviour that other people may find difficult to cope with. But the good thing is - about the brain - is it has a certain amount of what we call ‘plasticity’. In other words, it has the ability to make new connections and for people to re-learn some of the stuff that they, I won't say have forgotten, but mislaid for sure, some of the things they have learned. So if they are given kind of effective cognitive rehabilitation, then they can sometimes regain the social functions if you want, and the correct way of being again. In a similar way that physiotherapists when they... If somebody had brain damage in the motor areas of the brain, they work the muscles, which is sending signals back to the brain and saying, "It is still working". And the brain makes adjustments and makes new connections and function is sometimes restored. So I am thinking about that in terms of cognitive abilities and also behavioural abilities, that you can help people to restore those and rehabilitate those.