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Brain injuries

• What is a brain injury?
• A serious brain injury usually results in a loss of consciousness (coma) that may last only a few minutes or may extend to days, weeks, or months. If the coma is short, return to full or nearly full function is likely but not certain. The longer a person remains in a coma, the more likely that intellectual and speech impairment, behavioral disorders, and/or related physical disabilities may occur.
  
  A person doesn't have to lose consciousness to sustain a brain injury. Minor brain trauma—where a person experiences an alteration but little or no loss of consciousness and no resulting hospitalization—may also cause temporary or permanent damage to the brain.
  
  A person doesn't have to strike his or her head against something to sustain a brain injury. An example of this is "shaken baby syndrome. "
• What are some of the long-term consequences of a brain injury?
• Any or all of the following consequences may occur in varying degrees after a brain injury. Good pre-hospital care, appropriate trauma treatment and intensive rehabilitation are needed to minimize the consequences of a brain injury. Cognitive
  • memory loss (short and long term)
  • problems in arousal, attention, and concentration
  • problems in initiating action, planning action and follow up
  • problems in judgment
  • difficulty in recognizing one's own cognitive deficits/limits
  • difficulty with abstract thinking (one needs simple, concrete direction)
  • difficulty making generalizations based on a specific time, place or idea
  • spatial disorientation (problems with perception, direction, etc. )
  • slowness of thought processes
  • slowness and/or difficulty with speech
  Physical:
  • fatigability; maintaining attention and activity produces fatigue
  • visual impairment
  • hearing impairment
  • loss of taste
  • spasticity
  • hemiparesis (weakness on one side of the body)
  • seizures
  Psychosocial:
  • anxiety and depression
  • emotional lability (mood swings)
  • denial of any problem
  • inappropriate behaviours (impulsivity, disinhibition, lack of social judgment and appreciation of subtleties)
  • egocentricity (focus on one's self; loss of social perspective)
  • agitation/outbursts
  • sexual dysfunction
  • loss of social network/isolation
• Does ICBC provide specialized assistance to people with brain injuries?
• ICBC has a department that specializes in providing ICBC Accident Benefits to people who have suffered severe injuries in vehicle accidents. This includes people who have suffered moderate or severe brain injuries as occupants of vehicles as well as pedestrians and cyclists, regardless of fault.
  
  A person injured in a vehicle accident in British Columbia is generally entitled to rehabilitation up to a maximum value of $150,000. If you or a family member has suffered such an injury and ICBC has not appointed a Rehabilitation Coordinator from ICBC's Rehabilitation Department, you should insist that your ICBC adjuster refer the case to the Rehab Department. If the adjuster is not willing to do this, then speak to his or her manager and find out exactly why a referral is not being made. You should also speak to a lawyer who is experienced in handling brain injury cases.
  
  Once a Rehab Coordinator is appointed, he or she will immediately order your hospital records to determine the extent of your injuries. He or she will also appoint specialists to work with you, such as an occupational therapist, speech therapist, physiotherapist, psychologist, exercise therapist or house cleaner. Later on, after your condition has improved, he or she may hire a vocational consultant to assist you in preparing for your return to work.
• What role should my family doctor play in my rehabilitation?
• Your family doctor will receive the emergency room report and the hospital discharge report. This will give him or her some knowledge of what you or your loved one has gone through.
  
  Your family doctor is the only person who can refer you to specialists who are paid by the Medical Services Plan of British Columbia. The medical specialists who usually oversee the rehabilitation of people who have suffered a brain injury are:
  • a psychiatrist who specializes in treating people who have suffered a brain injury (very few do so)
  • a sleep disorder physician, if appropriate, and
  • a specialist in Physical and Rehabilitation Medicine, called a "physiatrist. "
  Your family doctor may refer you to the "Self-management Program for Chronic Mild Brain Injury" over 10 weeks at GF Strong Rehabilitation Centre in Vancouver, British Columbia, or to the outpatient Acquired Brain Injury programs at:
  • Fraser Health (covering Burnaby to Boston Bar). Phone 604-933-2050 to inquire about these programs
  • Vancouver Coastal Health (covering Pemberton to Richmond) at GF Strong Rehabilitation Centre in Vancouver, British Columbia. Phone 604-737-6272 to inquire about these programs
  • elsewhere in British Columbia
  A doctor's referral to a physiotherapist, occupational therapist or psychologist is not funded by the Medical Services Plan of British Columbia (MSP). ICBC will have to fund these treatments.
• What evidence is needed to prove that a person has suffered a mild traumatic brain injury in a vehicle accident?
• If emergency personnel at the accident scene suspect that a person has suffered a concussion, they use the Glasgow Coma Scale (GCS) to assess the degree of impairment of consciousness that the patient is suffering. GCS tests the patient's:
  • eye opening response to verbal stimuli or to pain
  • verbal response (is the patient confused or incomprehensible? ), and
  • motor response (does the patient obey commands for movement? )
  GSC is scored between 3 and 15 - 3 being the worst and 15 being the best. A GCS of 13 or higher correlates with a mild brain injury, 9 to 12 is a moderate injury and 8 or less is a severe brain injury.
  
  Sometimes a patient experiences a change in consciousness after an accident but returns to almost normal consciousness by the time emergency personnel arrive on the scene. The emergency personnel may assess the patient's GCS and find it to be 15 out of 15. In this case, it is extremely important to quickly identify and speak to any witnesses in the patient's vehicle (or in the vicinity) who may have noticed changes in the patient's consciousness prior to the emergency personnel's arrival, before they forget some or all of what they observed.
  
  Although a person's head doesn't have to strike something in order for that person to suffer a brain injury, it is often easier to prove a mild brain injury in a person with a GCS of 15 out of 15 if a person's head did strike something such as a side window or pillar.
  
  If there is any question that a patient arriving at a hospital emergency room may have suffered a concussion emergency medical staff should also test the patient's GCS. A patient's level of consciousness may sometimes drop between when they are at the accident scene and when he or she arrives at the hospital.
  
  Sometimes family members or friends meet with the patient in the emergency room. It is important that they note down any changes they notice in the patient's consciousness and cognitive functioning. For example, they may note examples of confusion in the patient.
  
  Friends and family members may notice changes in the patient over the next several days. They should report this to the patient's family physician when the patient is not in the room. Hopefully the patient's physician will also notice the changes. It may be valuable for family members and close friends to each keep a diary of their observations of the injured person.