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  Copyright © 1998 Head Injury Hotline
Brain Injury Types
From The Ashes: 
A Brain Injury Survivor's Guide 
     The Problem.  Though not always visible and sometimes seemingly minor, brain injury is complex. It can cause physical, cognitive, social, and vocational changes that affect an individual

On this page:
About the Brain
Traumatic Brain Injury
Acquired Brain Injury
Head Injury
Concussion Symptoms
Severe Head Injury
Moderate Brain Injury
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Brain Damage
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Selected Excerpts.. 

"Neuropsychological  impairments caused by brain injury may be characterized in terms of three functional systems  

  • (1) intellect which is the information-handling aspect of behavior; 
  • (2) emotionality, which concerns feelings and motivations;  and 
  • (3) control, which has to do with how behavior is expressed ."
" Brain damage rarely affects just one of these systems.  Rather, the disruptive effects of most brain injuries, regardless of their size or location, usually involve all three systems."  -- Source Neuropsychological Assessment, 3nd  Ed., 1995,  by Muriel D. Lezak

Selected Excerpts.. 
      "A number of years ago, while engaged in a head trauma research program at New York University Medical Center,  we became concerned with the other, ignored  end of the head trauma spectrum:  minor head injury. 

While a number of professionals have written consistently and eloquently in this area (notably Thomas Boll, Jeffrey Barth, and Dorothy Gronwall),  we found  gross ignorance and neglect of the long term problems associated with "minor" head trauma: those injuries where patients spent a brief time (if any) in the hospital, make quick medical recoveries, and were discharged directly home without any perceived need for formal rehabilitation.  
      We discovered, as others had reported, that these patients appeared fine until they attempted to resume their responsibilities at home, work, or school,  When they did  so, a significant number experienced great difficulty. 
    They complained of inability to remember, concentrate, organize, handle a number of tasks at once, and get as much work done efficiently as they used to.  
    Their relationships with family, peers and bosses often suffered, and they developed psychological problems.  
     Their doctors were unable to find anything wrong with them, and they were thought to be having psychiatric problems - or worse yet, to be malingering.  
     They became the bane of neurologist, psychologists, psychiatrists, and vocational counselors, all of whose usual techniques did not produce positive results." 

Source-- "Minor Head Injury:  An Introduction for Professionals"  December 1986,  
Thomas Kay, Ph.D., Coordinator, Head Trauma Research Project 


for a short period of time, or permanently. In many cases recovery becomes a lifelong process of adjustments and accommodations for the individual and the family. 

     Depending on the extent and location of the injury, impairments caused by a brain injury can vary widely. Among the most common impairments  are difficulties with memory, mood, and concentration. Others include significant deficits in organizational and reasoning skills, learning, cognitive, and executive functions. 

     Recovery from a brain injury can be inconsistent. In many cases gains may be closely followed by setbacks and plateaus. A "plateau" is not evidence that improvement have ended. Typically, plateaus are followed by gains. This pattern of gains and setbacks can continue  indefinately. 

     Changes in memory and organizational skills after a brain injury makes it difficult to function in complex environments. The tutorials and quizzes in this section are designed to help you understand how daily routines and life in general may be affected by brain injury. 

     Links on this page help you create a compensatory system, teach you how to use it, and monitor how well it is working. A number of those pages  provide practical suggestions for gathering information and developing effective action plans for coping with brain injury in daily living. 

About the brain. The brain has been described as a three pound universe.  It has come to be thought of in those terms because quite literally; we live in our brains. The brain is our personal, private universe.  It is through our brains that we experience ourselves and the environment.  It is though our brains that we understand our relationship to others.  Scientists think of the brain as the organ of reason, language, complex social relations, and morality. It is, after all, what makes us distinctly human. 

     The brain can be thought of as a sensory processor. Our experience of ourselves, and our environment is dependent on the brain's ability to receive, process, store, retrieve and transmit sensory information.  The ability to think, see, smell, feel, remember, and behave appropriately  is dependent on an intact brain. Even minor brain damage can result in permanent impairments in these functions.  Such impairments can interfere with normal everyday activities. 

        Brain damage, whether from surgery, strokes, tumors, disease, toxins, near drowning, electric shock, lightning strike, or head injuries can rob a person of a sense of self. It can  turn a person into a  mere shadow of his or her former self   At the very least brain damage can seriously compromise quality of life. While brain damage may strike a single individual, in reality it is the family that bears the brunt of its destructive impact. up arrow 

  Traumatic Brain Injury (TBI),  results from damage to brain tissue caused by an external force. Leading causes of TBI are motor vehicle accidents, acts of violence, falls, sports and recreational injuries, lightening strikes, electric shocks, and blows to the head.  TBI can occur without any outward physical evidence of injury or trauma. Examples include, whiplash, and shaken babies.   Also see Brain Injury Support Groups  for links to information and resources. 

