Vo l u m e O n e - T h i r d E d i t i o n Understanding Brain Injury Acute Hospitalization an educational guide for family & friends 800-697-5390 www.finr.net U NDERSTANDING B RAIN I NJURY Acute Hospitalization An Educational Guide for Family & Friends A CKNOWLEDGMENTS The third edition of this booklet was made possible with the help and dedication of the following health care professionals: -RUJH-9LOODOED0')$$&$3±3V\FKLDWU\ 5DOSK*RQ]DOH]0'±1HXURORJ\ Medical Illustrator $;6%LRPHGLFDO$QLPDWLRQ6WXGLR 7KHVHFRQGHGLWLRQRIWKLVERRNOHWZDVPDGHSRVVLEOHZLWKWKHKHOSDQGGHGLFDWLRQRIWKHIROORZLQJ KHDOWKFDUHSURIHVVLRQDOV Chief Editor 'DYLG6.XVKQHU0'1HXURORJ\ Contributing Editors :RXWHU,6FKLHYLQN0'1HXURVXUJHU\ 0LFKHO/DFURL[0'1HXURVXUJHU\ *HUDUG*DUFLD3V\'1HXURSV\FKRORJ\ 5DQGL&RKHQ0$00+6±6SHHFK3DWKRORJ\ This first edition of this booklet was made possible with the help and dedication of the following health care professionals: Authors -XGLWK60LWLJX\5106 *HRUJH7KRPSVRQ3K' -DPHV:DVFR0' Senior Editor 5REHUW%URRNV Contributing Editors :LOOLDP%XUNH3K' 1HLO0F*UDWK3K' 1DQF\6FKPLGW06 -XG\6RX]D)DPLO\$GYRFDWH Medical Illustrator (3HQQ\3RXQGHU(G0 T ABLE 1 INTRODUCTION 2 THE HEAD AND BRAIN R 6WUXFWXUHVDQG)XQFWLRQV 7KH6NXOO 7KH&RUWH[&HUHEUXP R )URQWDO/REHV R 3DULHWDO/REHV R 7HPSRUDO/REHV R 2FFLSLWDO/REHV 7KH&HUHEHOOXP 7KH%UDLQ6WHPDQG&UDQLDO 1HUYHV 10 BRAIN INJURIES &RQFXVVLRQV 6NXOO)UDFWXUHV 3HQHWUDWLQJ+HDG:RXQG $UWHULDO'LVVHFWLRQV 'LIIXVH$[RQDOLQMXU\ &HUHEUDO,QIDUFWLRQ6WURNH $QR[LF+\SR[LF(QFHSKDORSDWK\ ,QFUHDVHG,QWUDFUDQLDO3UHVVXUH +\GURFHSKDOXV &RQWXVLRQV +HPRUUKDJHV+HPDWRPDV (SLGXUDO+HPDWRPD ,QWUDFHUHEUDO+HPDWRPD 6XEGXUDO+HPDWRPD 6XEDUDFKQRLG+HPRUUKDJH ,QWUDYHQWULFXODU+HPRUUKDJH $QHXU\VP 6HL]XUHV &RPD OF C ONTENTS 23 ASSESSMENT AND TREATMENT (DUO\$VVHVVPHQW 'LDJQRVWLF7HVWV *ODVJRZ&RPD6FDOH 9LWDO6LJQVDQG5HIOH[HV (DUO\7UHDWPHQW 28 INTENSIVE CARE 34 ACUTE HOSPITALIZATION 39 SYMPTOMS AFTER BRAIN INJURY 3K\VLFDO3UREOHPV &RJQLWLYH,PSDLUPHQWV %HKDYLRUDO'LVRUGHUV 41 FAMILY ADJUSTMENT 45 ISOLATION 46 EXPECTATIONS 47 HOW TO HELP 49 MANAGING STRESS 51 MEMBERS OF THE TEAM 53 QUESTIONS & ANSWERS 55 GLOSSARY 60 APPENDIX OF MEDICAL ILLUSTRATIONS 61 SUGGESTED READINGS 62 NOTES I NTRODUCTION $ IDPLO\ PHPEHU RU FORVH IULHQG H[SHULHQFLQJ D EUDLQ LQMXU\ FDQ EH RYHUZKHOPLQJ DQG