brain injury - intro

• Jimmy calls himself the “walking wounded.” He worksas a messenger delivering packages and letters to officesand apartments throughout downtown Orlando. He likesto wear a tie, even when the weather is hot and humid. Helooks perfectly presentable; people who pass occasionallysmile hello. But if, say, a woman stopped and asked himfor directions, Jimmy would first look at her blankly, then,he’d start to stammer. He might even get angry and spewout a string of obscenities. What this woman and othersdidn’t realize, at first, is that he had a severe brain injuryyears ago. Jimmy’s scars are invisible.

• Arlene was riding her brand new bicycle down the hillnear her house. She’d walked, run, ridden, and sleddeddown that hill so many times in her young life that shecould close her eyes and instinctively know she hadreached the bottom. That’s exactly what she did thisspring day. Unfortunately, she couldn’t see the brokentree limb sitting in the middle of the road. She hit it at

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I N T R O D U C T I O N

TH E IM PAC T O F T H E BR A I NIN TO DAY’S WO R L D

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full speed, flew over the handle bars, and hit her head.She is still in a rehabilitation hospital, recovering fromher brain injury.

• Sam loved his new position. As vice president incharge of sales for a major corporation, his responsibil-ities were enormous. But, then again, Sam always didhave a great deal of energy. He always had time to lis-ten to his subordinates’ complaints and suggestions. Hemet his deadlines and was always one step ahead of thecompetition. In short, Sam was a one-man dynamo ofexecutive capability, and it was no secret that he wasbeing groomed for the corporation’s top spot. But all thiswas before his accident. A two-car collision on the inter-state left Sam befuddled, confused, and angry. Althoughhe suffered only a mild head injury, the damage wasenough to sabotage his managerial talents. He could nolonger lead — a fate Sam refused to acknowledge. By notaccepting this, Sam became an unhappy, bitter alcoholic.

These are only three short stories, three vignettes ofpeople whose lives have been irrevocably changedbecause of a brain injury. Unfortunately, they are notalone. Nor are their accidents isolated ironies of life. Astaggering 2 million people suffer from mild to moderatebrain damage every year, with 17% suffering from seriousbrain trauma that results in neurological deficits and lossof consciousness. But there’s more: Only 5% of them getthe help they need.

LIVING WITH BRAIN INJURY : A GUIDE FOR FA M I L I E S


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ONE LIFE TO LIVEAs late as the 1970s, 90% of all brain-injured patients died.

To d a y, thanks to an abundance of medical advances, higher-quality technology, and improved emergency care, more andmore people are surviving — not only military vets who sus-tained brain injuries in battle, but ordinary people with ordi-nary lives. Add the fact that contemporary Americans takemore risks — from bungee diving to mountain climbing,from driving cars at breakneck speeds to pursuing the brassring at any cost — and the evidence is undeniably clear thatbrain injury has indeed become a “Silent Epidemic.”

CAUSE AND EFFECTI t ’s a fact: A brain injury can occur to anyone at any

time. But there are some specific arenas that put peoplemore at risk:• The young between the ages of 15 and 24 always take more‘daredevil’ chances — with motorcycle, bicycle, and carcrashes causing more brain injuries than any other mode...• But the figures climb back up again after the age of 70,with most brain injuries the result of falls.• Bicycle accidents are becoming one of the major causesof head injury — with over 1,300 deaths each year. Butwearing a helmet can drastically cut down on the risk.• The causes of brain injury vary according to geography .In our car-oriented San Antonio, Texas, location, motorvehicles are the number-one culprit. In some cases, firearmsand assaults account for most of the brain injuries. In citieswhere there’s a great deal of construction and development,industrial accidents cause the most damage.

I M PACT OF THE BRAIN IN TODAY’S WORLD


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MIND OVER MAT T E RIn many ways, the brain is our most vulnerable organ.

An injury to the head doesn’t heal the same way the heart,or the liver, or a broken leg does. It isn’t a matter of “stayingoff your feet for a few weeks” or “getting plenty of rest” or“taking two aspirin and calling the doctor in the morning.”Brain injury affects who we are; the way we think, act, andfeel. It can change everything about ourselves in a matterof seconds. And it can create havoc in the people we love,our family and friends, who are suddenly faced with ad i sabled stranger with:• Cognitive dysfunction... including memory loss, perceptionand comprehension difficulties, and deficits in attention,organization, problem solving skills, and reasoning. • Physical impairments... including partial paralysis,s p a sticity, lack of coordination and balance, and swallow-ing d i f f i c u l t i e s .• Behavioral problems... including over- a g g r e s s i v e n e s s ,depression and mood swings, violence, and lack ofimpulse control.

