Acquired Brain Injury: general concepts to take into account

Acquired Brain Injury (ABI) is the consequence or result of a brain injury that appears suddenly after birth. It has multiple causes, and depending on where the damage is located, different physical, psychological or perceptual sequelae may appear. At the same time, it should also be taken into account that the damage does not affect adults in the same way as young people or children, since their brains are still in formation.

Causes of Acquired Brain Injury

The main cause of ABI is Cerebrovascular Accidents (CVA) or stroke. According to data from the Spanish Federation of Brain Injury (FEDACE), of the 104,071 new cases of Acquired Brain Injury that occur each year, 99,284 are caused by cerebrovascular accidents. Also noteworthy are those caused by trauma, especially cranioencephalic trauma, as well as tumors, brain infections and anoxias.

Sequelae of Acquired Brain Injury

When we speak of sequelae, we are referring to all those alterations that have been generated as a consequence of ACBD. These problems and dysfunctions can affect practically all areas of the body, depending on their location, the type of injury and its initial severity. According to the rehabilitation sector of ACD alterations, they are classified into the following:

• Epilepsy. This is a common complication in patients with acquired brain injury. Sometimes, the first epileptic episode may appear months or years after the injury.
• Alertness level. When suffering an ABI or severe trauma, loss of consciousness or coma is common. Coma is a temporary state in which the patient’s eyes are closed and he/she is unresponsive to the environment. The possible severity of coma is measured by ‘the Glasgow Coma Scale’ which measures the patient’s level of alertness, ranging from minimal grogginess to total unresponsiveness.
• Motor control. Motor-type difficulties are common, such as hemiplegia, i.e., paralysis in one half of the body, or hemiparesis, in which strength is lost in one half of the body.
• Communication. The ability to communicate may be impaired following brain injury. Alterations related to the ability to understand and express oneself. The best known is aphasia.
• Perception. There are difficulties in those processes related to the reception of information from the senses, balance…
• Cognition. Memory problems should be emphasized first and foremost, and in some cases it is not possible to recover its normal function. Problems of disorientation or confusion are also quite frequent.
• Behavior and/or emotion. They affect a good number of people. Their occurrence varies according to the area of the brain that has been affected and their severity. They may appear in combination and at different intensities. The most common are:
  • Irritability
  • Depression and anxiety
  • Apathy
  • Behavioral disinhibition
  • Emotional lability
  • Agitation
  • Wandering

• Activities of daily living. In this case, reference is made to a set of functions that combined can put at risk or seriously hinder the execution of some activities. Some examples would be incontinence, movement…

Phases of evolution and rehabilitation in Acquired Cerebral Damage

Depending on the regions affected and the severity of the lesion, different phases of evolution of the problem can be distinguished:

1. Critical phase. The moment of injury
2. Acute phase. Occurs in the ICU, and the objective is to save the patient’s life while minimizing possible sequelae.
3. Subacute phase. In this phase the sequela is treated individually and its average duration ranges from 6 to 18 months, although in some cases it may last for more than 24 months.
4. Chronic phase. This phase begins when, after rehabilitation, no improvement is observed. Its objective is to maintain the improvement achieved and to work on the patient’s integration in the maximum possible autonomy.

The evolution and results after rehabilitation for ACD are different depending on each case, since there are multiple variables that depend on the person, such as age, gender, personality… In addition, there are variables that may have an impact on the evolution, such as physical condition, family support, nutrition, social integration…

Neurological rehabilitation in these cases is based on executing a personalized plan to treat and address all the sequelae so that the patient can return to a form as close as possible to his or her former life.