World Head Injury Awareness Day : 20 March 2010
The KwaZulu-Natal Department of Health is observing the World Head Injury awareness Day on the 20 March 2010
According to the annual mid-year estimates from Statistics South Africa
(July 2009) the South Africa's population was 49.3 million. The 2001 census
estimated disability prevalence in South Africa to be 5% of the total population
An estimate of 89 000 cases of new traumatic brain injuries are reported
annually in South Africa.
The Department of Neurosurgery in Durban ,South Africa which was initially based
at Wentworth Hospital from 1980 to the end of November 2002 , which is currently
based at Inkosi Albert Luthuli Central Hospital as from December 2002, the
Department of Neurosurgery has seen from 1983 to 2006 a total admission of 43626
of which 18207 were trauma related .
What is brain injury?
Brain Injury Group (BIG) defines an acquired brain-injury as an acute injury
/impairment of normal brain function that causes altered cognitive functioning.
The brain injury could open or closed (Traumatic Brain Injury; Neurological
What are the causes of Head Injury?The three most common causes of a head injury are:
Motor vehicle, bicycle,
or vehicle-pedestrian mishaps (more than 50%); Falls (approximately 25%) and
violence (nearly 20%)
What are the risk factors of Head of Injury?
- Age: Individuals between the ages of 15 and 40 years as well as
individuals at extremes of age, less than 5 years and greater than 75 years
- Sex: Head injury occurs twice as often in men as in women.
- Other risk factors include: Alcohol and drug Abuse; Wars and violence;
Contact and extreme sports; Driving at high speeds and without seatbelts;
Driving motor cycles without helmets and construction work
What are the common Complications and Challenges?
Some people who have had a traumatic brain injury will experience at least
one seizure during the first week after the injury. This doesn't appear to
increase their chances of developing epilepsy. However, the chance of
epilepsy does increase if there are major structural injuries to the brain.
Skull fractures or penetrating wounds can tear the membranes (meninges) that
surround the brain, letting in bacteria. Infection of these membranes
(meningitis) can be especially dangerous because of its potential to spread
to the rest of the nervous system.
Injuries to the base of the skull can damage cranial nerves, which may
result in: Paralysis of facial muscles; Damage to the nerves responsible for
eye movements, which can cause double vision and damage to the nerves that
provide sense of smell.
Post Traumatic Hydrocephalus
Inability of the brain to absorb cerebrospinal fluid resulting in increased
amount in the brain causing high pressures.
Most people who have had a significant brain injury will experience some
problems in their cognitive skills, which may include: Thinking, reasoning,
problem solving, information processing, memory, speed of mental processing,
judgment, attention, multi-tasking.
The most common of these impairments is short-term memory loss. That means
the injured person recalls information from before the head trauma, but has
to struggle to learn new information after the head trauma.
Communication problems are common. Some people who have had brain injuries
have problems with spoken and written language, while others have problems
deciphering nonverbal signals. In some cases, poor cognitive skills may
disrupt the ability to succinctly organize thoughts and ideas.
Brain injuries typically interfere with impulse control, so inappropriate
behaviour is often present during recovery and rehabilitation. Patients may
be more irritable, anxious or depressed. These unstable emotions and
impaired social skills may pose the greatest coping challenge for many
Problems involving senses may include: A persistent ringing in the ears;
Difficulty recognizing objects; Impaired hand-eye coordination, which can
make one appear clumsy; Blind spots or double vision; and a bitter taste or
a bad smell.
Post-concussion syndrome is a complex disorder in which concussion symptoms
such as headaches and dizziness manifest. These symptoms can last for weeks
and sometimes months after the impact that caused the concussion.
Emotional problems e.g. depression, insomnia and lack of interest in daily
activities and work may be experienced by patients with head injury.
Alzheimer's or Parkinson's disease
A traumatic brain injury appears to increase the risk of eventually
developing Alzheimer's disease and, to a lesser degree, Parkinson's disease.
The higher the frequency and severity of the injuries, the greater the risk.
Coma and Death
A person who is unconscious and unresponsive is in a coma. A coma may also
lead to a vegetative state or death.
How do you prevent Head Injury?
Head injury prevention methods include:
- Always wear a seat belt in a motor vehicle
- Use an appropriate child safety seat or a booster
- Never drive under the influence of alcohol or drugs
- Always wear a helmet when on a bicycle, motorcycle, scooter and other open unrestrained vehicles
- Wear a helmet when participating in contact sports
- Wear a helmet when horseback riding
Fall Prevention Methods:
- Use the rails on stairways
- Provide adequate lighting, especially on stairs for people with poor
vision or who have difficulty walking
- Place bars on windows to prevent children from falling
- Sit on safe stools
- Do not place obstacles in walking pathways
- Keep guns locked in a cabinet
- Store guns unloaded
- Store ammunition apart from guns
How do you manage head injury patient at home?
Once the patient has been discharged from the inpatient rehabilitation
treatment unit, the outpatient phase of care begins and goals often will
shift from assisting the person to achieve independence in basic routines of
daily living to assessing and treating broader psychosocial issues
associated with long-term adjustment and community re-integration.
Patients will often have problems in the areas of general cognition, social
cognition/awareness, behaviour and emotional regulation that present
significant challenges, in terms of being able to resume expected social
roles. Often these problems are complicated by adjustment issues that emerge
as the person becomes more aware of their residual deficits and faces the
challenges of coming to terms with the long-term effects of the injury.
