An acquired brain injury (ABI) is damage to the brain which occurs after birth.¹ A traumatic brain injury is caused by an outside blow or jolt to the head, often as a result of a motor vehicle accident or a fall. This blow or jolt can cause your brain to move within the skull. This movement causes bruising or swelling of the brain. It can also cause long, thin nerve fibres to snap or break and blood vessels to tear and bleed. Just like anywhere else in the body, the bruising and swelling in the brain will resolve with time. Nerves can recover and blood vessels will heal like any other cut. However, the bruising, swelling, snapped nerves and broken or torn blood vessels can cause damage. An acquired brain injury can cause problems with how a person moves, thinks, feels and behaves.¹

A non-traumatic brain injury can result from a stroke, aneurysm, tumor, anoxia or an infection in the brain. When a stroke occurs, blood flow to a part of the brain is interrupted or decreased when a blood vessel is blocked or weakened. With an aneurysm the wall of an artery weakens and bulges out. If it breaks, there is bleeding in the brain, which causes a brain injury. An anoxic injury occurs when the brain doesn't receive enough oxygen, such as when the heart stops during a cardiac arrest. Encephalitis causes swelling in the brain. It is usually the result of an infection.¹

The brain is very complex and every injury to the head is a little different. Some symptoms of a head injury will show up right away, others may show up days or weeks after the original blow to the head.¹ Brain injuries are categorized into mild, moderate or severe.

Concussions are a type of mild traumatic brain injury (MTBI). A simple definition of traumatic brain injury is "an injury that alters the way the brain functions." Many people who are in an accident don't realize they may have sustained a mild brain injury or concussion. They may or may not have lost consciousness.¹ A concussion does not require a direct hit to the head.² Common symptoms include:

• Headache¹
• Fatigue¹
• Sleep difficulties¹
• Decreased concentration, memory and executive functions¹
• New depression or anxiety¹
• Dizziness²
• Nausea/vomiting²
• Disorientation/confusion²

The medical field does not have one way to diagnose a concussion. They may need more than one tool to tell patients if they have a concussion. Tools include:

• Exam from a doctor or neuropsychologist
• Neuropsychological testing
• Other tests such as MRI, CT, or PET scans²

Full recovery should occur in about 3 months. The Ontario Neurotrauma Foundation estimates 73-88% of those with a mild ABI can return to work within a year of their injury.²

Brain injuries are considered moderate when there is a loss of consciousness ranging between 15 minutes but less than 24 hours. The person may have neurological changes in brain that are evident on an EEG or CT scan. The person will typically experience:

• Fatigue
• Headache, dizziness
• Loss of memory for the events just prior to and just after the accident
• Difficulties with thinking, attention, concentration
• Difficulties with word finding
• Anxiety and depression
• Often irritable (this is a behavioural change)¹

A Severe Brain Injury represents someone who is in a coma (unconscious) for a period of greater than 24 hours.¹

Cognition is a person's ability to think and make sense of what is going on around them. A brain injury survivor may have problems with:

• Remembering things
• Concentrating or sustaining attention
• Organizing every day activities
• Multi-tasking or doing more than one thing at a time
• Making decisions
• Solving problems
• Initiating activities
• Sequencing activities
• Finding the right word or phrase when speaking
• Understanding what is said or what they have read
• Writing words¹

The brain injury survivor may feel:

• Anxious about things
• Sad or depressed
• "Up and down" emotionally, or have mood swings
• More impulsive or may act without really thinking
• More easily frustrated (irritable) or angry
• Not able to socialize as easily as prior to injury
• More self-centred or lack sensitivity to others
• Lack interest in both past activities or what is going on right now¹
• Post-traumatic stress disorder
• Grieving
• Apathy²

A brain injury survivor may also experience problems with:

• Poor balance, vertigo, dizziness² (I needed to work with a vestibular physiotherapist in order to address these issues.)
• Changes in vision: blurred or double¹
• Difficulty judging how far away things really are¹
• Increased sensitivity to light or sound¹
• Decreased sense of smell or taste¹
• Easily tired, wanting to sleep for long periods¹
• Changes in ability to regulate body temperature¹
• Headache¹
• Tinnitus¹
• Seizure¹
• Sexual problems¹
• Sleep disorders²
• Autonomic nervous system dysfunction³

