Types of Brain Injury In Patient and Nursing Education
Types of Brain Injury and Nursing Educator
Traumatic Brain Injury
A fall, car accident, gunshot wound, and a blow to the head are just a few potential causes of traumatic brain injury (TBI). Falls are the leading cause of TBI, particularly for children from birth to the age of 4 and adults older than the age of 75. Approximately 2.5 million people sustain a TBI each year in the United States. Of these cases. approximately 75% involve concussions or other mild forms of head injury (CDC, 2016b).
The potential long-term effects of TBI are significant and can seriously affect the quality of life of those affected. Nationally, billions of dollars are spent each year on hospital, rehabilitation, long-term, and palliative care for victims of this injury (Kline & Bondi, 2016).
Although anyone can sustain a TBI, in recent years awareness has increased about the risks for TBI associated with military service and sports. Because of the development of protective devices for combat, soldiers are now surviving explosions that at one time were considered deadly.
However, rarely do soldiers come out of these events unscathed and many suffer from major or minor repeated head injuries over one or more deployments (McKee & Robinson, 2014; PBS, 2011). Likewise, football players, skiers, cheerleaders, and others involved in high school, college, professional, and recreational sports are at greater risk than the general population for TBI.
Considerable efforts are underway to prevent and respond to these sports related injuries including new rules and regulations regarding play and improved protective devices (Brainline.org, 2014).
TBI includes two specific types: closed head injury, which refers to non penetrating injury, and open head injury, which refers to penetrating injury resulting in brain tissue exposure and disruption of normal protective barriers. Males are 1.5 times more likely than females to sustain a TBI as are individuals with ADHD ( Schachar , Park, & Dennis, 2015).
The two age groups at highest risk for the injury are infants to 4-year olds and 15- to 19-year olds. The CDC (2016b) estimates that at least 5.3 million Americans currently have a long term or life-long need for help to perform activities of daily living resulting from a TBL.
The cognitive deficits that occur depend on the severity and location of the injury but may include poor attention span, slowness in thinking, confusion, difficulty with short term and long-term memory, distractibility, sleep disorders, mental fatigue, and difficulty with organization , problem solving, reading, and writing (ASHA, 2016).
Also, TBI is associated with an array of neurological and psychiatric abnormalities that affect behavior such as posttraumatic stress disorder, impulsivity, socially inappropriate behavior, and poor judgment (McGee, Alekseeva, Chemyshev, & Minagar , 2016 ) .
Stages of Brain Injury
As might be expected, communication skills will more than likely be an issue. Cognitive deficits may persist for an extended time. The treatment of people with severe brain injury is most often divided into three stages:
1. Acute care (in an intensive care unit)
2. Acute rehabilitation (in an inpatient brain-injury rehabilitation unit)
3. Long-term rehabilitation after discharge (at home or in a long-term care facility)
When considering the teaching needs of patients with a TBI at each of these stages, it is important to remember that the family, not just the individual who was injured, must be addressed. The effects of TBI can be devastating and can affect everyone (Rashid et al., 2014; Warren et al., 2016).
Careful assessment of the individual and the family must be done and teaching must focus not only on the ongoing care of the patient but also on the resources available to assist the individual and family.
At every stage of treatment, many hurdles need to be conquered. Once the injured person's life is assured and the physical condition improves, the client is discharged from the acute care unit. Although the client may look healthy upon discharge, he or she may still require rehabilitation. For this reason, families need to be kept up to date on their loved one's prognosis and progress from the very beginning.
Throughout the rehabilitation process, family teaching must be consistent and thoughtful, because most of the residual impairments are not visible except for the sensorimotor deficits.
The communication, cognitive perceptual, and behavioral changes associated with TBI may be dramatic. However, one of the most difficult problems for the family is often the recognition that their relative will probably never be the same person again. In fact, personality changes present a significant burden for the family.
Studies have shown that the level of family stress is directly related to the extent of the individual's personality changes and the relative's own perception of the symptoms arising from the head injury ( Grinspun , 1987; McGee et al., 2016).
Although most of the literature deals with the importance of family inclusion during the rehabilitation period, clearly persons with brain injury will always need the involvement of their family. Again, the benefits of participation in family groups are immeasurable. Considerable strength is gained from group participation, and learning is accomplished through a friendly, informal approach. Most important, people with brain injury need unconditional acceptance from their friends and family.
Patients recovering from TBI face many challenges. Just as the family needs to adjust to the changes in their injured family member, patients themselves must cope with loss of identity. The significant physical and cognitive changes caused by the brain injury often alter how the individual interacts with the world (Fraas & Calvert, 2009). They face not only recovery from physical injury but often an uncertain future.
Learning needs for this population center on the issues of patient safety and family coping. Safety issues are related to cognitive and behavioral capabilities. Families are faced with a life changing event and will require ongoing support and encouragement to take care of themselves. Recovery may require several years, and most often the person is left with some form of impairment.
According to the CDC (2016b), 40% of all persons hospitalized with a TBI have at least one unmet need for services 1 year after the injury. The most frequently noted needs relate to managing stress and emotional upsets, controlling one's temper, improving one's job skills, and regaining memory and problem solving ability.Marshall et al. (2015) describes a set of revised guidelines for the management of mild TBI and the symptoms that persist after injury.
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