Acquired Brain Injury is a lesion that occurs suddenly in brain structures as a consequence of an accident or disease. 78% of the causes of Acquired Brain Injury are strokes.
Stroke, or Acute Cerebrovascular Accident, is an injury that occurs in the brain with a rapid onset, due to a sudden disorder of cerebral circulation. It is a pathological process of the cerebral blood vessels that alters the function of a certain region of the brain.
Studies show that although it affects older people, it has recently been observed in younger and younger people, although its presence is less serious. Fifty percent survive this accident, although with significant emotional sequelae and cognitive deficits.
This pathology continues to be a serious health and social problem in our environment. Regarding the emotional sequelae, it is very common for the family and caregivers to refer to changes in the patient’s personality as a consequence of the stroke or due to the situation itself.
The most frequently observed features are: emotional variability and sensitization, which, according to the patient, are either in a situation of happiness disconnected from his or her situation or in a state of permanent nervousness or irritability. Among the main limitations at the cognitive and behavioral level, depending on the patient and the location of his lesion, we could describe a wide spectrum of changes, such as:
- Lower tolerance to frustration.
- Irritability.
- Verbal and physical aggressiveness.
- Childishness and egocentrism.
- Decreased social sensitivity.
- Impatience and deterioration of the capacity of introspection.
The patient may also experience apathy, difficulty in taking initiative, lack of critical ability, defective social judgment, inability to perform a task, disinhibition or tendency to infantilism. These disturbances may range from a mild accentuation of the premorbid personality to a substantial personality change.
The person may appear to have forgotten basic rules of behavior, previously rewarding social acts may no longer be rewarding, and he or she may have problems with hierarchy and authority. He or she may even find it difficult to negotiate and follow basic rules of friendship and to maintain stability in emotional relationships, all as a result of not understanding how others feel and not empathizing with a vision for the future.
The most serious consequences of this are:
- Increased risk of divorce.
- Loss of contact with previous friends.
- Tendency to social isolation that often persists over time.
What changes occur in the patient’s life?
The impact of acquired brain injury involves the rupture of the life process of a person and his or her family. For this reason, the first months after the injury are vital since this is the time of acceptance and adaptation to the new situation. Ignorance of the brain injury generates doubts and anguish.
It is difficult to face what is unknown. The physical effects are disabling from the outset, both for the sufferer and for family members or caregivers, which is usually the main source of concern for the patient from the outset. One third of those affected have severe and disabling sequelae.
Its physical, cognitive and emotional consequences affect the patient individually, although being part of a social network, the latter is also affected by the impact and suddenness of the accident, in this case, indirectly.
Diagnosis and treatment: neuropsychological evaluation
The neuropsychologist evaluates the family dynamics, detects and prioritizes the needs and changes that the brain injury generates in the family. He also analyzes the available and potential situational coping resources and establishes therapeutic intervention strategies.
Neuroimaging techniques, such as MRI or CT, are not able to detect all the neurological dysfunction in an acquired brain injury. The most sensitive measure to assess brain integrity is the measurement of human behavior, an analysis that is performed through Neuropsychological Assessment.
The assessment can identify dysfunctions that are invisible to MRI or CT, especially in cases of mild stroke. Therefore, Neuropsychological Assessment is the diagnostic test that most accurately determines the area in which a focal brain lesion is located and determines its performance.
The brain lesion may not match the focal nerve anatomy seen on neuroimaging tests.
The tests used in Neuropsychological Assessment are very useful for the proper diagnosis of the impact of stroke, its localization and the design and adjustment of the neuropsychological rehabilitation process following the examination. Currently there is a wide range of tools for neuropsychological assessment.
The choice of tests and the objectives of the evaluation, which is performed after a clinical interview by the neuropsychologist, vary according to each patient. The analysis should consider a wide range of variables, such as: age, sex, functional level of the affected person, cultural background, work activity and other life experiences.
The Neuropsychological Exploration has the following objectives:
- Define the level of the patient’s brain functioning, identify the brain dysfunction and locate it.
- To provide information on the patient’s potential for recovery, the estimated speed to resume the previous lifestyle.
- Identify mild disorders when other diagnostic studies are ambiguous – document the recovery of cognitive function after medical treatment, and help plan cognitive rehabilitation by determining the effectiveness of cognitive rehabilitation.
- To promote realistic outcomes for the patient and family and to help understand possible residual deficits. It is also to contribute to the planning of rehabilitation programs.
Cognitive functions generally explored in the neuroscientific examination:
- Abstract reasoning and conceptualization.
- Attention.
- Language.
- Memory.
- Motor.
- Orientation.
- Sensitivity and perception.
- Visuospatial.
Although in the best of the cases it reaches the total cure, that is to say, the symptoms and sequels disappear completely, it usually leaves in the ex-patient a new phase of vigilance of his behavior in the daily life. Some of the most frequent are: new eating habits, reduction of toxics and stress and more preventive medical care.