Brain trauma and psychological functioning

One of my amazing mentors was Dr. James Lewis, clinical psychologist and neuropsychologist, whom I met when I was studying for my doctorate at Catholic University, in Washington DC.

While completing my neuropsychology training, I worked with Dr. Lewis, who often represented many patients in court, innocent victims in cases of lead poisoning, shaken baby syndrome, and traumatic brain injuries.

When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countrecoup. A bruise directly related to trauma, at the site of impact, is called a coup (pronounced COO) lesion. As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a countrecoup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain. In simple terms, your brain/us around inside your skull, which is very hard, and creates damage.

General symptoms of a head injury:
A person may have varying degrees of symptoms associated with the severity of the head injury. The following are the most common symptoms of a head trauma.
Symptoms may include:
Raised, swollen area from a bump or a bruise
Small, superficial (shallow) cut in the scalp
Headache
Sensitivity to noise and light
Irritability
Confusion
Lightheadedness and/or dizziness
Problems with balance
Nausea
Problems with memory and/or concentration
Change in sleep patterns
Blurred vision
“Tired” eyes
Ringing in the ears (tinnitus)
Alteration in taste
Fatigue or lethargy
Moderate to severe head injury (this requires immediate medical attention).
Loss of consciousness
Severe headache that does not go away
Repeated nausea and vomiting
Loss of short-term memory, such as difficulty remembering the events that led right up to and through the traumatic event
Slurred speech
Difficulty with walking
Weakness in one side or area of the body
Sweating
Pale skin color
Seizures or convulsions
Behavior changes including irritability
Blood or clear fluid draining from the ears or nose
One pupil (dark area in the center of the eye) is dilated, or looks larger, than the other eye and doesn’t constrict, or get smaller, when exposed to light
Deep cut or laceration in the scalp
Open wound in the head
Foreign object penetrating the head
Coma (a state of unconsciousness from which a person cannot be awakened; responds only minimally, if at all, to stimuli; and exhibits no voluntary activities)
Vegetative state (a condition of brain damage in which a person has lost his thinking abilities and awareness of his surroundings, but retains some basic functions such as breathing and blood circulation)
Locked-in syndrome (a neurological condition in which a person is conscious and can think and reason, but cannot speak or move)
The symptoms of a head injury may resemble other problems or medical conditions. Always consult your doctor for a diagnosis.

Diagnosis:
The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the doctor obtains a complete medical history of the patient and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.
Diagnostic tests may include:
Blood tests
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Electroencephalogram (EEG). A procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. You may have to drink a fluid that helps with imaging, called with contrast.

Treatment is individualized, depending on the extent of the condition and the presence of other injuries. If the patient has a severe head injury, he or she may require monitoring for increased intracranial pressure (pressure inside the skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to permanent brain damage.

Lifetime care:
The key is to promote a safe environment for children and adults and to prevent head injuries from occurring in the first place. The use of seat belts when riding in the car and helmets (when worn properly) for activities, such as bicycle riding, in-line skating, and skateboarding may protect the head from sustaining severe injuries.

I very firmly tell my patients that they cannot afford to fall down or take a tumble. Please use canes, walkers, or whatever is required to prevent injury in the future, please. 

Persons who suffer a severe brain injury may lose muscle strength, fine motor skills, speech, vision, hearing, or taste function, depending on the brain region involved and the severity of brain damage. Long- or short-term changes in personality or behavior may also occur. These persons require long-term medical and rehabilitative (physical, occupational, or speech therapy) management.

The extent of the person’s recovery depends on the type of brain injury and other medical and psychiatric problems that may be present. It is important to focus on maximizing the person’s capabilities at home and in the community. Positive reinforcement will encourage the patient to strengthen their self-esteem and promote independence, which is the overall goal. 

Embolden Psychology
Embolden

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Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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