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A
traumatic brain, or closed head injury, occurs approximately
once every 16 seconds and annu ally
effects over 700,000 individuals in North America. By definition,
a CHI is any injury caused by a blunt blow to the head,
upon which the head was accelerating and suddenly stopped. Most
commonly occurring in motor vehicle accidents, this injury rarely
produces any focal or central lesions.
| The most common symptom of head injury is loss of
consciousness after a blow to the head for even a brief
period of time. |
Instead, the damage is spread over the surface of the brain
due to the acceleration, rotation, compression and expansion
of the brain within the skull after impact. As a result, many
parts of the brain are effected. Closed head injuries are not
always caused by something as serious as a motor vehicle accident.
In many cases they can be caused by every day activities like
falling off roller blades, jungle gyms, or even street corner
curbs. Regardless of the cause of head injury, an array of unique
changes can take place in behavior and language.
HOW
WILL I KNOW IF I HAVE A HEAD INJURY?
The
most common symptom of head injury is loss of consciousness
after a blow to the head for even a brief period of time.
Confusion regarding the time, date, or location of accident
are also indications of brain trauma. Other salient factors
are presence of a coma, or difficulty remembering new information
after waking up from a coma.
The
length of unconsciousness experienced by an individual has
been used to characterize the severity of head injury. If
the unconsciousness lasts less than twenty minutes, and post-traumatic
amnesia less than an hour, the injury is considered mild.
If a person is unconscious for at least a day and post-traumatic
amnesia lasts more than twenty-four hours, it is considered
severe. More symptoms include tremors, spastic muscle movements,
difficulty swallowing and slurred speech.
HOW
MIGHT A HEAD INJURY EFFECT MY BODY?
Changes
after a head injury may be physical, cognitive and/or behavioral.
Physically, an individual may experience seizures or a decrease
in speed and coordination of muscle movements. Muscles may
also move with excessive or inadequate tension, causing tremors
or spasticity. Behaviorally, an individual may become impulsive,
acting without thought of consequence. Agitation, irritability
and egocentrism may also be noticed, as well as depression
to the point of threats of suicide.
Cognitively,
an individual may experience changes in the following six
areas:
- Attention,
or the ability to hold thoughts and events in consciousness.
The individual may become easily distracted. The ability
to concentrate and focus on one thing at a time lessens
noticeably. Language skills suffer due to decreased ability
to understand what is heard and read. Expressive language
is often inappropriate and confused, and ability to maintain
topic is minimal.
- Perception,
or the ability to recognize features and relationships
among those features. Errors in perception may yield weakness
in judgement based on what is seen or heard, causing spatial
organization to be difficult. Impaired perception may cause
an individual to focus on one part of an object, or to neglect
a portion of his visual field. Evidence of this may be seen
at dinner when an individual has an entire plate of food
but only eats the food on the left half until the plate
is rotated.
- Memory
and Learning, which involves the storage and
retrieval of information. Impairments in memory and learning
will splinter to all aspects of communication, but specifically,
a decrease in ability to follow multi-step directions is
seen. Reading comprehension and spelling are challenged,
and patients have difficulty retrieving words to express
feelings. When these words are found, language is typically
fragmented and non-specific. Arranging sequential facts
creates obstacles, and there is little or no ability to
express thoughts in a timely manner.
- Organization
or the analyzing, classifying, integrating and comparing
of information. If stricken with a head injury, an individual
may display poor problem solving, social judgement, or goal
maintenance. Self-direction and confidence may be poor,
as may be the ability to manage tasks and time. Conversational
skills suffer and the ability to discern main ideas into
themes becomes difficult.
- Reasoning,
or the ability to draw conclusions from past experience,
may be one of the more obvious effects of a CHI. Actions
and thoughts become concrete, causing impulsive and reactionary
behavior. These individuals may be swayed easily, unable
to understand consequences of their behavior, or demonstrate
poor social judgement. Communication is impaired by socially
inappropriate comments, and the understanding or expression
of abstract concepts becomes difficult. Poor reasoning may
effect the ability to persuade people through language,
understand humor, or follow complex conversation.
- Problem
solving and judgement which involves identification
of goals, relevance of information, exploration of solutions,
and the ability to select appropriate options. A poor skill
set in this area causes inflexible thinking and difficulty
using compensatory strategies. Behavior is often impulsive
and decisions are made in a "trial and error"
format.
Although
the physical and behavioral effects of a head injury are serious,
cognitive deficits seem to challenge family and friends more
than the patients themselves.
Especially
in cases of mild to moderate head injury where physical symptoms
may be minimal if present at all, individuals often appear
"normal." Victims of head injury may speak clearly,
walk without assistance, and drive cars. With cognitive impairments
practically invisible to strangers, family members become
extremely concerned for their loved ones’ safety. One
of the most important things to begin accomplishing in speech
therapy is increasing the patient’s awareness of his
deficits. By orienting individuals to their recent changes
in cognitive function, comprehensive therapy programs create
coping mechanisms for everyone involved.
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