Freud discussed that the ‘conscious mind is only the tip of the iceberg of our mental processes’. His view was that a much larger part of what drives our thoughts and behaviours is not evident to our conscious self. You can read more about his theories here.
Our brain is constantly pulling information from the environment, it uses this information to steer our behaviour, but often these influences are not consciously recognised. The seamless and efficient way in which the brain functions for us is often something we take for granted. The subtle physical adjustments we make to stabilise ourselves while we walk and / or the interpretation and subsequent response to what we see through our eyes happens without often a second thought. It is only when the brain is ‘broken’, as in the case of an acquired brain injury (ABI), that the narrative it provides results in a mismatch with reality or our abilities.
An efficient brain is central to our independence and wellbeing, and it is for this reason that the impact of an acquired brain injury is so keenly felt. Here we consider what is an acquired brain injury and some of the potential functional consequences.
Acquired Brain Injury (ABI)
Any brain damage sustained since birth is called an Acquired Brain Injury (ABI). For most people who sustain a brain injury due to trauma the injury is visibly obvious, and symptoms appear quickly, but the long-term functional consequences can take weeks, months or even years to determine.
According to the latest data from the UK’s leading head injuries charity, Headway, the number of people being admitted to hospital with Acquired Brain Injury between 2005 and 2017 rose by a worrying 10%. In other words, by 2017, a staggering 954 patients were being admitted every day, or around one every 90 seconds.
Of course, survivors of the more severe types of ABI are likely to experience the most pronounced symptoms and functional consequences, these are the sort of symptoms that affect personality, relationships and independence. But in all cases, Neuro OT and other forms of rehabilitation and support is vital.
In the medical world, Acquired Brain Injury (ABI) is divided into two categories:
Traumatic Brain Injury (TBI) – caused by a physical trauma to the head, such as a bump, blunt force impact, blow or a jolt, that disrupts the normal function of the brain. This is the leading category of brain injuries worldwide and most commonly arises from road traffic or sports accidents, accidents at home or work.
Non-Traumatic Brain Injuries – when there is no trauma to the head but the damage to the brain is caused by other means, such as infections, a tumour, or a stroke.
The symptoms of ABIs are wide and varied and can range from mild to severe, occasional to constant, and short to long-term. There may be changes in the survivor physically, in their way of thinking (cognitive), in their moods or in their behaviour.
Physical effects of brain injury could include:
- loss of consciousness lasting a second or for a longer period of time, the three disorders of consciousness include coma, vegetative state and minimally conscious state;
- mobility and balance problems;
- stiff or weak limbs including disorders of muscle tone;
- varying degrees of paralysis;
- disorders of movement including, among other things, tremor and ataxia;
- sensory impairment including changes in sight, smell, hearing, taste or touch;
- sensory processing disorders;
- increased tiredness and overwhelming fatigue; or
- speech and language difficulties.
Cognitive effects of a brain injury could include:
- memory problems;
- problems with receptive and expressive language including expressive and receptive dysphasia;
- difficulties with vision and visual perception;
- lack of motivation that may also be linked to depression;
- attention deficits or difficulties with concentrating;
- slowed processing of information,
- challenges with executive function, which is the way we plan, organise and complete tasks;
- repetitive communication or being unable to move topics on in a conversation which is called perseveration; or
- problems understanding themselves or others including insight, awareness and empathy.
Emotional and psychiatric effects of brain injury could include:
- personality changes;
- mood swings including emotional lability;
- depression and feelings of loss;
- anxiety;
- frustration and anger; or
- Post-Traumatic Stress Disorder (PTSD).
Behavioural effects of brain injury could include:
- lack of interest or concern, which is called apathy;
- self-centredness or egocentricity;
- fixating on things which can present as obsessive behaviour;
- acting or speaking without any thought for the consequences, which is also called impulsiveness;
- loss of control over their behaviour or disinhibition; or
- displaying verbal or physical outbursts, which presents as irritability and aggression.
Epilepsy is also a common complication following acquired brain injury.