IULJKWHQLQJ 7KH XQFHUWDLQW\DVVRFLDWHGZLWKWKHEUDLQLQMXU\SURJQRVLVDQGHYHQWXDORXWFRPHDGGVWRWKLVVWUHVV,WLVGLIILFXOWIRU DSK\VLFLDQRURWKHUKHDOWKFDUHSURIHVVLRQDOWRSUHGLFWWKHRXWFRPHGXULQJWKHILUVWGD\VZHHNVDQGHYHQPRQWKV $ORQJ ZLWK IDPLO\ PHPEHUV SK\VLFLDQV PXVW ³ZDLW DQG VHH´ KRZ WKH SDWLHQW SURJUHVVHV7KHUH LV QR FHUWDLQ FRUUHODWLRQEHWZHHQEUDLQLQMXU\VHYHULW\DQGWKHILQDOIXQFWLRQDORXWFRPH,WLVQRWXQXVXDOWRIHHODORQHDQG FRQIXVHGZKLOHVWUXJJOLQJWRXQGHUVWDQGDQGFRSHZLWKWKLVFRPSOH[FRQGLWLRQ $OWKRXJKHDFKIDPLO\PHPEHURUIULHQGPD\GHDOZLWKWKHFULVLVLQKLVRUKHURZQZD\DOOFDQEHQHILWIURPFHUWDLQ EDVLF NQRZOHGJH UHJDUGLQJ QRUPDO EUDLQ IXQFWLRQ DQG EUDLQ LQMXU\ 7KLV ERRNOHW DQG LWV FRPSDQLRQ ± Understanding Brain Injury, Neurologic Rehabilitation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¶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¶VSK\VLFDOFRJQLWLYHDQGEHKDYLRUDOIXQFWLRQWKHDFXWHPHGLFDOWUHDWPHQW DQGLQIRUPDWLRQUHJDUGLQJUHODWHGDGMXVWPHQWLVVXHV 1 T HE H EAD AND B RAIN Structures and Functions 7KHEUDLQLVWKHFRQWUROFHQWHUIRUWKHHQWLUHERG\DQGGLUHFWVDOOLWVYROXQWDU\DQGDXWRQRPLFIXQFWLRQVVXFKDV FLUFXODWLRQEUHDWKLQJGLJHVWLRQHOLPLQDWLRQDQGPRWLRQ6LJQDOVIURPWKHILYHVHQVHV±VLJKWVPHOOWDVWHWRXFK DQGKHDULQJDUHSURFHVVHGWKURXJKWKHEUDLQ,QDGGLWLRQWKHEUDLQLVUHVSRQVLEOHIRUKLJKHUKXPDQIXQFWLRQVDQG DWWULEXWHV LQFOXGLQJ WKRXJKW FRPSUHKHQVLRQ PHPRU\ VSHHFK HPRWLRQ DQG SHUVRQDOLW\ 8QGHUVWDQGLQJ WKH QRUPDOVWUXFWXUHDQGIXQFWLRQRIWKHEUDLQLVWKHILUVWVWHSLQOHDUQLQJDERXWWKHHIIHFWVRILQMXU\ This section will cover the structures and functions of the following areas: 7KH6NXOO 7KH&RUWH[&HUHEUXP 7KH&HUHEHOOXP 7KH%UDLQ6WHP CORONAL VIEW OF THE HEAD LATERAL VENTRICLE The Skull CORTEX SKULL EPIDURAL SPACE SUBDURAL SPACE 7KH VNXOO VHUYHV DV WKH ERQ\ HQFDVHPHQWIRUWKHGHOLFDWHWLVVXHVWKDW XHVWKDW DURA MATER PDNH XS WKH EUDLQ 7KH VNXOO SURWHFWV SURWHFWV WKHEUDLQIURPWKHEXPSVDQGEUXLVHVRI XLVHVRI HYHU\GD\ OLIH 6XSSRUWLQJ PIA MATER DQG SURWHFWLQJWKHEUDLQZLWKLQWKHVNXOODUH NXOODUH WKUHH OD\HUV RI PHPEUDQHV 7KHVH 7KHVH PHPEUDQHVKHOSWRVHSDUDWHDQGSURWHFW SURWHFW WKHOREHVRUVHFWLRQVRIWKHEUDLQ7KH Q7KH RXWHUPRVWPHPEUDQHLVFDOOHGWKHGXUD KHGXUD BRAIN STEM CEREBELLUM PDWHU RU GXUD IRU VKRUW 7KH PLGGOH OD\HULVFDOOHGWKHDUDFKQRLGPHPEUDQH PEUDQH SPINAL CORD VERTEBRAE DQGWKHPHPEUDQHLQGLUHFWFRQWDFWZLWK DFWZLWK WKH EUDLQ¶V