About Brain Injury
Acquired Brain Injury is a complex disability that can happen to anyone regardless of ethnicity, age, gender or social status.
In Australia, around 1 in 45 Australians live with an Acquired Brain Injury, which causes limitations in their day-to-day lives. Of those living with ABI, three quarters are under 65.
Common effects of Acquired brain injury include poor memory and concentration, emotional changes, headaches and fatigue.
The Invisible Disability
Acquired Brain Injury is a common but hidden disability in the community. For this reason it is often named “the invisible disability,” as the nature and impacts of brain injury are neither well understood nor recognised. The sometimes subtle cognitive, behavioral and emotional changes that can come with acquired brain injury are often not recognised by those who do not have knowledge of ABI. Instead there is potential for the effects to be mistaken for a character flaw, drunkenness or ‘other condition,’ leading to inappropriate treatment or exclusion.Common Misconceptions
Common confusion and misconceptions include mistaking acquired brain injury for an intellectual disorder or mental illness. Acquired brain injury is not to be confused with an intellectual disability. An intellectual disability is a congenital condition, which affects global/overall intellectual functioning. A person with ABI may retain their intellect; however have difficulty with specific mental abilities such as memory, concentration or planning. This means a person will require different treatments and have different support needs, depending on their condition.What is acquired brain injury?
The term acquired brain injury (ABI) refers to all forms of damage to the brain after birth. This includes traumatic brain injury and non-traumatic causes of brain injury. Non- traumatic brain injuries arise from conditions such as brain tumour, meningitis, encephalitis, stroke and hypoxia. Additionally, brain damage may be an outcome of long-term alcohol or substance abuse.
Traumatic brain injury (TBI) is an acquired brain injury caused by a blow to the head or by the head being forced to move rapidly forward or backward, usually with some loss of consciousness. This may be the result of a motor vehicle accident, fall, and assault or sporting accident.
• 22,710 people were hospitalised for a traumatic brain injury in Australia between 2004-05 [1].
Effects
The brain is the control centre of all our major areas of functioning, including emotional, sensory, cognitive and physical. For this reason damage can produce a wide array of effects, which make it a complex and not easily categorised disability.People with a brain injury often fall into multiple disability groups. Disability group include disability related to physical impairment, sensory impairment, psychiatric, impairment and or cognitive impairments. According to an Australian Institute of Health and Welfare (2007) report most people with an ABI reported having 2, 3 or 4 areas of limitation, with 3 the most common [2].
There are five areas in which people with ABI may experience short and long term changes:
- Medical difficulties e.g. difficulty swallowing, chronic pain, headaches, epilepsy, incontinence
- Changes in physical and sensory abilities e.g. balance and coordination, fatigue, changes in vision, hearing
- Changes in the ability to think and learn (cognition) e.g. memory deficits, poor attention, problem solving, concentration and planning.
- Changes in behaviour and personality (psychological) e.g. irritability, impulsivity, mood changes, loss of emotional control and disinhibition
- Communication difficulties e.g. speech impairment, excessive talking.
As acquired brain injury is a complex disability no two people will experience exactly the same effects. Depending on the location, severity (mild to severe) and mechanism of damage (e.g. whether through brain tumour or encephalitis) people will experience their own combination of effects. People also come with their own set of strengths, pre-injury lifestyles and personalities, which all impact on how an Acquired Brain Injury is managed and experienced.
While the outcome and effects of the injury are heavily influenced by the nature and severity of the injury itself, appropriate treatment, rehabilitation and support play a vital role in determining the level of recovery. With the right support people can continue to recover and improve for many years after acquiring a brain injury.
Issues associated with ABI
An Acquired Brain Injury can introduce many changes to a person’s life and their family’s. A person may be at the height of responsibility in their lives, trying to raise a family, maintain a house, earn a living and build a romantic relationship. An Acquired Brain Injury can bring dramatic or subtle changes to these areas and a person’s role or level of participation in them. Following a brain injury a person may require assistance with initiating and performing personal care, domestic tasks, and help with pursuing social activities.
The challenges faced by a person with acquired brain injury will often depend on the stage of recovery. Three broad stages can be described:
- Immediately following an injury, while in hospital, the challenge is surviving and healing.
- In rehabilitation the challenges are recovering lost abilities and working on new skills, while developing an understanding of the nature of their injury.
- Back in the community the focus is adjusting and re-developing a quality of life despite any continued effects of brain injury.
- After a brain injury, an individual can have up to a four-in-five likelihood of developing a diagnosable mental illness [3].
- Major depression occurs in approximately 27% of TBI patients. There is a 1.5 times higher lifetime chance of depression in TBI compared with non head-injured patients [3].
Depression can occur as a psychological reaction to the injury and frustration with changes in mental and physical abilities. Feelings of loss and grief are often associated with the changes introduced by acquired brain injury. Other associated factors include negative changes in lifestyle such as reduced social circle, isolation and lack of meaningful activities.
The impact on the family
Family and friends are a vital source of support for a person with an acquired brain injury. During the hospital phase, key family members may play multiple roles including advocate, guardian, and nurse. Feelings during these times may fluctuate from overwhelmed and stressed to hope and joy in the progresses.
Back in the home family, partners and friends may be required to cope with personality and behavioural changes that can arise following acquired brain injury. This can put strain on family relationships as the family try to learn ways to assist their loved one. While supporting a loved one, it is important that personal well-being is regularly checked on and given adequate attention. This way better supported can be provided to a loved one in the long run, by lowering stress levels and feelings of burden. Creating strong connections with other carers, can provide much needed social and emotional support and understanding.
Words of Hope
People with a brain injury and their family may come across negative attitudes or opinions surrounding the level of recovery that can be made following acquired brain injury. However it is important to not lose that hope. Hope is what helps people strive toward greater recovery and achievements. With the right support people with a brain injury can continue to improve many years beyond the common two year cut off and families can continue to strengthen.
Tips on Recovery:
- Celebrate every success; even seemingly small improvements can have a big impact
- Break tasks down and achieve the task step by step
- The support of family, friends and a wider network is vital
- Focus on what you can do, instead of what you can’t
- Focus on your strengths
- Stay positive and use humour
- Family should be involved in the rehabilitation process
- The person with an acquired brain injury should be involved in developing their own recovery/compensatory strategies
See the Synapse magazine , The Facts or fact sheets for more information on ABI.
References
[1] Australian Institute of Health and Welfare (2008). Hospital separations due to traumatic brain injury, Australia 2004-05. Retrieved June 1, 2009, from http://www.aihw.gov.au/publications/index.cfm/title/10505
[2] Australian Institute of Health and Welfare (AIHW) (2007) Disability in Australia: Acquired Brain Injury (Bulletin no. 55). Retrieved June 1, 2009, from http://www.aihw.gov.au/publications/index.cfm/title/10492
[3] Brain Injury Australia Inc. (2007). Complexities of co-morbidity (acquired brain injury and mental illness) and the intersection between the health and community services system Health Paper.’ Retrieved June 1, 2009, from http://www.bia.net.au/publications.htm
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