The widespread impact of brain injury of all types is one of the biggest, and most under-acknowledged issues of our time.
The brain is extremely delicate and can be injured and affected much more easily than most people realize. It does NOT take much to cause damage that leads to all kinds of subtle and not-so-subtle behavioral problems.
Brain injuries not only affect the injured, they profoundly affect families, friends, coworkers, relationships, jobs, finances, and society. The collective impact of brain injury on society as a whole is beyond measure and vastly under-acknowledged.
Each year millions of people world wide are seriously brain injured in vehicles, on the job, and other accidents. Serious brain injuries end up in hospitals and are therefore counted and acknowledged as brain injuries. These are the tip-of-the-tip of the brain injury iceberg.
Each year a far greater number of people experience what may seem to be relatively minor incidents, the kind that do NOT end up in hospitals. A knock to the side of the head from a fall. A bang on the head playing sports. A shake of frustration to a baby because it keeps crying. Going just a little to far with alcohol or drug use. A nagging headache from exposure to carbon monoxide around a poorly vented fireplace.
Even a mild impact or incident can easily cause a brain injury, especially if it is to a region of the head that has previously sustained an impact. Brain injuries can easily compound on themselves. While the person may think they are fine, their brain may well have been injured. This can lead to all kinds of behavioral and cognitive issues.
Most people with mild brain injury are not aware that they are living with a brain injury AND that it is affecting them AND the people around them. For each brain injury that is acknowledged there are likely hundreds, perhaps thousands of brain injuries that go unacknowledged. This is the part of the brain injury iceberg that is beneath the water.
Each year worldwide, millions of new brain injuries are added to the already millions living with brain injuries. Year after year the number builds. The number of people living with, and suffering from brain injury is not known. Nobody knows how deep the brain injury iceberg goes - but it is MASSIVE.
Areas of the brain, their function, and how they may be affected
Cerebral Cortex
Frontal Lobe: most anterior, right under the forehead
Functions:
- How we know what we are doing within our environment (consciousness)
- How we initiate activity in response to our environment
- Judgments we make about what occurs in our daily activities
- Controls emotional response
- Controls expressive language
- Assigns meaning to the words we use
- Involves word associations
- Memory for habits and motor activities
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Observed Problems:
- Loss of simple movement of various body parts (paralysis)
- Inability to plan a sequence of complex movements needed to complete multi-step tasks, such as making coffee (sequencing)
- Loss of spontaneity in interacting with others
- Loss of flexibility in thinking
- Persistence of a single thought (preservation)
- Inability to focus on task (attending)
- Mood changes (emotionally labile)
- Changes in social behavior
- Changes in personality
- Difficulty with problem solving
- Inability to express language (Broca's Aphasia)
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Parietal Lobe: near the back and top of the head
Functions:
- Location for visual attention and touch perception
- Goal-directed, voluntary movements
- Manipulation of objects
- Integration of different senses that allows for understanding a single concept
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Observed Problems:
- Inability to attend to more than one object at a time
- Inability to name an object (anomia)
- Inability to locate the words for writing (agraphia)
- Problems with reading (alexia)
- Difficulty with drawing objects
- Difficulty in distinguishing left from right
- Difficulty with doing mathematics (dyscalculia)
- Lack of awareness of certain body parts and/or surrounding space (apraxia) that leads to difficulties in self-care
- Inability to focus visual attention
- Difficulties with eye and hand coordination
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Occipital Lobes: most posterior, at the back of the head
Functions:
Observed Problems:
- Defects in vision (visual field cuts)
- Difficulty with locating objects in environment
- Difficulty with identifying colors (color agnosia)
- Production of hallucinations
- Visual illusions - inaccurately seeing objects
- Word blindness - inability to recognize words
- Difficulty in recognizing drawn objects
- Inability to recognize the movement of an object (movement agnosia)
- Difficulties with reading and writing
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Temporal Lobes: side of head above ears
Functions:
- Hearing ability
- Memory acquisition
- Some visual perceptions
- Categorization of objects
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Observed Problems:
- Difficulty in recognizing faces (prosopagnosia)
- Difficulty in understanding spoken words (wernicke's aphasia)
- Disturbance with selective attention to what we see and hear
- Difficulty with identification of, and verbalization about objects
- Short-term memory loss
- Interference with long-term memory
- Increased or decreased interest in sexual behavior
- Inability to categorize objects (categorization)
- Right lobe damage can cause persistent talking
- Increased aggressive behavior
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Brain Stem: deep in the brain – leads to the spinal cord
Functions:
- Breathing
- Heart Rate
- Swallowing
- Reflexes to seeing and hearing (startle response)
- Controls sweating, blood pressure, digestion, temperature (autonomic nervous system)
- Affects level of alertness
- Ability to sleep
- Sense of balance (vestibular function)
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Observed Problems:
- Decreased vital capacity in breathing, important for speech
- Swallowing food and water (dysphagia)
- Difficulty with organization/perception of the environment
- Problems with balance and movement
- Dizziness and nausea (vertigo)
- Sleeping difficulties (insomnia, sleep apnea)
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Cerebellum: located at the base of the skull
Functions:
- Coordination of voluntary movement
- Balance and equilibrium
- Some memory for reflex motor acts
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Observed Problems:
- Loss of ability to coordinate fine movements
- Inability to reach out and grab objects
- Tremors
- Dizziness (vertigo)
- Slurred Speech (scanning speech)
- Inability to make rapid movements
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When it comes to rehabilitation it is important to appreciate the whole person. Each problem area affects other areas. Often, resolving one problem has a major impact on other problems. For example, re-establishing physical balance and eliminating dizziness can greatly enhance concentration and attention, which then improves cognition and problem solving.
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