     Memory mood and fatigue are common complaints of brain injury patients. Intellectual dullness and mental rigidity are obvious signs of brain injury. Personality changes are common, and rapid mood swings alternate with waxing and waning energy levels. Taken individually, such impairments might not amount to much.  However, such impairments usually appear in groups or clusters. In many cases the impairments are widespread and disrupt many brain systems. The overall effect can be profoundly disabling. 

    Acquired Brain Injury, (ABI), results from damage to the brain caused by strokes, tumors, anoxia, hypoxia, toxins, degenerative diseases, near drowning and/or other conditions not necessarily caused by an external force. Go to Brain Injury Links for more information on acquired brain injury and related resources. 

   Head Injury.  The terms head injury, traumatic brain injury and acquired brain injury are often used interchangeably. However, most people associate the term "head injury" with some type of external physical damage to the head.  Many such head injuries are superficial, and amount to nothing more than a temporary, although bothersome, injury and associated discomfort. 

       The most severe types of  head  injury can cause extensive functional limitations such a paralysis, and severely limited mental functioning. A little further down the continuum of head injuries you will find moderate head injuries. Moderate head injuries are characterized by   corresponding degrees of functional limitations mostly in the form of diminished mental skills. Then on the other end of the continuum you'll find what's called concussion, mild or minor head injuries. Like the moderate head injuries, mild head injury can cause impairments in mental functioning. The irony of mild head injuries is that often times, such injuries do not even require a hospital stay, yet they result in changes so profound that lives are forever changed.   The term mild head injury belies the true nature of the  resultant impairments. up arrow 

     Concussion. A concussion  results from the brain being battered or violently shaken.  Typically, it is followed by a alteration in consciousness.  That is, the person is knocked out, loses consciousness, or remains conscious, but appears dazed, witless, disoriented.  The term concussion is often used interchangeably with the terms:  head injury, mild brain injury, head dinged, or bell rung. It is important to note that a blow to the head is not required for brain damage to occur.   Also see Concussion FAQ 

    Concussion Symptoms Early symptoms of concussion include headache; dizziness or vertigo; lack of awareness of surroundings; and nausea and vomiting.  Late symptoms of concussion include:  persistent low-grade headache, lightheadedness, poor attention and concentration, memory dysfunction, difficulty doing simple math, difficulty finding words, slowed reaction time, fatiguability, irritability and low frustration threshold, intolerance of bright lights,  difficulty focusing vision, intolerance of  loud noises, occasional ringing in the ears, anxiety, depression, mood swings, and sleep disturbances. Also see Concussion in Sports

The Dangers of Concussion 
    " ...during the minutes to few days after concussion injury, brain cells that are not irreversibly destroyed remain alive but exist in a vulnerable state. This concept of injury-induced vulnerability has been put forth to describe the fact that patients suffering from head injury are extremely vulnerable to the consequences of even minor changes in cerebral blood flow and/or increases in intracranial pressure and apnea.... 

     "Experimental studies have identified metabolic dysfunction as the key  postconcussion physiologic event that produces and maintains this state of vulnerability. This period of enhanced vulnerability is characterized by both an increase in the demand for glucose (fuel) and an inexplicable reduction in cerebral blood flow (fuel delivery).58 The result is an inability of the neurovascular system to respond to increasing demands for energy to reestablish its normal chemical and ionic environments. This is dangerous because these altered environments can kill brain cells." --  
The American Orthopaedic Society for Sports Medicine - url: http://www.intelli.com/vhosts/aossm-isite/html/main.cgi?sub=151 

     Severe Head Injury.   Severe head injuries usually result from crushing blows or penetrating wounds to the head. Such injuries crush, rip and shear delicate brain tissue. This is the most life threatening, and the most intractable type of brain injury.   Also see our Coma page. 

   Typically, heroic measures are required in treatment of such injuries. Frequently, severe head trauma results in an open head injury, one in which the skull has been crushed or seriously fractured. Treatment of open head injuries usually require prolonged hospitalization and extensive rehabilitation. Typically, rehabilitation is incomplete and for most part there is no return to pre-injury status. Closed head injuries can also result in severe brain injuryup arrow 

     Moderate and Minor Head Injuries. Most brain injuries result from moderate and minor head injuries. Such injuries usually result from a non-penetrating blow to the head, and/or a violent shaking of the head. As luck would have it many individuals sustain such head injuries without any apparent consequences. However, for many others, such injuries result in lifelong disabling impairments. 

   Mechanism of Injury.  The brain is somewhat mobile within the spiny interior of the skull. Under normal circumstances the delicate brain is protected from contact with the spiny contours of the skull. This protective barrier is known as cerebrospinal fluid. It surrounds the brain, and under normal circumstances, cushions the brain from contact with its hard, spiny shell. 

