You are on Focus Physiotherapy’s web page on traumatic brain injuries following car accidents.
Focus Physiotherapy is a physiotherapist owned group of clinics. As physiotherapists we are very proud of this fact, and we think it makes us better. We hold ourselves up to higher standards, and we care about your recovery. We want you to get better.
Our goal is caring for you and providing excellent physiotherapy and rehabilitation for all your needs. We educate both the patient and the family on all aspects of care and our goal in this section is to provide you with the information you need to begin your journey towards recovery from a brain injury.
A Head injury is an injury to the scalp, skull, or brain.
The most important consequence of head trauma is traumatic brain injury. Head injury may occur either as a closed head injury, such as the head hitting a car’s windshield; or as a penetrating head injury, as when a bullet pierces the skull. Both may cause damage that ranges from mild to profound. Very severe injury can be fatal because of profound brain damage.
External trauma to the head is capable of damaging the brain, even if there is no external evidence of damage. More serious injuries can cause skull fracture, blood clots between the skull and the brain, or bruising and tearing of the brain tissue itself.
Injuries to the head can be caused by car accidents, sports injuries , falls, workplace accidents, assaults, or bullets. Most people have had some type of head injury at least once in their lives, but rarely do they require a hospital visit.
Brain injury is most likely to occur in males between ages 15 and 24, usually as a result of car and motorcycle accidents. About 70 percent of all accidental deaths are due to head injuries, as are most of the disabilities that occur after trauma. Among children and infants, head injury is the most common cause of death and disability.
Causes and symptoms
A head injury may cause damage both from the direct physical injury to the brain and from secondary factors, such as lack of oxygen, brain swelling, and disturbance of blood flow. Both closed and penetrating head injuries can cause swirling movements throughout the brain, tearing nerve fibers and causing widespread bleeding or a blood clot in or around the brain. Swelling may raise pressure within the skull (intracranial pressure) and may block the flow of oxygen to the brain.
Head trauma may cause a concussion , in which there is a brief loss of consciousness without visible structural damage to the brain. In addition to loss of consciousness, initial symptoms of brain injury may include:
- memory loss and confusion
- partial paralysis or numbness
After a head injury, there may be a period of impaired consciousness followed by a period of confusion and impaired memory with disorientation and a breakdown in the ability to store and retrieve new information. Others experience temporary amnesia following head injury that begins with memory loss over a period of weeks, months, or years before the injury (retrograde amnesia). As a person recovers, memory slowly returns. Post-traumatic amnesia refers to loss of memory for events during and after the accident.
Epilepsy occurs in 2–5 percent of those who have had a head injury; it is much more common in people who have had severe or penetrating injuries. Most cases of epilepsy appear right after the accident or within the first year and become less likely with increased time following the accident.
Closed head injury
Closed head injury refers to brain injury without any penetrating injury to the brain. It may be the result of a direct blow to the head; of the moving head being rapidly stopped, such as when a person’s head hits a windshield in a car accident; or by the sudden deceleration of the head without its striking another object. The kind of injury the brain receives in a closed head injury is determined by whether the head was unrestrained upon impact and the direction, force, and velocity of the blow. If the head is resting on impact, the maximum damage will be found at the impact site. A moving head will cause a contrecoup injury where the brain damage occurs on the side opposite the point of impact, as a result of the brain slamming into that side of the skull. A closed head injury also may occur without the head being struck, such as when a person experiences whiplash. This type of injury occurs because the brain is of a different density than the skull and can be injured when delicate brain tissues hit against the rough, jagged inner surface of the skull.
Penetrating head injury
If the skull is fractured, bone fragments may be driven into the brain. Any object that penetrates the skull may implant foreign material and dirt into the brain, leading to an infection.
