Posts Tagged Nerves
Traumatic brain injury (TBI) occurs when a sudden injury causes damage to your brain. A “closed head injury” may cause brain damage if something hits your head hard but doesn’t break through your skull. A “penetrating head injury” occurs when an object breaks through your skull and enters your brain.
Symptoms that may occur after TBI may include:
- Loss of coordination
- Slurred speech
- Poor concentration
- Memory problems
- Personality changes
According to the CDC, the leading cause of TBI is falls, particularly for young children and adults over 65. Other common causes of TBI include accidental blunt force trauma, motor vehicle accidents, and violent assaults.
If you have had a TBI, rehabilitation (or rehab) will be an important part of your recovery. Rehab can take many forms depending on your needs, and might include physical, occupational, and speech therapy, as well as psychiatric care and social support. All of these are designed to help you recover from the effects of your injury as much as possible.
Why might I need rehab after traumatic brain injury?
Rehab may help:
- Improve your ability to function at home and in your community
- Help treat the mental and physical problems caused by TBI
- Provide social and emotional support
- Help you adapt to changes as they occur during your recovery
Rehab can also help prevent complications of TBI such as:
- Blood clots
- Pressure ulcers, also called bedsores
- Breathing problems and pneumonia
- A drop in blood pressure when you move around
- Muscle weakness and muscle spasm
- Bowel and bladder problems
- Reproductive and sexual function problems
What are the risks of rehab after traumatic brain injury?
Rehab after a TBI is not likely to cause problems. But there is always a risk that parts of treatment such as physical or occupational therapy might lead to new injuries or make existing symptoms or injuries worse if not done properly.
That’s why it is important to work closely with your rehab specialist who will take steps to help prevent problems. But they may still happen. Be sure to discuss any concerns with your healthcare provider before rehab.
How do I get ready for rehab after traumatic brain injury?
Before you can start rehab, you must get care and treatment for the early effects of TBI. This might include:
- Emergency treatment for head and any other injuries
- Intensive care treatment
- Surgery to repair brain or skull injuries
- Recovery in the hospital
- Transfer to a rehabilitation hospital
What happens during rehab after traumatic brain injury?
Every person’s needs and abilities after TBI are different. You will have a rehab program designed especially for you. Your program is likely to involve many types of healthcare providers. It’s important to have one central person you can talk to. This person is often called your case coordinator.
Over time, your program will likely change as your needs and abilities change.
Rehab can take place in various settings. You, your case coordinator, and your family should pick the setting that works best for you. Possible settings include:
- Inpatient rehab hospital
- Outpatient rehab hospital
- Home-based rehab
- A comprehensive day program
- An independent living center
Your individual program may include any or all of these treatments:
- Physical therapy
- Physical medicine
- Occupational therapy
- Psychiatric care
- Psychological care
- Speech and language therapy
- Social support
You have many options for rehab therapy, and the type of rehab therapy that you need will be determined by your care team. Your care team will assess your needs and abilities. This assessment may include:
- Bowel and bladder control
- Speech ability
- Swallowing ability
- Strength and coordination
- Ability to understand language
- Mental and behavioral state
- Social support needs
What happens after rehab for traumatic brain injury?
How long your rehab lasts and how much follow-up care you will need afterwards depends on how severe your brain damage was and how well you respond to therapy. Some people may be able to return to the same level of ability they had before TBI. Others need lifetime care.
Some long-term effects of TBI can show up years later. You may be at higher risk long-term for problems such as Parkinson disease, Alzheimer disease, and other forms of dementia.
After rehab you may be given these instructions:
- Symptoms and signs that you should call your healthcare provider about
- Symptoms and signs that are to be expected
- Advice on safety and self-care
- Advice on alcohol and drug use
- Community support resources available to you
Your primary care provider should be given all the records and recommendations from your therapy team to help ensure that you continue to get the right care.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
Advances in the control of prosthetic arms, or even exoskeletal arms, continue to amaze. Yet someone with a severe neck injury doesn’t need any such device since the greatest arm they could imagine is sitting right there hanging off their shoulder — but unable to perform. Efforts to control an artificial arm may seem impotent to these folks, when a bridge spanning just a couple centimeters of scar tissue in the spinal column can not even be made. A way forward is now taking shape at Case Western University in Ohio. Researchers there are gearing up to combine the Braingate cortical chip developed at Brown University with their own Functional Electric Stimulation (FES) platform.
