The Brain,its Injuriesand their rehabilitationBy: Dora Kukucska (2015)

What is the brain?

▪ The brain is the control centre for all the body’s functions, such as walking, talking, swallowing, breathing, taste, smell, heart rate and so on. It also controls all our thinking functions, our emotions, how we behave and all our intellectual (cognitive) activities, such as how we attend to things, how we perceive and understand our world and its physical surroundings, how we learn and remember and so on.

▪ The brain is a soft, jelly-like centre of the human nervous system. It is completely enclosed in the skull and floats in a protective sea of cerebrospinal fluid. This fluid supports and nourishes the brain and acts as a shock absorber for rapid head movements.

(TRG,2015)

Parts of the brain and their functions

▪ The brain is a bilateral organ that consists of three main parts (Cerebrum, Cerebellum and brain stem).

▪ The cerebrum is composed of 4 cortex (lobes); frontal lobe, parietal lobe, occipital lobe and temporal lobe.

▪ Different parts of the brain perform different functions:

• The largest of the brain structures

• Main site of the “higher cognitive functions” (executive functions)

• Voluntary motor control, inhibition

• Cognition, intelligence, attention, language processing (Broca’s area) and comprehension

• Libido, sense of smell• Skilled movements• Initiative, creative thought • Extremely vulnerable to

damage. Due to its large size it is almost always damaged

• Paralysis• Inability to express language

(aphasia)Most common cognitive changes• Loss of spontaneity in social

situations• Atypical social skills and

personality traits• Problem solving • Planning and organizing

If damaged

Functions

(Kolb & Winshaw, 1990)

• Sense of touch (tactile sensation)

• Appreciation of form through touch (stereognosis)

• Response to internal stimuli (proprioception)

• Integration information from different senses

• Some language and reading functions

• Some visual functions• Integrates information from

the ventral (what) and dorsal (where) visual pathways

• Inability to locate and recognize objects (hemispatial neglect)

• Inability to recognize parts of the body (somatosensory agnosia)

• Disorientation• Lack of coordination• Inability to recognize objects by

touch • Simultaneous extinction• Apraxia

Function

If damaged

(Kandel, Schwartz & Jessel, 1991)

• Vision• Reading• Processes where

objects are• Movement

perception• Visuo-spatial

orientation

• Hallucinations• Blindness• Achromatopsia, Akinetopsia• Synaesthesia• Visual agnosia (including

prosopagnosia)• Alexia• Optic ataxia

Function

If damaged

(Kandel, Schwartz & Jessel, 1991)

• Auditory memories • Some hearing • Visual memories • Some vision pathways

(ventral)• Other memory • Music • Fear • Some language • Some speech • Some behaviour and

emotions • Sense of identity • Recognition• Understanding language

(Wernicke’s area)

• Wernicke’s aphasia• Prosopagnosia• Agnosia• Persistent talking• Long-short term memory loss• Increased/ decreased sexual

behaviour• Aggression• Damage to the left temporal lobe is

associated with verbal memory and processing speech sounds

• Damage to right temporal lobe is associated with deficit in non-verbal memory (faces, facial expressions)

Functions

If damaged

Kolb & Wishaw (1990)

DON’T take it for granted!

▪ Injuries to your brain, skull, or scalp are all types of head injury. A head injury may be mild or severe depending on what caused it. Some injuries produce bleeding within your skull. Others cause damage on the outside of your head. These injuries may be in the form of lacerations, bumps, or bruises.

▪ In the UK every year 1 million people go to hospital as result of brain injury. Out of these:

• 150.000 people will suffer from minor brain injury• 10.000 people will suffer from moderate brain injury• 11.000 people will suffer major brain injury (about 15% will return to work within 5 years)• 4.500 will never return to work and will require full time support for the rest of their lives• 120.000 people are currently suffering from long-term effects of Brain injury

Some stats

Types of Injuries

▪ These mechanisms are the highest causes of brain injury: Open head Injury, Closed Head Injury, Deceleration Injuries, Chemical/Toxic, Hypoxia, Tumors, Infections and Stroke.

Stroke

If blood flow is blocked through a cerebral vascular accident (stroke), cell death in the area deprived of blood will resultIf there is bleeding in or over the brain (haemorrhage or hematoma) because of a tear in an artery or vein, loss of blood flow and injury to the brain tissue by the blood will also result in brain damage.

Symptoms of stoke

▪ The signs and symptoms of a stroke vary from person to person but usually begin suddenly. As different parts of your brain control different parts of your body, your symptoms will depend on the part of your brain affected and the extent of the damage.

