Symptoms
post-injury can be mild, moderate or severe. Mild includes but
not exclusive to; headache, confusion, light headedness, dizziness,
blurred vision, tinnitus, fatigue / lethargy change in sleep
patterns, behavioural and mood changes, memory and concentration
problems. Moderate or severe include all of the above in addition
to; persistent headache, repeated vomiting and nausea, convulsions
or seizures, slurred speech, weakness or numbness in extremities,
loss of coordination and an increase in confusion and agitation.
The consequences of TBI can be divided into cognitive, behavioural
and neurological.
Cognitive
These can occur either singularly or in combinations with variable
effects which may change in severity and presentation over time.
These may include memory impairment and difficulties in attention
and concentration, problems with language use, visual perception
and difficulties with frontal lobe functions such as executive
skills in problem solving, insight, judgment, planning and information
processing. In children, learning of new skills may be impaired.
Behavioural
These include a decrease in the ability to initiate responses,
increases in physical aggression and agitation, learning
difficulties, altered sexual functioning, and social disinhibition.
Patients can experience mood changes such as emotional lability
(mood swings), personality changes, depression and anxiety.
Neurological
The neurological consequences are many and complex often influencing
any sensory, motor (movement) and autonomic functions across
a time-course often spanning many months and may be lifelong
in some patients. Traumatic brain injury can cause a dramatic
change in the life course for the patient and their family but
also has consequences for friends, the community and society
in general.
Because of the complexity, recovery can be a series of “gains” followed
by “setbacks” and “plateaus” continuing
indefinitely. Plateaus do not indicate that a treatment's benefits
have ended and are typically followed by further gains.
Most of the consequences are apparent within the first few days
and months after the initial injury depending on the severity
of the trauma. Head injury can cause impairments of voluntary
movement and can cause new movement disorders; these long-term
effects in approximately 20% of severe head injury patients may
include tremor, Parkinsonism, dystonia (co-contraction of muscles
resulting in deformed posture), chorea (involuntary writhing
movement of a limb), myoclonus (“electric-like” jerks)
and tics; rarely are these in isolation but combined with paresis (partial loss of movement), spasticity
and ataxia (unsteady or clumsy movement). Tremor may improve
longterm but other movement disorders tend to persist. Coexisting
with dystonia, there is often persistent muscle hypertonia (spasticity) and rigidity accompanying
the limb or axial deformity. Dystonia can be generalised, regional
or segmental appearing after the first month until up to 9 years
post the injury; hemidystonia (one-sided) is more prevalent than
generalised. The incidence of contractures after severe brain injury has been reported to be as high as 84% requiring rehabilitation. |
