Traumatic Brain Injury

by Dr. Lorin Bradbury

Question: Could you delve into the function of the brain, what occurs after a brain injury, and what could be given and done to enhance recovery?

That is a rather global question, but I will answer the best I can. I am assuming that you are referring to what is called a Traumatic Brain Injury (TBI). A TBI occurs when an external force traumatically injures the brain.

TBI can be classified based on severity and whether it’s a closed or penetrating head injury. Other factors related to classification of the head injury include where the injury is located and whether it’s localized or diffuse.

Trauma to the brain can be caused by a direct impact or by acceleration. Injury is caused not only at the moment of impact, but by a variety of events that occur in the minutes and days following the injury. These can include changes in cerebral blood flow and the pressure within the skull. Frequently, there is damage to the brain on the opposite side of the impact due to what might be compared to a wave in a bathtub.

It’s difficult to answer your question concerning what occurs, because a TBI can cause a broad spectrum of physical, cognitive, emotional, and behavioral effects. Outcomes are all along the spectrum from complete recovery to permanent disability to death. The prognosis worsens with the severity of injury.

Fortunately, most TBIs are mild and do not cause permanent or long-term disability. However, any TBI has the potential to cause significant, long-lasting disability.

Permanent disability is estimated to occur in 10% of mild injuries, 66% of moderate injuries, and 100% of severe injuries. Although some people with TBI have mild cognitive and social impairments, most mild injuries completely resolve within three weeks, and almost all people with mild TBI are able to live independently and return to the jobs they had before the injury.

Amazingly, over 90% of people with moderate TBI are able to live independently, though some require assistance in areas such as employment and managing their financials.

Factors that make for a poorer prognosis include use of alcohol and/or illicit drugs, and advanced age at the time of the injury. Also, if the injury occurs before the age of 2, the prognosis is poorer.

As to what can be done to enhance recovery, that will depend on the type and severity of the injury. Rehabilitation is always a part of the treatment plan. It aims to improve independent function at home and in society, and to help the injured person to adapt to his or her disabilities.

A multidisciplinary approach to treatment is key to a more promising outcome. Community-based rehabilitation is required for a large percentage of TBI patients, including vocational rehabilitation. As with other areas of modern medicine, treatment with medication can help to manage and alleviate psychiatric or behavioral problems.

Lorin L. Bradbury, Ph.D. is a licensed psychologist in private practice in Bethel. For appointments, he can be reached at 543-3266. If you have questions that you would like Dr. Bradbury to answer in the Delta Discovery, please send them to The Delta Discovery, P.O. Box 1028, Bethel, AK 99559, or e-mail them to [email protected]

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