"Acquired brain injury" (brain injury) refers to brain damage arising from a traumatic event or cerebral hemorrhage. Brain injuries in which there is a loss of consciousness (coma) of more than 24 hours are defined as serious and obtain a score equal to or less than eight points in a coma measuring instrument called the Glasgow Coma Scale (GCS).
Cranium-encephalic trauma, for example, is the result of a direct hit or a force applied to the head that is so strong as to cause brain damage. What happens in a car accident, for example, is that the brain, projected at a certain speed and acceleration, undergoes a sudden stop and therefore sudden deceleration, with consequent injuries caused by the internal impact of the brain against the cranium.
Naturally, the higher the speed at which the impact occurs the greater the brain damage will be. The cranial - encephalic trauma is defined open if the impact causes fractures of the cranial box and damages the more consistent and resistant meningeal casing, defined as "dura mater", and closed if the impact damages the brain without fracturing the skull.
50 Brain function
The brain, along with the spinal cord contained within the spinal column, go to form the Central Nervous System of which the main cells are neurons, which once dead no longer have the ability to reproduce during the course of life. This means that neurons destroyed by a traumatic event cannot be reproduced and are therefore lost forever. However, our brain can have the ability to compensate for the loss of neurons by generating new connections between the remaining cells thus creating new ways to replace lost functions.
Obviously, as we know, the brain is contained within the skull and is completely enveloped in a series of membranes, the meninges, the most external of which is as hard as leather and is called dura mater and is divided into two main structures called cerebral hemispheres each of which performs different tasks:
LEFT HEMISPHERE: (dominant in a right-handed subject) controls the
functions of language such as comprehension and the production of words and speech, reading and writing
RIGHT HEMISPHERE: controls visual-spatial functions and movements
51 Each hemisphere is formed of four lobes:
FRONTAL LOBE: involved in emotional control and the production of language
PARIETAL LOBE: involved in memory functioning and language comprehension (left hemisphere)
TEMPORAL LOBE: the center of sensory control
OCCIPITAL LOBE: the area dedicated to the perception of visual images
Just like the hemispheres, the cerebral lobes also work in a synergistic and coordinated way.
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1.1 Treatment and the rehabilitation process
People with severe acquired brain injuries obviously need highly specialized treatment. It is divided into different phases, each of which has different goals and objectives addressed to different aspects of the patient’s life. It is important to underline that a serious trauma event not only has repercussions on all aspects of the patient’s life but also on those of his or her family.
The rehabilitation of a person with severe brain injury is carried out by a group of professionals working in a team, the essential members of which are the physiatrist, the nurse, the physiotherapist and the speech therapist. After being admitted to the Rehabilitation Unit, the trauma patient is assessed and on the basis of the results the team draws up a tailor-made rehabilitation program, which also defines the team’s objectives and what they aim to achieve by the end of the care pathway.
In the first stage, when the patient comes out of the coma and is transferred to the Rehabilitation Unit from Intensive Care, the main objectives concern:
Achieving satisfactory clinical stability
The recovery of autonomy in the so-called basic vital functions
The prevention or the reduction of damage caused by immobility
Facilitating the recovery of the abilities to communicate with the environment
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Progressively, if the patient has achieved satisfactory clinical stability and has recovered, even partially, a certain ability to communicate and collaborate, the new objectives are:
Improving motor ability by trying to move their limbs
Improving cognitive skills, trying to encourage the recovery of their ability to pay attention, to express themselves correctly and to remember
Improving behavioural skills.
There are various systems to classify the level of recovery that a person can achieve following brain injury. One of the simplest and mostly widely used is the Glasgow Outcome Scale (GOS), a tool that ranks the recovery level in five categories:
Good recovery: the person basically succeeds in resuming the level of autonomy and life as before
Moderate disability: the person manages to recover a certain autonomy but presents cognitive difficulties
Serious disability: the person manages to recover the ability to communicate with the environment but is not autonomous in daily activities and needs the help of other people
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Vegetative state: the person is in a situation of "non-responsive wakefulness"; keeps their eyes open but is not able to communicate with the environment
Death: unfortunately, death without recovery of consciousness is possible
1.2 Coma and the recovery of consciousness
Coma is a state of unconsciousness that manifests itself with the inability to have contact with the environment and the impossibility of obtaining voluntary reactions from the patient.
The consequences of coma can be of varying degrees, depending on the patient’s age, extension of the lesions, duration of the period of unconsciousness, and the recovery times of the neurological functions. The seriousness of a coma is measured by:
1. The Glasgow Coma Scale (GCS): the scale that is used to evaluate the