    However, when the head is subjected to violent forces, such as those exerted in: automobile accidents;  violent shaking or whiplash;  forceful falls and blows; the brain may sustain permanent damage. Such damage results from the delicate brain being forcibly rotated and battered within the spiny skull, also known as, the brain vault. During such episodes brain tissue is ripped, torn, stretched, battered and bruised.  Such battering is followed by bleeding, swelling and bruising of brain tissue.  Sometimes the brain can recover from such insults without any apparent consequences.  In other cases the resultant difficulties can last a lifetime.  (Also see 2nd Impact Syndrome

     Brain Damage. Such damage, which results in functional impairments, can substantially interfere with the ability to return to a normal lifestyle. They are known as functional impairments because they interfere with the ability to perform basic functions such as walking and talking, thinking and knowing remembering and understanding. For example, memory, mood and fatigue top the list of the many on-going impairments that are caused by brain damage. Even a minor brain injury can have substantial, lifelong consequences.   See TBI Checklist 

    Substantial Lifelong Consequences. After brain injury, things that once were easy and familiar become strange and difficult. Intensive mental effort is usually required to do things that required little or no effort before brain injury. Work and school, personal and family life often suffer too. Typically, children become unmanageable, grades drop, personalities change and they regress to a earlier  developmental stage. 

     In adults, deadlines are missed, jobs are lost, savings dwindle and nerves fray. Behavior regresses and becomes upredictable, unreliable, frequently inappropriate, and sometimes violent,  role reversals are common.  While only one family member may have sustained a brain injury the entire family suffers from its massive intrusion. 

     Scope of the Problem. Each year an estimated 5 million persons in the United States sustain head injuries. Of that number, 2 million Americans sustain head injuries that result in permanent impairments. Many such injuries do not even require a stay in the hospital, yet they result in impairments so profound that lives are forever changed. 

    Recognizing the Problem. Often, the effects of minor to moderate brain injuries are not immediately apparent. Many months may go by before brain injury changes become apparent. Even then, special training and expertise are required to properly diagnose such impairments. Such fields of specialization are known as Neuropsychology and Neuropsychiatry. 

   Recognizing such problems is made even more difficult by perceptual and expressive impairments caused by brain injury. Brain injury causes diminished self-awareness that interferes with the ability to recognize changes in the self. It also causes mental confusion and a sense of uncertainty about experiences. Difficulties finding familiar words to communicate thoughts and desires hinders communication and fuels frustration. Many individuals do not report such symptoms out of fear of being thought of as mentally unsound. Others are shamed by such symptoms in themselves. 

     Additionally, the very nature of brain injury interferes with the ability to recognize the problem. Frequently, brain injury causes memory impairments and expressive disorders. In real terms, this means that even when the memory survives the words might become elusive. Such impairments can hamper the ability to provide the doctor an accurate symptom picture. 

     Even minor head injury, also known as concussion, can cause substantial difficulties or impairments that can last a lifetime. Whiplash too, can result in the same difficulties as head injury. Such impairments can be helped by rehabilitation, however many individuals are released from treatment without referrals to brain injury rehabilitation, or guidance of any sort. 

     HELP IS AVAILABLE. For many who sustain head injuries, the effects last for a few days or weeks. When the effects last longer than a few months medical, legal or rehabilitation services might be advisable. Whether the need is for expert professional help or knowledgeable self-help headinjury.com can empower you navigate the mysterious landscape of brain injury.  Go to the menu above for additional resources, or call for your personalized consultation, 206-621-8558

Adapted with permission  from: "Don't Get Mad Get Powerful, A Manual for building Advocacy Skills," MI P&A 
Rimel, R.W., RN, NP, Giordani, Bruno, M.A., Barth, J.T., Boll, Thomas, PhD, & Jane, J., MD, PhD, Disability Caused By Minor Head Injury, Neurosurgery, 1981; Vol. 9, Number 3:221-227
Lezak, Muriel, Ph.D., Neuropsychological Assessment, Oxford University Press, 1983. 
Fisher, Jerid, Ph.D., Cognitive and Behavioral Consequences of Closed Head Injury. Seminars in Neurology, Vol. 5, Number 3, September 1985. 
Hooper, Judith & Teresi, Dick, The 3-pound Universe.  Dell Publishing Co., NY 1986. 
Kay, Thomas, Ph.D., "Minor Head Injury: An Introduction for Professionals."   U.S. Dept. of Education, 1986.
Packard, Russell C., M.D., "WS6: Mild Head Injury." Association for Applied Psychophysiology and Biofeedback, 1993. 
Galski, Thomas, Ph.D., and Carnevale, George, P.D., "Proving Cognitive and Behavioral Brain Injuries." Trial Magazine, September 1996.
Kelly, P. James, M.D., and Rosenberg, Jay H., M.D., Diagnosis and Management of Concussion in Sports, Neurology 1997; 48:575-580 
Wrightson and Gronwall, Mild Head Injury,  Oxford University Press, 1999
Also see our Noteworthy Publications page
Brain Injury Resource Center 
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