Family members may benefit from psychotherapy and social support services.
Support for caregivers becomes particularly important during the outpatient
phase of care when behavioural and cognitive problems may complicate and
impair the relationships that patients have with those around them. Major
challenges occur in sustaining these relationships, particular in the
context of marriage, when the impact of the injury significantly alters the
relationship in such a way that the resumption of an adult-level interactive
relationship may be deeply undermined.
Caretakers of traumatically brain injured patients can often feel a great
deal of emotional stress, which can reduce the quality of care. Respite care
such as supported living and residential holidays, supported days out doing
activities like walking, cycling and climbing offers relief for them and a
new area of brain stimulation for the patient. When dealing with caretakers,
providers of respite care need to be sensitive and reassuring; some
caretakers may have feelings of guilt or inadequacy.
What are the support programmes for head injury patient?
Head injury patient will be cared for by a team of professionals who
specialize in the care of trauma victims through rehabilitation.
Their goals are to:
- Stabilize the medical and rehabilitation issues related to brain injury
and the other injuries.
- Prevent secondary complications. Complications could include pressure
sores, pneumonia and contractures.
- Restore lost functional abilities. Functional changes could include
limited ability to move, use the bathroom, talk, eat and think.
- The staff will also provide adaptive devices or strategies to enhance
- The staff will begin to analyze with the family and the patient what
changes might be required when the person goes home.
- Each day, the patient will participate in therapy. Initially, the patient
may require staff assistance for even the simplest activities: brushing
teeth, getting out of bed and eating. The patient also may require staff for
safety because there is a risk of falling, eloping (trying to get out of the
hospital to go home) or getting hurt. The patient may be confused and
The Rehabilitation Team:
1) The Physiatrist/ Medical Officer: is the team leader in the
rehabilitation program. Physiatrists treat a wide range of problems,
including the changes after brain injury. The physiatrist will assess and
prescribe the treatment and direct the team.
2)The Neuropsychologist: is a key member of the rehabilitation team. The neuropsychologist will assess the patient's changes in thinking and
behaviour. Changes could include:
3)The Rehabilitation Nurse: Assists patients with brain injury and chronic
illness in attaining maximum optimal health, and adapting to an altered
lifestyle. The Rehabilitation Nurse provides care for the patient in the
nursing unit. The focus of nursing care is on:
- Poor memory
- Poor attention and concentration
- Poor decision-making
- Language and communication abilities
- Inability to speak
- Inability to understand when spoken to
- Many patients are unaware of the changes in the brain and how those
changes affect their daily lives. A patient may not understand what has
happened and may be distraught by being away from home. Through education
and counselling, the neuropsychologist can help assure the patient and the
- Health maintenance
- Potential for aspiration
- Impaired skin integrity
- Bowel and bladder incontinence
- Impaired physical mobility
- Impaired or limited ability to take care of self
- Ineffective airway
- Sleep pattern disturbance
- Chronic pain
- Impaired cognition
- Impaired verbal communication and comprehension
- Sexual dysfunction
4) The Physiotherapist: works with people with orthopaedic problems, such as
low back pain, knee injuries or pain reduction. With traumatic brain injury,
the Physio's job is to minimize or overcome paralyzing effects related to
the brain injury. Physiotherapists are experts in the examination and
treatment of musculoskeletal and neuromuscular problems that affect the
abilities to move and function in daily life.
Physiotherapists help with transfers to and from the bed when a patient
cannot walk alone. They train a person to begin to walk and move more
normally. Physios will assess and or treat patients for: balance, posture,
strength, need for a wheelchair, brace or cane, quality of movement,
spontaneous movement, coordination of movement, increased sensation of
sensory-motor activities and pain management
5) The Occupational Therapist (OT): assesses functions and potential
complications related to the movement of upper extremities, daily living
skills, cognition, vision and perception. OTS helps determine, with the
patient, the best ways to perform daily living skills including showering,
dressing and personal hygiene. The OT will identify equipment for eating,
dressing and bathing.
The OT also will look at skills to prepare the patient for a return to the
home. These skills include: activities of daily living including bathing,
dressing, cooking, grocery shopping, banking, budgeting and others. OTs also
assists a patient with readiness for returning to work by assessing
prevocational and vocational skills.
6) Head Injury Support group
Help patient to feel that they are not alone and to share their experiences
7 ) Social Worker
Social workers are skilled in helping families receive the practical help
that is needed. They can provide information about benefits, accommodation
and transport and information on disability grant if needed. The social
worker is also an experienced counsellor, and is there to talk to about
emotions and feelings.
8) Speech and Language Therapist
Speech and language therapists aim to help patients communicate more
effectively using both the spoken and written word. They may provide
structured exercises and activities aimed at improving speech and language
skills, or may work with other staff and relatives to improve all-round
communication. The speech therapist will also have experience of
Head injury is a devastating condition that causes major psychosocial
complications and requires a multidisciplinary approach for treatment to be
For more information on head injury, you can contact Dr. Basil Enicker at
the Department of Neurosurgery, Inkosi Albert Luthuli Central Hospital tel.
031 240 1133, email firstname.lastname@example.org or the Disability and
Rehabilitation Programme on tel. 033 846 7247 or email Daniel.email@example.com
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