VXUIDFH LV FDOOHG WKH SLD SLD PDWHU ILLUSTRATION 1.1 2 &OHDU FHUHEURVSLQDO IOXLG VXUURXQGV DQG FXVKLRQV WKH EUDLQ DQG LWV PHPEUDQHV 0DQXIDFWXUHG ZLWKLQ VPDOO SDVVDJHZD\VRUYHQWULFOHVLQVLGHWKHEUDLQWKLVIOXLGWUDQVSRUWVFHUWDLQQXWULHQWVEHWZHHQEORRGYHVVHOVDQGWKH EUDLQ 7KH YHQWULFOHV FRQVLVW RI WZR ODWHUDO INSET VIEW OF THE HEAD WITH BRAIN ARACHNOID MEMBRANE SUBDURAL SPACE EPIDURAL SPACE DURA MATER SKULL YHQWULFOHVDQGDWKLUGDQGIRXUWKYHQWULFOH SKIN 7KHEUDLQFRQVLVWVRIWKUHHPDLQVHFWLRQVQDPHO\ WKH FRUWH[ DOVR FDOOHG WKH FHUHEUXP RU FHUHEUDO FRUWH[ WKH FHUHEHOOXP DQG WKH EUDLQVWHP $OWKRXJK WKH EUDLQ RSHUDWHV LQ D KLJKO\ LQWHUFRQQHFWHG PDQQHU HDFK VHFWLRQ KDV GLVWLQFW IXQFWLRQV DQG FKDUDFWHULVWLFV )RU H[DPSOH RQH SUBARACHNOID SPACE PIA MATER DUHD FRQWUROV EDODQFH ZKLOH DQRWKHU UHJXODWHV HPRWLRQV%HFDXVHWKHVNXOOLVDULJLGVWUXFWXUHWKH VSDFHZLWKLQLWUHPDLQVIL[HG1HDUO\SHUFHQWRI WKLV VSDFH LV RFFXSLHG E\ WKH PHPEUDQHV DQG CORTEX ILLLUSTRRATION 1.2 FHUHEURVSLQDO IOXLG 7KH UHPDLQLQJ SHUFHQW FRQVLVWVRIWKHFRUWH[FHUHEHOOXPDQGEUDLQVWHP 7KH&RUWH[&HUHEUXP 7KH ODUJHVW VHFWLRQ RI WKH EUDLQ WKH FRUWH[ LV GLYLGHG LQWR WZR FRQQHFWHG KHPLVSKHUHV RU VLGHV WKDW FRQWURO LPSRUWDQWIXQFWLRQVVXFKDVVSHHFKSHUFHSWLRQDQGPHPRU\7KHOHIWVLGHRIWKHEUDLQFRQWUROVPRYHPHQWDQG UHFHLYHVVHQVRU\PHVVDJHVIURPWKHULJKWVLGHRIWKHERG\7KHULJKWVLGHRIWKHEUDLQFRQWUROVPRYHPHQWDQG UHFHLYHV VHQVRU\ PHVVDJHV IURP WKH OHIW VLGH RI WKH ERG\ 6SHFLILF DUHDV ZLWKLQ WKH FHUHEUDO FRUWH[ UHJXODWH VHSDUDWHIXQFWLRQV)RUH[DPSOHWKHVSHHFKFHQWHUJRYHUQVWKHDELOLW\WRIRUPVRXQGVLQWRPHDQLQJIXOZRUGV SKUDVHVDQGVHQWHQFHV (DFKSHUVRQKDVDGRPLQDQWDQGDQRQGRPLQDQWFHUHEUDOKHPLVSKHUH7KHGRPLQDQWKHPLVSKHUHXVXDOO\RQWKH OHIWFRQWUROVFRJQLWLYHIXQFWLRQVLQFOXGLQJVSHHFKFRPSUHKHQVLRQDQGWKHDELOLW\WRSHUIRUPUHDGLQJZULWLQJ DQGDULWKPHWLFFDOFXODWLRQV7KHQRQGRPLQDQWKHPLVSKHUH¶VIXQFWLRQVLQFOXGHVSDWLDOSHUFHSWLRQDQGFUHDWLYLW\ VXFKDVDUWLVWLFDQGPXVLFDOVNLOOV 3 (DFKFHUHEUDOKHPLVSKHUHLVVXEGLYLGHGLQWRIRXUGLVWLQFWOREHVIURQWDOSDULHWDOWHPSRUDODQGRFFLSLWDO Frontal Lobes LATERAL VIEW OF THE HEAD WITH FULL BRAIN SKULL DURA MATER /RFDWHGLQWKHIURQWRIWKHFHUHEUXPEHKLQGWKH KH IRUHKHDGERQHWKHIURQWDOOREHVFRQWULEXWHWRD RD SHUVRQ¶V MXGJPHQW UHDVRQLQJ SHUVRQDOLW\ W\ FRONTAL LOBE PARIETAL LOBE CORTEX PRWLYDWLRQ LQKLELWLRQ DQG FRQFHQWUDWLRQ Q +RPH RI SHUVRQDOLW\ WKH IURQWDO OREH