A brain injury survivor may also experience problems with:

• Sleeping pattern may be disrupted
• Falling asleep
• Sleeping longer or shorter than usual
• Waking during night more often
• Waking up in morning feeling unrefreshed or feeling like you didn't sleep at all¹

A brain injury survivor may also experience problems with a feeling of one or both of two types of fatigue:

• Physical: after an injury, the body needs extra rest for the injury to heal
• Mental: the brain gets tired more easily. This fatigue can make it harder for the survivor to think and learn.

Survivors are often easily over-stimulated by noise and activity that wouldn't bother most of us. This leads the injured brain to shut down when overloaded. The survivor may not realize or appreciate when they are tired or overwhelmed. They may need encouragement to have a nap or quiet time during the day. They may need encouragement to practice good sleep hygiene.¹

The Brain begins to heal when the swelling begins to reduce. Neurons are cells in the brain that send the brain's messages to other parts of the brain and body. When the swelling subsides, the neurons can begin to recover their function. If neurons are badly damaged, the brain needs to find other ways to take over those functions by making new connection routes. Recovery is the most rapid during the first months after a brain injury. This is when the building blocks or foundation for further improvements are established. Further recovery can occur and may take the form of "fine tuning" these foundations. Sometimes survivors and family are disappointed when the rapid recovery slows down or stops.¹

There are no proven (i.e. evidence-based) treatments, only guidelines for managing concussion. There is no magic bullet, but there are ways to manage symptoms.²

For Survivors:

• Do what you can.² Having a routine and pacing activities will help the survivor to do as much as they are able¹
• Gradually return to activities such as school, work and recreation (See Guidelines for Return to Play After a Concussion)²
• Increase your time and effort in activities as able without worsening symptoms²
• Controlled aerobic exercise training may be effective in treating symtoms² ("controlled" means stopping when symptoms arise)
• To help the brain make the new connections, the survivor will need to practice activities many times¹
• Self-care is even more important than usual (good diet, exercise, sleep, pacing)²
• Use relaxation/mindfulness meditation² Do an Internet search for "free mindfulness resources". These will be 3-40 minutes long. One study showed decreased cortisol levels in individuals who used mindfulness meditation for 8 weeks.²
• Use psychotherapy²
• Use a notebook/diary to set goals, record activities, and log achievements.² (Usually survivors compare themselves to how they were before their injury rather than focusing on the gains that have been made. A diary/journal is helpful for seeing the progress.)
• Talk to a friend - social relationships are important²
• Many people with a brain injury can do most things they did previously. However, they may have to do it differently than before the injury¹
• Getting help from various sources will help the survivor make the most of their recovery¹

Many different factors influence your recovery, including:

• How severe your head injury was¹
• How healthy you were prior to the head injury¹ (physically & mentally)²
• Whether there have been prior head injuries or concussion¹ (particularly if sustained before the brain has had a chance to heal)²
• Your age at the time of the head injury¹
• Your attitude towards life¹
• The presence of family/friends/meaningful activities¹

There is currently no good evidence to support the alternative therapies (hyperbaric oxygen treatment, drugs, herbal remedies).²

A worse outcome is linked to:

• Pre-injury psychological and/or physical health issues²
• More initial symptoms and psychological distress following injury²
• Deficits in memory and executive functioning²
• Reduced social interaction²
• Loss of consciousness²
• Low mood²
• Poor psychosocial factors (e.g. lack of family support)²
• Poor lifestyle (e.g. poor diet, lack of exercise)²
• Low expectations for recovery²

For Family: Patience needs to become your new best friend.¹

About 10-15% of individuals who sustain a single concussion experience symptoms beyond the normal recovery period of 3 months.² When symptoms last beyond 3 months it is considered "Post Concussive Syndrome." Those with multiple concussions are more likely to have lasting symptoms and take longer to recover.²