I am often asked clinical questions pertaining to traumatic brain injury (TBI). There are two major types of TBI that include closed head injury (CHI) in which the skull is struck and does not fracture. The second type is known as open head injury in which the skull is struck and fractures (split the head open). Sometimes an open head injury is advantageous as it permits room for the predictable swelling or edema that occurs with head injuries. The problem with an open head injury is high risk for infection.
Closed head injuries are caused by a blow to the head from a motor vehicle accident, sports such as football, hockey, and even soccer, falls, and being hit by an instrument or other object. The brain sits in a liquid medium called cerebral spinal fluid and it will move inside the skull with an accelerating and then decelerating force. The brain can be injured at the site of the trauma (coup) and also on the opposite side of the brain as it moves in the liquid medium and hits against the skull (contracoup). As the skull is most rugged in the front and temporal skull regions with a smoother surface in the rear of the skull, it is common to experience cognitive and behavioral changes related to damage in the fronto-temporal region.
Such changes in cognition from a closed head injury typically involve memory, attention, and personality change. It is difficult to predict behavioral and cognitive changes related to open head injuries until the site of the damage is clearly known. Other factors such as loss and duration of loss of consciousness and memory loss that predates the time of the injury (retrograde amnesia) and post-dates the injury (anterograde amnesia) relate to extent and severity of the brain injury.
Treatment for TBI includes medication, surgery, speech, occupational, and physical therapy, and time. Improved function and cognition occurs primarily in the first year post injury, but improvement can continue to occur into the third year. Little is known about the effects of a proactive brain health lifestyle and or the consistent use of cognitive-based mental exercise software on recovery. This is an empirical question that is generating interest and attention.
The brain will heal to some degree, hopefully to a complete recovery, and one should not discount lifestyle for brain health and use of cognitive exercises to help in the process.
Dr. Paul Nussbaum
fit brains
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