Physical effects
Most people make an excellent physical recovery after a brain injury, which can mean there are few, or no, outwards signs that an injury has occurred. There are often physical problems present that are not always so apparent, but can have a real impact on daily life.
In this section we cover problems with:
Damage to the brain that causes movement difficulties usually happens to the motor cortex, the brain stem and the cerebellum. As one side of the brain affects the motor co-ordination on the opposite side of the body, a person often experiences a weakness or paralysis of one side.
Damage to the cerebellum affects fine co-ordination of the muscles, and can mean continuing problems with dexterity even after a period of improvement.
Difficulties with balance can be caused by damage to the vestibular system, which is a small mechanism at the back of the skull. Even a minor brain injury can upset this delicate organ, so that the person often feels dizzy. Learning to walk again after a head injury involves re-learning the basic developmental stages so that they learn to balance before a stable posture can be achieved.
Contractures, that is, abnormal shortening of muscles that makes it very hard to stretch limbs, can seriously affect posture. Exercises provided by the physiotherapist are essential in helping to overcome this in the early stages. More severe contractures may require the muscle to be encased in plaster and gradually stretched.
Physiotherapy can help with these problems by keeping the muscles moving and re-training your body to adopt a more 'normal' posture. Speak to you GP or other treating doctor about this.
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Dyspraxia is a disorder of deliberate voluntary actions, or sequences of actions. That means it is different from problems with motor co-ordination or movement. The person may not have a problem with actual movement, rather the problem lies with being unable to put movements together deliberately and intentionally. This kind of problem can often be perceived as a lack of co-operation on the person's part. A good example of the kind of problem would be a person who cannot bend his elbow when instructed to, but a few minutes later could tell the time by looking at his watch which involves bending his elbow quite automatically.
Rehabilitation aims to break actions down into a sequence of activities, with cues and prompts, which is then practised until the cues and prompts can be gradually dispensed with.
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Different parts of the sensory cortex deal with sensations in different parts of the body. After a head injury, people may experience a loss of sight, hearing, taste, smell (anosmia) and so on without actually damaging any of the sense organs. If the sensory cortex has been bruised, a gradual recovery of sensation may be possible. If the area has been torn, it is unlikely to return to normal functioning.
Our factsheet 'Loss of taste and smell after brain injury' can be downloaded free of charge from our factsheets page.
Processing what the eyes see is carried out in the Occipital Lobe at the back of the brain. Damage here can result in either full or partial blindness, or gaps in the visual field. Visual neglect is covered in the section on cognitive problems. Temperature control can also be affected, particularly by damage to the brain stem.
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Fatigue after head injury can be one of the most limiting symptoms because it affects everything a person does. Energy stores are easily depleted, and it can take a long time to build up the reserves again. By pushing themselves too hard a head injured person can exhaust the supply of energy, so it is better to recognise the early signs of fatigue and to rest.
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Around a quarter of people with severe head injuries are still suffering from headaches two years after the accident. The effects range from mild, occasional inconvenience to nearly total incapacitation. These headaches are generally aggravated by stress, or by trying to 'do too much'.
Headaches can be helped by a stress management programme, the same medication as is used for migraine treatment, muscle relaxation or acupuncture.
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Damage, particularly to the cranial nerve, can result in dysarthria. This means that the muscles needed for articulation of speech become weak and un-coordinated. This can cause speech to become slurred, slower or quieter than normal.
A speech and language therapist can help the patient relearn basic muscle movements, and improve the quality of speech to a degree.
Dysphagia is a problem affecting the ability to chew and swallow. This can cause choking or malnutrition, and may result in a person being fed using a tube through the nose or direct to the stomach, at least in the short term.
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Continence is a cognitive skill since the subtle signs that a person needs to use the toilet must be recognised. It is also a physical skill, in that the person needs to be able to act on the signs. After a head injury, a number of basic skills like this need to be relearned.
Other factors affect continence, such as medication, physical disability, communication difficulties and embarrassment, and all need to be taken into account.
When purely physical problems have been eliminated, sometimes a person may continue to be incontinent as a way of objecting to a situation, or as a way of getting attention. A behaviour modification programme can be worked out with the help of nursing staff, or a clinical psychologist for more severe problems.
In most areas, a continence adviser is available. They can help you to overcome your difficulties by assessing your situation and advising you on medication, equipment or alternative therapies that may be able to help. Speak to your GP or a member of your medical team and ask for a referral.
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In some cases damage to the pituitary gland can occur alongside brain injury. This can cause hormonal changes. The effects of this can be wide-ranging, and in some cases can overlap with the symptoms of brain injury.
You can find out more about the symptoms of this on the Pituitary Foundation's website, using the link at the bottom of the page. If you are concerned that this could apply to you, you should discuss this with your GP or treating physician.
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Injury to the brain in the form of a scar increases the risk of an epileptic attack. This is more likely to happen in a penetrating injury, where the skull has been fractured and the brain pierced by the skull or some other foreign object.
Although the wound heals, the resulting scar causes the electrical activity in that area to be unstable and liable to bursts of uncontrollable activity. Seizures brought on by a head injury often occur within the first week after the injury, but the first may not appear until one or two years have passed. A person is not considered free of seizures until 2 or 3 seizure-free years have passed.
In the UK it is usual for a person to surrender their driving licence until a time when a doctor decides the person is seizure-free. There is more information on driving after a brain injury in the driving section.
Our factsheet 'Brain Injury and Epilepsy' can be downloaded free of charge from our factsheets page. The charity Epilepsy Action provide a great deal of advice on epilepsy, use the link below to get to their website.
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