A skull fracture is a medical emergency that must be treated promptly to prevent possible brain damage. Such an injury may be obvious if blood or bone fragments are visible, but it is possible for a fracture to have occurred without any apparent damage. A skull fracture should be suspected if there is:
- blood or clear fluid leaking from the nose or ears
- unequal pupil size
- bruises or discoloration around the eyes or behind the ears
- swelling or depression of part of the head
Bleeding (hemorrhage) inside the skull may accompany a head injury and cause additional damage to the brain. A blood clot (hematoma) may occur if a blood vessel between the skull and the brain ruptures; when the blood leaks out and forms a clot, it can press against brain tissue, causing symptoms from a few hours to a few weeks after the injury. If the clot is located between the bones of the skull and the covering of the brain (dura), it is called an epidural hematoma. If the clot is between the dura and the brain tissue itself, the condition is called a subdural hematoma . In other cases, bleeding may occur deeper inside the brain. This condition is called intracerebral hemorrhage or intracerebral contusion (from the word for bruising).
In any case, if the blood flow is not stopped, it can lead to unconsciousness and death. The symptoms of bleeding within the skull include:
- nausea and vomiting
- loss of consciousness
- unequal pupil size
If the head injury is mild, there may be no symptoms other than a slight headache. There also may be confusion, dizziness, and blurred vision. While the head injury may seem to have been quite mild, in many cases symptoms persist for days or weeks. Up to 60 percent of persons who sustain a mild brain injury continue to experience a range of symptoms called postconcussion syndrome as long as six months or a year after the injury.
The symptoms of postconcussion syndrome can result in a puzzling interplay of behavioral, cognitive, and emotional complaints that can be difficult to diagnose, including the following:
- mental confusion
- behavior changes
- memory loss
- cognitive deficits
- emotional outbursts
The extent of damage in a severe head injury can be assessed with computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, electroencephalograms (EEG), and routine neurological and neuropsychological evaluations.
Doctors use the Glasgow Coma Scale to evaluate the extent of brain damage based on observing a person’s ability to open his or her eyes, respond verbally, and respond to stimulation by moving (motor response). People can score from three to 15 points on this scale. People who score below eight when they are admitted usually have suffered a severe brain injury and will need rehabilitative therapy as they recover. In general, higher scores on the Glasgow Coma Scale indicate less severe brain injury and a better prognosis for recovery.
After initial emergency treatment, a team of specialists may be needed to evaluate and treat the problems that result. A penetrating wound may require surgery. Those with severe injuries or with a deteriorating level of consciousness may be kept hospitalized for observation. If there is bleeding inside the skull, the blood may need to be surgically drained; if a clot has formed, it may need to be removed. Severe skull fractures also require surgery. Supportive care and specific treatments may be required if the person experiences further complications. People who experience seizures, for example, may be given anticonvulsant drugs, and people who develop fluid on the brain ( hydrocephalus ) may have a shunt inserted to drain the fluid.
In the event of long-term disability as a result of head injury, Focus Physiotherapy is capable of providing a variety of treatment programs once the period of hospitalization has passed such as short term interim treatments and long-term rehabilitation.
Prompt, proper diagnosis and treatment can help alleviate some of the problems that may develop after a head injury. However, it usually is difficult to predict the outcome of a brain injury; a person’s prognosis may not be known for many months or even years.
The outlook for someone with a minor head injury generally is good, although recovery may be delayed, and symptoms such as headache, dizziness, and cognitive problems can persist for up to a year or longer after an accident. This can limit a person’s ability to work and cause strain in personal relationships.
Serious head injuries can be devastating, producing permanent mental and physical disability. Epileptic seizures may occur after a severe head injury, especially a penetrating brain injury, a severe skull fracture, or a serious brain hemorrhage. Recovery from a severe head injury can be very slow, and it may take five years or longer to heal completely. Risk factors associated with an increased likelihood of memory problems or seizures after head injury include age, length and depth of coma, duration of post-traumatic and retrograde amnesia, presence of focal brain injuries, and initial Glasgow Coma Scale score.
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