Brain injury is unpredictable in its consequences. Brain injury affects who we are, the way we think, act, and feel. It can change everything about us in a matter of seconds. The most important things to remember:
• A person with a brain injury is a person first
• No two brain injuries are exactly the same
• The effects of a brain injury are complex and vary greatly from person to person
• The effects of a brain injury depend on such factors as cause, location, and severity
1.7 million people sustain a traumatic brain injury (TBI) each year. According to the Centers for Disease Control and Injury Prevention, the leading causes of TBI are:
• Falls (35.2%)
• Motor vehicle-traffic crashes (17.3%)
• Struck by/against events (16.5%)
• Assaults (10%)
A Healthy Brain
To understand what happens when the brain is injured, it is important to realize what a healthy brain is made of and what it does. The brain is enclosed inside the skull. The skull acts as a protective covering for the soft brain. The brain is made of neurons (nerve cells). The neurons form tracts that route throughout the brain. These nerve tracts carry messages to various parts of the brain. The brain uses these messages to perform functions. The functions include our coordinating our body’s systems, such as breathing, heart rate, body temperature, and metabolism; thought processing; body movements; personality; behavior; and the senses, such as vision, hearing, taste, smell, and touch. Each part of the brain serves a specific function and links with other parts of the brain to form more complex functions. All parts of the brain need to be working well in order for the brain to work well. Even “minor” or “mild” injuries to the brain can significantly disrupt the brain’s ability to function.
An Injured Brain
When a brain injury occurs, the functions of the neurons, nerve tracts, or sections of the brain can be affected. If the neurons and nerve tracts are affected, they can be unable or have difficulty carrying the messages that tell the brain what to do. This can change the way a person thinks, acts, feels, and moves the body. Brain injury can also change the complex internal functions of the body, such as regulating body temperature; blood pressure; bowel and bladder control. These changes can be temporary or permanent. They may cause impairment or a complete inability to perform a function.
Functions of the Brain
The brain is divided into main functional sections, called lobes. These sections or brain lobes are called the Frontal Lobe, Temporal Lobe, Parietal Lobe, Occipital Lobe, the Cerebellum, and the Brain Stem. Each has a specific function as described below.
Parietal Lobe Functions
Sense of touch
Spatial perception
Differentiation (identification) of size, shapes, and colors
Visual perception
Occipital Lobe Functions
Vision
Cerebellum Lobe Functions
Balance
Skilled motor activity
Coordination
Visual perception
Brain Stem Functions
Breathing
Arousal and consciousness
Attention and concentration
Heart rate
Sleep and wake cycles
Frontal Lobe Functions
Attention and concentration
Self-monitoring
Organization
Speaking (expressive language)
Motor planning and initiation
Awareness of abilities and limitations
Personality
Mental flexibility
Inhibition of behavior
Emotions
Problem solving
Planning and anticipation
Judgment
Temporal Lobe Functions
Memory
Understanding language (receptive language)
Sequencing
Hearing
Organization
Right or Left Brain
The functional sections or lobes of the brain are also divided into right and left sides. The right side and the left side of the brain are responsible for different functions. General patterns of dysfunction can occur if an injury is on the right or left side of the brain.
Injuries of the left side of the brain can cause:
Difficulties in understanding language (receptive language)
Difficulties in speaking or verbal output (expressive language)
Catastrophic reactions (depression, anxiety)
Verbal memory deficits
Impaired logic
Sequencing difficulties
Decreased control over right-sided body movements
Injuries of the right side of the brain can cause:
Visual-spatial impairment
Visual memory deficits
Left neglect (inattention to the left side of the body)
Decreased awareness of deficits
Altered creativity and music perception
Loss of “the big picture” type of thinking
Decreased control over left-sided body movements
Diffuse Brain Injury (The injuries are scattered throughout both sides of the brain) can cause:
Reduced thinking speed
Confusion
Reduced attention and concentration
Fatigue
Impaired cognitive (thinking) skills in all areas
When the brain injury causes impaired movement of upper or lower limbs the Tutor system has demonstrated remarkable improvement when integrated into the post stroke physiotherapy program.
Intensive exercise practice has shown to improve functional movement ability following orthopedic and neurological injury and disease. Patient motivation and control of the exercise practice are the fundamental factors that are required for optimum functional recovery. Traditional practice is mostly based on low technology tools that intrinsically lack features to challenge and motivate the patient to intensive exercise training. In addition low technology tools do not provide sufficient resolution to completely control the required exercise performance.
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The system consists of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.
Currently in use in leading U.S. and foreign hospitals and clinics the new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified.
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