KDV D TEMPORAL OCCIPIT CCIPITAL TAL LOBE LOBEE CEREBEL EREBELLUM LLU UM ZLGHUUDQJHRIMREVWKDQDQ\RWKHUSDUWRIWKH KH EUDLQ ,W FRQWUROV RXU DELOLW\ WR PDNH VRXQG QG GHFLVLRQV FRQFHQWUDWH SODQ DQG RUJDQL]H ,W KHOSV\RXWRKDYHDVHQVHRIVHOILQUHODWLRQWR WR WKH UHVW RI WKH ZRUOG ,W DOORZV IRU DYDLODEOH OH LQIRUPDWLRQWREHXVHGLQSODQQLQJSULRULWL]LQJ J BRAIN STEM VERTEBRAE SPINAL CORD VHTXHQFLQJ VHOIPRQLWRULQJ VHOIFRUUHFWLQJ J LQKLELWLQJ LQLWLDWLQJ FRQWUROOLQJ RU DOWHULQJ QJ EHKDYLRU ILLUSTRATION 1.3 /DUJHVWRIWKHEUDLQ¶VOREHVWKHIURQWDOOREHH[WHQGVIURPWKHIURQWRIWKHEUDLQWRWKHFHQWUDOVXOFXVIXUURZ(DFK KHPLVSKHUHKDVDIURQWDOOREH 7KHIURQWDOOREHVFRQWDLQWKHIROORZLQJLPSRUWDQWDUHDV 3UHPRWRUFRUWH[ %URFD¶VDUHD 3UHIURQWDOFRUWH[ 3ULPDU\PRWRUFRUWH[ 7KH IURQWDO OREHV DUH HDVLO\ GDPDJHG E\ DFFLGHQWDO LQMXU\ 'HJHQHUDWLYH EUDLQ 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HOVHLVWRXFKHG7KHSDULHWDOOREHFDQLGHQWLI\H[DFWO\ZKHUH\RX¶UHKXUWZKHQ\RXJHWLQMXUHG 7KLVOREHUHPLQGVWKHEUDLQKRZWRXVHWRROV,WXVHV³ERG\PHPRU\´WRUHVSRQGDXWRPDWLFDOO\WRDFWLRQVWKDWDUH VRIDPLOLDU\RXGRQ¶WKDYHWRWKLQNDERXWWKHPEHIRUH\RXDFW²OLNHDEDVHEDOOSOD\HUVZLQJLQJDEDW,WDOVR JRYHUQVDWWHQWLRQ 7KH SDULHWDO OREH OLHV EHWZHHQ WKH IURQWDO DQG RFFLSLWDO OREHV LQ WKH PLGGOH XSSHU EUDLQ FHUHEUXP (DFK KHPLVSKHUH KDV D SDULHWDO OREH ZLWK RQH KHPLVSKHUH GRPLQDQW 7KH GRPLQDQW KHPLVSKHUH JRYHUQV VSHHFK UHDGLQJZULWLQJDQGFDOFXODWLQJ,WSODQVFRPSOH[DFWLRQVDQGSOD\VDUROHLQSHUFHSWLRQDQGERG\LPDJH 7KHRWKHUOREHXVHVYLVXDOLQIRUPDWLRQWRSURYLGHDSLFWXUHRIWKHVXUURXQGLQJZRUOGDQG\RXUERG\¶VSRVLWLRQLQ LW²KRZ\RXUERG\LVRULHQWHGLQVSDFH7KLVVHQVHRIERG\SRVLWLRQKHOSV\RXWRSHUIRUPVSDWLDOWDVNV 7KH WHPSHURSDULHWDO MXQFWLRQ ZKHUH WKH SDULHWDO DQG WHPSRUDOOREHV PHHW KHOSV \RX WR ILJXUH RXW ZKDW¶V RQ VRPHRQHHOVH¶VPLQG7KLVUHJLRQLVUHVSRQVLEOHIRURXWRIERG\H[SHULHQFHV 5 Damage to the Parietal Lobes $SHUVRQZLWKDEUDLQOHVLRQVWURNHWUDXPDWLFEUDLQLQMXU\RUGHJHQHUDWLYHGDPDJHLQWKLVDUHDPD\QRWEHDEOH WRUHFRJQL]HIDFHVWHOOOHIWIURPULJKWGUDZUHPHPEHUZRUGVRUQXPEHUVVSHDNQRUPDOO\RUVWD\IRFXVHG7KH\ PD\PLVMXGJHGLVWDQFHDQGWKHSRVLWLRQRIREMHFWV7KH\PD\JHWORVWJRLQJIURPRQHURRPWRDQRWKHULQWKHLURZQ KRPH7KHLUVHQVHRIWRXFKSDLQRUWHPSHUDWXUHPD\QRWZRUNSURSHUO\7KH\PD\EHFRPHFRQIXVHGDQGXQDEOH WRGUHVVWKHPVHOYHVRUSHUIRUPVLPSOHWDVNV Temporal Lobes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