It has long been known that electrical stimulation can directly control muscles. The problem is that it is fairly inaccurate, and can be painful or damaging. Stimulating the nerves directly using precisely positioned arrays is a much better approach. One group of Case Western researchers recently demonstrated a remarkable device called a nerve cuff electrode that can be placed around small segments of nerve. They used the cuff to provide an interface for sending data from sensors in the hand back to the brain using sensory nerves in the arm. With FES, the same kind of cuff electrode can also be used to stimulate nerves going the other direction, in other words, to the muscles.
The difficulty in such a scheme, is that even if the motor nerves can be physically separated from the sensory nerves and traced to specific muscles, the exact stimulation sequences needed to make a proper movement are hard to find. To achieve this, another group at Case Western has developed a detailed simulation of how different muscles work together to control the arm and hand. Their model consists of 138 muscle elements distributed over 29 muscles, which act on 11 joints. The operational procedure is for the patient to watch the image of the virtual arm while they naturally generate neural commands that the BrainGate chip picks up to move the arm. (In practice, this means trying to make the virtual arm touch a red spot to make it turn green.) Currently in clinical trials, the Braingate2 chip has an array of 96 hair-thin electrodes that is used to stimulate a small region of motor cortex.
The trick here is not just to find any sequence that gets the arm from point A to point B, but to find sequences similar to those that real arms actually use in particular tasks. This is important because each muscle has not only a limited contraction range, but also a limited range where it can actually deliver significant force, and generate feedback signals about those forces. When muscles contract they obviously change shape, but less obvious perhaps, is that their shape at any given moment affects how the other muscles leverage the joints they work. Just as important is the effect of the opposing muscles that control counter movements.
Few movements that we make, even low-force movements, consist of pure contractions of the active muscle and pure inhibition of the opposing muscle. In actuality, muscle units on both sides can be firing in alternating bursts to quickly ratchet joint angles open, particularly when the vector of end-point movement is oblique to the axes of individual arm segments. In other words, even in a simple movement like a bench press, both the biceps and triceps generate forces alternately at various points in the lift, despite the fact that the weight rises uniformly in the upward direction.
If artificial methods of control are going to be used for flesh-and-blood systems, particularly ones that have been idle for some time, overstimulation (or mis-stimulation) when lifting anything even slightly heavy is something to be guarded against. Many sports injuries, such as those in older people performing unfamiliar moves, happen not because they reach too far or too hard, but because their nervous system is not sufficiently practiced to be able to protect the muscle.
While no model for limb movement can be perfect, for the majority of everyday tasks, close may be good enough. The eventual plan is that the patient and the control algorithm will learn together in tandem so that the training screen will not be needed at all. At that point, we might say that Case Western will have a pretty slick interface to offer.
When a traumatic brain injury occurs, according to the National Institutes of Health, several brain functions are disrupted causing various degrees of damage from mild to permanent.
Traumatic brain injury can be caused by blunt force trauma or by an object piercing the brain tissue.
Symptoms may be mild and temporary, moderate, or severe. Often, the injury requires brain surgery to remove ruptured blood vessels or bruised brain tissue.
Disabilities may arise depending on the extent of damage from the traumatic brain injury.
The following six brain functions suffer the most after a traumatic brain injury, according to the Mayo Clinic:
When an injury occurs at the base of the skull and damages the cranial nerves, the following complications may result:
- Facial muscle paralysis
- Eye nerve damage resulting in double vision
- Loss of sense of smell
- Vision loss
- Loss of facial sensation
- Problems with swallowing
A traumatic brain injury, depending on the severity of damage, can cause significant changes in cognitive and executive functioning abilities including the following:
- Mental processing speed
- Attention or concentration
- Problem-solving skills
- Multitasking abilities
- Task initiation or completion ability
Traumatic brain injuries can significantly disrupt and affect cognitive and communication skills and have lasting social implications. The following communication and social problems may result from a traumatic brain injury:
- Difficulty understanding speech or writing
- Difficulty with speech or writing
- Disorganized thoughts
- Conversational confusion and awkwardnes
Behavioral changes may be seen after a traumatic brain injury and may include the following:
- Lack of self-control
- Risky behavior
- Self-image issues
- Social difficulties
- Verbal or physical outbursts
Emotional changes may include the following:
- Mood swings
- Lack of empathy
- Insomnia and other sleep-related problems
- Self-esteem changes
Damage from a traumatic brain injury may greatly affect a person’s senses including:
- Ringing in the ears
- Problems with hand-eye coordination
- Blind spots or double vision
- Issues with taste or smell
- Tingling, pain, or itching of the skin
- Dizziness or vertigo
- Object-recognition difficulties