But all is not bleak. The medical and technologicaladvances that have kept brain-injured patients alive havealso developed better and more successful treatments.

THE “RE” FA C T O RBrain recovery often means extensive rehabilitation —

retraining and relearning that requires time, consistencyexpertise, and a structured, secure environment. In fact,without rehabilitation, the patient may stop far short of hispotential. Here’s proof: In a study of severely brain-injured



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young adults with serious cognitive and emotional distur-bances, 50% of those who received rehabilitation w e r efound to be productive three-quarters of the time, asopposed to only 36% of those who did not receive treatment.Ultimately they were not only less emotionally disturbedthan those head-injured young adults who did not gothrough rehabilitation, but they also did better on memoryand learning tests. Other studies of severely brain-injuredpatients who had received rehabilitation found that manyof them were able to become useful members of society, ifthey had support.

These results are not surprising. It is only in a rehabil-itation setting that a patient will have the most advancedequipment and most comprehensive care. And it is onlyin this setting that a family can get the education theyd e sperately need to cope with the day-to-day problemsthat crop up in brain injury — and to truly help their hurtloved ones.

But perhaps the most compelling reason for rehabilitationis its goal: independence. With successful treatment, a brain-injured patient may regain at least some of his ability to:

1 . Live, work, and enjoy life in our society.2 . Redevelop social and family relationships

on a more equal basis.3 . Participate within the community.

H o w e v e r, proper rehabilitation doesn’t come cheap. Aperson with a moderate brain injury can conceivablyspend more than $100,000 in treatment. The figure canzoom literally into the millions for severely brain-injuredsurvivors who need long-term care.



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Fortunately help is at hand. The United Statesg o v e r nment has recognized that brain injury is indeed aserious problem nationwide. Congress had declared theentire ‘90s “The Decade of the Brain,” appropriating $15million to the dual fields of brain injury rehabilitation andbrain injury prevention. As we head into the first decadesof the 21st century, brain injury research continues to beat the forefront of scientific and medical funds allocation;brain injury and brain safety continue to make the news inall media throughout the world.

The insurance industry, too, has discovered the benefitsof rehabilitation in the bottom line: Every dollar usedfor brain injury rehabilitation saves up to $35 in futuremedical costs.

Yet, despite this important financial and publicr e c o g n ition, there is no denying the pain of the individualf a m i l y, the individual victim — and the high cost of braininjury in both emotional and practical terms. There is,after all, no price tag on loss, no “discounts” on the turnaboutof fate. But there is hope.

And that’s where this book comes in.

BRAIN INJURY: A GUIDE FOR FA M I L I E SWe have been involved in the field of head injury

r e h abilitation for many years. In our work at HealthSouthRIOSA, we have seen countless incapacitated brain-injured patients become functioning members of society.To g e t h e r, we long felt the need for a clear and helpfulguide for families who are thrust into the world of braininjury — a book that would not only contain all necessaryinformation, but offer reassurance as well. Thus L i v i n g



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with Brain Injury: A Guide for Families was born, abook that not only addresses you, the family members, butm e d i c a l professionals who are just now embarking on acareer in head injury rehabilitation. Now the demand forthis book in the United States and around the globe hascreated the need for a second edition — one that includesmore up-to-date information and one that addresses theconcerns of families in the new millennium.

Within these updated pages, we will take you on a journeythrough the brain. You will discover how the brain works,and why. We will explore the many varied and complexsymptoms that come into play when the brain is injured.Step by step, we will show you the rehabilitation process,including the new theories of neural plasticity and constraintt h e r a p y, as well as offer sound advice on choosing the bestrehabilitation hospital for your loved one. And, mostimportant, we will pinpoint how you can help a brain-injured survivor in the best and least stressful ways — forboth of you.

We know there is life after brain injury. After readingthis book, it is our hope that you, too, will believe this tobe true.



brain injury - intro

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