Brain Injury
What is Acquired Brain Injury (ABI):
ABI is a broad term that describes a vast array of injuries that occur to the brain at any
point after birth. An acquired brain injury is an injury to the brain, which is not
hereditary, congenital, degenerative, or induced by birth trauma.  Such injuries can
be caused by stroke, lack of oxygen, blood clot or trauma.

What is Traumatic Brain Injury (TBI):
A traumatic brain injury (TBI) occurs as the result of a blow or jolt to the head or a
penetrating head injury that disrupts the function of the brain. Not all blows or jolts to
the head result in a TBI. The severity of such an injury may range from "mild," a brief
change in mental status or consciousness to "severe," an extended period of
unconsciousness or amnesia after the injury.  The leading causes of TBI are motor
vehicle accidents, falls, violence and sports injuries. In the United States traumatic
brain injury (TBI) is a leading cause of death for persons under age 45.  A TBI can
result in short or long-term problems with independent function.  

Types of Open Head Injuries:
The following are terms used to describe types of skull fractures that can occur with
open head injuries:

Depressed Skull Fracture - Broken piece of skull bone moves towards the brain.

Compound Skull Fracture - The scalp is cut and the skull is fractured

Basilar Skull Fracture - The skull fracture is located at the base of the skull (neck
area) and may include the opening at the base of the skull.  It Can cause damage to
the nerves and blood vessels that pass through the opening at the base of the skull.

Battle's Sign - The skull fracture is located at the ear's petrous bone.  This produces
large "black and blue mark" looking areas below the ear, on the jaw and neck.  It may
include damage to the nerve for hearing.  Blood or cerebral spinal fluid may leak out
of the ear. This is termed "CSF Oterrhea".

Raccoon Eyes - The skull fracture is located in the anterior cranial fossa.  This
produces "black and blue" mark looking areas around the eyes.  Cerebral spinal
fluid may leak into the sinuses. This is termed "CSF Rhinorrhea".  Nerve damage for
the sense of smell or eye functions may occur.

Diastatic Skull Fracture - The skull of infants and children are not completely solid
until they grow older.  The skull is composed of jigsaw-like segments (cranial
fissures) which are connected together by cranial sutures. Skull fractures that
separate the cranial sutures in children prior to the closing of the cranial fissures are
termed "diastatic skull fractures".

Cribiform Plate Fracture - The cribiform plate is a thin structure located behind the
nose area.  If the cribiform plate is fractured, cerebral spinal fluid can leak from the
brain area out the nose.

Closed Head Injury
When a person receives an impact to the head from an outside force, but the skull
does not fracture this is termed a "closed head injury".  With a closed head injury,
when the brain swells, the brain has no place to expand. This can cause an increase
in intra cranial pressure (the pressure within the skull).  If the brain swells and has
no place to expand, this can cause brain tissues to compress, causing further injury.
As the brain swells, it may expand through any available opening in the skull,
including the eye sockets. When the brain expands through the eye sockets, it can
compress and impair the functions of the eye nerves.
The complete diagnosis of a brain injury is made with a physical examination and
diagnostic tests.  During the examination, the physician obtains a complete medical
history and inquires as to how the injury occurred.  Diagnostic tests may include:

  • X-ray - A picture that shows if bones are broken or fractured.
  • Angiogram - A test to look at the blood vessels in the brain.
  • Computed Tomography Scan (CT or CAT scan) - A specialized type of   x-ray
    that measures the density of brain or other internal organs.  It generates an
    image of the organs.  

  • Electroencephalogram (EEG) - Measures the electrical activity in the brain,
    which is produced by the activity of the nerve cells.  It can be used to check for
    the presence of seizures or decreased activity in the brain.
  • Electrocardiogram (EKG) - Used to assess the function and electrical activity
    of the heart.
  • ICP Monitor - Measures intra cranial pressure inside the brain by placing a
    narrow tube through a small hole in the brain.
  • Neuroimaging - Tests that visually show the activity of the brain during various
    tasks.  These studies may include single photon emission computerized
    tomography (SPECT), position emission tomography (PET), and MRI.
  • Magnetic Resonance Imaging (MRI) - A diagnostic procedure that uses a
    combination of large magnets, radio frequencies, and a computer to produce
    detailed images of organs and structures within the body, including the brain.
Living with a Brain Injury:
The long-term or permanent results of brain injury may require post-injury and
possibly life-long rehabilitation. A person with a brain injury may experience cognitive
and personality changes. Cognitive impairments, memory problems, and changes
in executive functioning are common after a brain injury. It is common for patients
with a brain injury to have difficulties with problem-solving.  