▪ Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped.

▪ Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm.

▪ Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake.

▪ Time – it is time to dial 999 immediately if you notice any of these signs or symptoms. (NHS, 2015)

F.A.S.T.

Precursor and symptoms of stroke

Symptoms in the FAST test identify most strokes, but occasionally a stroke can cause different symptoms.

Other symptoms and signs may include:

•complete paralysis of one side of the body •sudden loss or blurring of vision •dizziness •confusion •difficulty understanding what others are saying •problems with balance and co-ordination •difficulty swallowing (dysphagia) •a sudden and very severe headache resulting in a blinding pain unlike anything experienced before •loss of consciousness

(NHS,2015)

A

Stroke facts

▪ Stroke kills twice as many women as breast cancer and more men than prostate and testicular cancer combined a year.

▪ Black people are twice as likely to have a stroke compared to white people.

▪ Black and South Asian people have strokes at a younger age compared to white people.

▪ Stroke is the largest cause of complex disability – half of all stroke survivors have a disability.

▪ Over a third of stroke survivors in the UK are dependent on others, of those 1 in 5 are cared for by family and/or friends.

(Stroke Association, 2015)

▪ Stroke occurs approximately 152,000 times a year in the UK; that is one every 3 minutes 27 seconds.

▪ There are around 1.2 million stroke survivors in the UK.

▪ 3 in 10 stroke survivors will go on to have a recurrent stroke or TIA.

▪ 1 in 4 strokes are fatal within a year.

▪ Stroke is the fourth single largest cause of death in the UK and second in the world.

▪ By the age of 75, 1 in 5 women and 1 in 6 men will have a stroke.

What can be done? – early recovery

▪ There's still so much we don't know about how the brain compensates for the damage caused by stroke. In some cases, the brain cells may be only temporarily damaged, not killed, and may resume functioning over time. In other cases, the brain can reorganize its own functioning. Every once in a while, a region of the brain "takes over" for a region damaged by the stroke. Stroke survivors sometimes experience remarkable and unanticipated recoveries that can't be explained. General recovery guidelines show:

▪ 10% of stroke survivors recover almost completely▪ 25% recover with minor impairments▪ 40% experience moderate to severe impairments requiring special care▪ 10% require care in a nursing home or other long-term care facility▪ 15% die shortly after the stroke

(NSA,2015)

Rehabilitation in general

▪ Rehabilitation actually starts in the hospital as soon as possible following a stroke. In patients who are stable, rehabilitation may begin within two days after the stroke has occurred, and should be continued as necessary after release from the hospital.

▪ Depending on the severity of the stroke, rehabilitation options can include:▪ A rehabilitation unit in the hospital with inpatient therapy▪ A subacute care unit▪ A rehabilitation hospital with individualized inpatient therapy▪ Home therapy▪ Returning home with outpatient therapy▪ A long-term care facility that provides therapy and skilled nursing care▪ The long-term goal of rehabilitation is to improve function so that the stroke

survivor can become as independent as possible. This must be accomplished in a way that preserves dignity and motivates the survivor to relearn basic skills that the stroke may have impaired - skills like bathing, eating, dressing and walking.

Rehabilitation team

▪ Physiatrist. Specializes in rehabilitation following injuries, accidents or illness▪ Neurologist. Specializes in the prevention, diagnosis and treatment of stroke and other diseases of the brain and

spinal cord▪ Rehabilitation Nurse. Specializes in helping people with disabilities; helps survivors manage health problems that

affect stroke (diabetes, high blood pressure) and adjust to life after stroke▪ Physical Therapist (PT). Helps stroke survivors with problems in moving and balance; suggests exercises to

strengthen muscles for walking, standing and other activities▪ Occupational Therapist (OT). Helps stroke survivors learn strategies to manage daily activities such as eating,

bathing, dressing, writing or cooking▪ Speech-Language Pathologists (SLP). Helps stroke survivors re-learn language skills (talking, reading and

writing); shares strategies to help with swallowing problems▪ Dietician. Teaches survivors about healthy eating and special diets (low salt, low fat, low calorie)▪ Social Worker. Helps survivors make decisions about rehab programs, living arrangements, insurance, and support

services in the home▪ Neuropsychologist. Diagnoses and treats survivors who may be facing changes in thinking, memory, and behavior

after stroke▪ Case Manager. Helps survivors facilitate follow-up to acute care, coordinate care from multiple providers, and link to

local services▪ Recreation Therapist. Helps stroke survivors learn strategies to improve the thinking and movement skills needed

to join in recreational activities

Thank you for listening