The brain is a complicated, fragile and delicate organ. Damage to a localized area responsible for managing explicit functions may reveal itself rather immediately while the patient is undergoing initial testing and treatment. For example, damage to the occipital region of the brain may manifest itself in the form of vision impairment where there once was none. Conversely, because damage to the brain may occur deep within the tissues, symptoms or cognitive dysfunctions may manifest themselves only long after the patient is released from care and after the more superficial symptoms have resolved.
Subcortical areas deep within the brain are commonly injured in car crashes. These areas are responsible for assisting in processing information or enhancing communication between the hemispheres. Damage to areas responsible for more complicated cognitive functions may come to light only after the patient returns to their natural environment and reassumes multifaceted tasks. Multifaceted or complex tasks are common cognitive exercises requiring the use of more than one portion of the brain at a time. For example, balancing activities, the recognition and drawing of pictures, engaging in conversation without forgetting what the other person said, discriminating sizes and shapes, interpreting touches and feelings, and making judgments.
Damage to subcorticol areas affect other aspects of the brain’s functioning and manifest themselves in the following cognitive functions:
Problems with Learning and Memory. Although retrograde memory of learned skills remains relatively intact, ascertaining new abilities may prove challenging for a brain damaged patient. Despite a successful return to their previous occupation, they may develop problems when promoted, advanced to new positions or are mandated to acquire new skills. Mental rigidity is an ever-lurking dilemma for brain damaged survivors. Moreover, they may be unable to perform the simplest, most mundane memory tasks and regularly misplace common articles such as car keys, wallets, cell phones or important documents. Even moving furniture may prove to have an unsettling effect on a brain damaged patient.
Problems with Attention and Concentration. This is an area of great hardship and frustration for a brain damaged patient. The inability to concentrate on a single task, conversation or direction due to a distraction, i.e., another conversation in the background, a chirping bird or barking dog, machinery, etc. poses the greatest test for brain damaged patients and is typically indicative of a frontal lobe injury, the site of the brain most vulnerable to damage in car accidents. These individuals often lose track of time, are unable to smoothly transition from one conversation to another when interrupted and lose their thought in mid-sentence. Understandably, they become insecure and emotionally fragile, requiring a considerable amount of emotional support and patience from friends and loved ones alike.
Problems with Information Processing, Speed, and Capacity. This is another area of great frustration for a brain damaged individual. Closed head injuries affect one’s ability to react quickly, process simple information, follow instructions, and may affect short-term memory. They become easily “overloaded” (and overwhelmed) with incoming information and are unable to process thoughts at the speed in which they’re accustomed. This affects all areas of their lives which leads to frustration, stress, depression and isolation which only serves to compound the problem.
Problems with Executive Functions. Executive or higher level cognitive functions include planning, reasoning, prioritizing, organizing, sequencing steps to complete a task, and monitoring one’s own behavior. Because brain damaged individuals are unaware of their inability to monitor their own behavior, plan or prioritize activities, family members and friends are most affected by this problem. As a result, it is problems with executive functions that negatively impacts relationships and, in some cases, results in divorce and self-imposed exile.
Problems with Emotions. The inability to monitor one’s own behavior leads to behavioral problems and, in some instances, personality changes. For example, a brain damaged individual may become impulsive, angry, unable to practice self-restraint, experience mood swings and dramatic emotional outbursts, exhibit frustration, tension and depression, behavioral problems which negate the development of healthy relationships.
Miscellaneous Problems. For unknown reasons, brain damaged patients cite fatigue, sleep disorders and loss of smell as other sources of irritation and concern.
Clinicians are challenged by the inability to recognize the extent to which cognitive “malfunctions” affect a patient’s life. First, brain damage affects one’s ability to verbally convey these cognitive disturbances to a clinician. With even the most educated brain damaged patient, words become elusive, impairing one’s ability to discuss these disturbances in concise terms. Secondly, the brain damaged patient may not always perceive or recognize these cognitive changes within themselves so as to convey them adequately to a clinician. Still further, those who do recognize within themselves that something may be wrong, may be ill-advised by clinicians unable to measure specific cognitive changes, rendering the patient frustrated and depressed. Finally, a brain damaged individual may experience confusion, uncertainty, or even embarrassment about their experiences and not relay them entirely to a clinician for fear of repercussion or shame. All of these affect the clinician‘s ability to fully comprehend the extent of brain damage.
Tragically, as a result, patients are released from care without referrals to brain injury rehabilitation facilities or guidance of any sort.
Part 5: Recovery and Rehabilitation
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• Johnson, G. (1998). Traumatic brain injury survival guide: How the brain is hurt. Retrieved from website www.tbiguide.com/howbrainhurt.html.