Cognitive impairments often affect the ability to do normal daily activities, such as
bathing, dressing, eating, working, learning and money management.  
The Rancho
Los Amigos Scale
is often used to evaluate deficits in cognitive level.  

Rancho Level       Clinical Correlate
I                                No Response
II                               Generalized response
III                              Localized response
IV                              Confused-agitated
V                               Confused-inappropriate
VI                              Confused-appropriate
VII                             Automatic-inappropriate
VIII                            Purposeful and appropriate

It is often difficult and unsafe for patients with a brain injury to live on their own and
may require supervision for safety reasons.  Memory is usually one of the first
problems people experience after a head injury, and it is one of the last of the
cognitive functions to return.  A log book or memory book may be helpful in
compensating for deficits in memory.  

Executive Functioning is the mental capacity to plan, initiate and direct a person's
own activities.  

There may be impaired speech or difficulty finding and using the right words or
phrases.  It may be difficult to understand the speech of a person with a brain injury if
there is weakness in facial muscles, which can cause slurred or halted speech.  The
individual may speak in a flat tone without any tone or inflections (
prosody).  Difficulty
naming objects is often seen even in the more mild brain injuries.  Communication
problems may be receptive or expressive in nature.  

Behavioral changes are also common after a brain injury.  The individual may
become easily confused or frustrated.  They may be unable to control verbal and
physical aggression.  One of the common symptoms of traumatic brain injury is that
disinhibition.   A person suffering from TBI disinhibition is more likely to "speak his
mind" and say socially inappropriate things where a normal person might think them
but have the sense not to say them. The other aspect of disinhibition is that it can
also lead to addictions to drugs and alcohol.

Some individuals become depressed and avoid social interactions with other
people.  Intimacy may be difficult for a person after a brain injury.  It may be more
difficult for the individual to establish and maintain relationships.  

Common side effects of a brain injury include:
  • Physical or medical changes -  headaches, seizures, and changes in
  • Motor Changes - loss of bowel or bladder control, coordination or balance,
    weakness and fatigue.
  • Vision Problems - Weak eye muscles, double or blurred vision, light
    sensitivity.  These symptoms are often one of the last to be treated and often
    escapes detection.
  • Hearing Problems - decreased hearing or deafness and tinnitus (ringing).
  • Touch - Musculoskeletal pain, dizziness or headaches
  • Smell - Loss of smell (anosmia)
  • Certain psychiatric disorders are more likely to develop if damage changes
    the chemical composition of the brain.

Although brain injuries are known for causing extreme stressors in family and
interpersonal relationships, it is extremely important for friends and family of a
person with a brain injury to be an active part in the
rehabilitation and recovery
process.  Often they have a more accurate input as to the changes in the individual.  
A person with a brain injury may be unaware or in denial as to the extent of their
impairment.  They may be unable to generalize situations and may even resist

Neuropsychologist may be consulted to evaluate the extent of any deficits.
Neuropsychologists use tests to localize dysfunction to specific areas of the brain.

There will be many decisions that need to be made, including, where will the
individual live, home care needs, adaptations for safety and mobility, transportation
needs, locating specialists and or recreational agencies.  Education is an important
aspect of rehabilitation especially for the person who will retain guardianship or
provide care for the individual.  A
case manager may be chosen to help with planning
and implementing care.  
Many severe head injuries could be                 
prevented by wearing protective helmets
during certain sports, or when riding a bike or
motorcycle. Seat belts and airbags can
prevent many head injuries that result from
car accidents. Appropriate protective
headgear always should be worn on the job
where head injuries are a possibility.
Functions of the brain:
The human brain weighs approximately three pounds and sits in the skull for
protection.  The brain is responsible for controlling all voluntary functions such as
walking, talking and eating.  It also controls functions that occur naturally, like
breathing, circulation and the five senses.  It is responsible for more complex
activities, such as, thinking, reading, remembering and learning.

Temporal Lobes: Located at
the side of head above the
ears and are involved in
auditory processing.
Parietal Lobe: Located near the back and top of the head. The parietal lobe
integrates sensory information

Occipital Lobes: Located most posterior, at the back of the head.  This area is the
visual processing center.

Cerebellum: Located at the base of the skull.   A region of the brain that plays an
important role in the integration of sensory perception and motor output.

Brain Stem: Located deep within the brain.  Information related from the body to the
cerebrum and cerebellum and vice versa, must traverse the brain stem.
Source: Brain Injury Association of America
Medical Social Work
Rehabilitation Management, LLC
Medical Social Work Rehabilitation
Management, LLC.
32 Farmington Rd.
Livonia, MI 48152
Ph: 734-513-4100
Fax: 734-513-0900