INFORMATION FOR CANDIDATE:

You are an HMO in ICU and the consultant asks you

to talk to the relatives of a 25 year old Mich Winter
who was involved in a severe motor cycle crash
resulting in severe head injury with extensive skull #,
an epidural haematoma and axonal shear injuries to
his brain. Despite neuro-surgery the patient has not
regained consciousness and is still sedated and
ventilated. The outcome is uncertain and the family
wants to know what to expect with an acquired brain
injury.You have had frequent contact with the family
and established a good rapport, therefore the director
of the unit asks you to talk to them.
YOUR TASK IS TO: to explain the principles of
acquired brain injury to the family.

Acquired Brain Injury (or ABI) refers to any type of brain damage that occurs after
birth. ABI can result from numerous causes, including disease (infection, Parkinsons,
CVA, MS, Alzheimers), substance abuse, oxygen deprivation, infection or a blow to the
head. Every brain injury (like every individual) is unique. ABI can affect a persons
cognitive (e.g. thinking/ learning / memory / concentration), physical (e.g. headaches,
fatigue, speech, swallowing, chronic pain, epilepsy), emotional/psychological or
independent functions (behaviour, personality, withdrawal, impaired relationships). In
some cases, all three functional areas are involved, with serious effects on the previous
level of independence enjoyed by the person with an acquired brain injury. The
impairment experienced can range from mild to profound, can be temporary or
permanent, sometimes for the rest of the patients life, even a permanent coma like state,
although these issues are very difficult, if not impossible to predict.
Traumatic Brain Injury (TBI)
A person can suffer TBI as a result of a blow to the head or a rapid movement of the
head that leads to damage to the brain (shearing forces), usually with loss of
consciousness. The sudden movement or force can result in brain trauma, for example by
oxygen not being able to get through to brain cells and by bleeding, clotting or bruising.
TBI can be mild or severe, and the impairment suffered can be temporary, long term (but
still recovering) or permanent.

Frontal Lobe:
The frontal lobe area of the brain is the main site for:
Attention and concentration
Awareness of abilities and limitations
Emotions
Inhibition of behaviour

Initiation
Personality
Planning and anticipation
Self-monitoring
Social and moral reasoning
Social and sexual behaviour
Speaking (expressive language)
Thinking.
Damage to the frontal lobe can result in personality changes, a lack of initiative,
inflexibility or problems adapting to new situations.
Temporal Lobe
The temporal lobe is that part of the brain involved in:
Hearing
Memory (The Temporal Lobe contains the hippocampus, which is concerned
with making new memories)
Organisation
Sequencing and categorising objects
Understanding speech.
Damage to the temporal lobe can lead to memory difficulties and problems in
understanding what you hear.
Parietal Lobe
The parietal lobe of the brain controls such functions as:
Differentiation of size, shapes and colours.
Drawing
Face movements
Feeling and touch
Perception of temperature, pain and pressure
Visual and spatial perception.
Damage to the parietal lobes can lead to problems in telling left from right, difficulty
with reading and writing or with tasks like putting together puzzles.
Occipital Lobe
The occipital lobe has several functions, but is mainly concerned with:
Vision (ability to make sense of what is seen).
Damage to the occipital lobe can result in an inability to recognise objects and faces
on sight.
Cerebellum
Balance
Co-ordination
Skilled motor activity.
Brain stem
Arousal and consciousness
Attention and concentration
Breathing
Heart rate
Sleep and wake cycles.

Another important fact to remember is that the brain is further divided into two sides,
called the left hemisphere and the right hemisphere. The left hemisphere controls the
movements of the right-hand side of the body and vice versa.
So the nature of physical impairment and movement difficulties that many people with
ABI experience will be governed by which hemisphere of the brain was injured.

Cognitive
Lack of insight, poor short term memory,
poor concentration, slowed responses, poor
planning and problem solving, lack of
initiative, inflexibility, talking excessively,
difficulties in understanding speech, and
inappropriate sexual behaviour
Physical
Fatigue, decreased motor control, balance
problems, paralysis, sleep disturbances,
communication difficulties, hearing loss,
visual problems, difficulty with
temperature control and physical effects
caused by alcohol and drugs.
Emotional
Depression, anxiety, mood swings,
emotional lability, lack of self control (disinhibition),
irritability, temper, impulsivity,
socially inappropriate behaviour, selfcentredness,
dependency.
Medical
Hydrocephalus (an abnormal accumulation
of cerebrospinal fluid within cavities called
ventricles inside the brain), epilepsy,
swallowing difficulties, incontinence,
changes to senses, headaches, psychiatric
symptoms such as visual and auditory
hallucinations.
Communication
Difficulties with e.g. speech impairment, excessive talking.
The challenges faced by a person with acquired brain injury will often depend on the
stage of recovery. Three broad stages can be described:
Immediately following an injury, while in hospital, the challenge is surviving and
healing.
In rehabilitation the challenges are recovering lost abilities and working on new skills,
while developing an understanding of the nature of their injury.
Back in the community the focus is adjusting and re-developing a quality of life despite
any continued effects of brain injury.

Often it is the emotional and cognitive changes of Acquired Brain Injury that causes more
ongoing disability and distress than physical impairment. These problems can impact on
employment, the family network and social life. Mental illness is common following
Acquired Brain Injury. Major depression occurs in approximately 27% of TBI patients.
Depression can occur as a psychological reaction to the injury and frustration with
changes in mental and physical abilities. Feelings of loss and grief are often associated
with the changes introduced by acquired brain injury. Other associated factors include
negative changes in lifestyle such as reduced social circle, isolation and lack of
meaningful activities.
The impact on the family
Family and friends are a vital source of support for a person with an acquired brain injury.
During the hospital phase, key family members may play multiple roles including
advocate, guardian, and nurse. Feelings during these times may fluctuate from
overwhelmed and stressed to hope and joy in the progresses.
Back in the home family, partners and friends may be required to cope with personality
and behavioural changes that can arise following acquired brain injury. This can put strain
on family relationships as the family try to learn ways to assist their loved one. While
supporting a loved one, it is important that personal well-being is regularly checked on
and given adequate attention. This way better supported can be provided to a loved one in
the long run, by lowering stress levels and feelings of burden. Creating strong connections
with other carers, can provide much needed social and emotional support and
understanding.
Words of Hope
People with a brain injury and their family may come across negative attitudes or opinions
surrounding the level of recovery that can be made following acquired brain injury.
However it is important to not lose that hope. Hope is what helps people strive toward
greater recovery and achievements. With the right support people with a brain injury can
continue to improve many years beyond the common two year cut off and families can
continue to strengthen.
Tips on Recovery:
Celebrate every success; even seemingly small improvements can have a big impact
Break tasks down and achieve the task step by step
The support of family, friends and a wider network is vital
Focus on what you can do, instead of what you cant
Focus on your strengths
Stay positive and use humour
Family should be involved in the rehabilitation process
The person with an acquired brain injury should be involved in developing their own
recovery/compensatory strategies.
At this stage it would be far too early to talk about details of Michs prognosis and he will
have to be assessed regularly and there will be the involvement of a multidisciplinary
team which may include but is not limited to nurses, neurologists, physiotherapists,
occupational therapists, speech-language pathologists, and psychologists.