Written by Daniel Bode [1]
Introduction
The human brain. A complex organ with much responsibility. It controls emotion, thought, memory, locomotion, and other autonomous actions, that if not managed would lead to unfavourable outcomes. Our brains give us the ability to interpret the world around us by receiving, processing, and storing all sensory information. Damage to such an intricate and complex organ could interfere with information processing, as well as possibly prevent necessary functions from being executed inhibiting daily function.
World Head Injury Awareness Day
World head injury and awareness day is observed annually on the 20th of March to educate the public about traumatic head injuries. The campaign hopes to increase understanding of the chronic nature of brain injuries, reduce the stigma that is coupled with brain injuries, spread awareness about brain injury diversities, and help improve care and support for those with brain injuries and the social groups around them.
What is a head injury?
Head injuries, like many areas of academia, require constant exploration and research due to their complexity, thus definitions have evolved over the years. Historically a head injury was deemed to be any blow to the head, a laceration of the scalp or the head, or altered consciousness (Jennett et al., 1977; Teasdale, 1995). However, in 2014 The National Institute for Health Care Excellence (NICE) published guidelines that define head injury as “any trauma to the head other than superficial injuries to the face.” (National Institute for Health and Care Excellence (NICE),2014a). More recently, organisations have categorised head injuries into three areas (Brain Injury Group, 2021; Centers for Disease Control and Prevention, 2021; John Hopkins Medicine, n.d.)
- mild: resulting in a loss of consciousness for not more than 15 minutes,
- moderate: resulting in comatose for not more than 6 hours and with post-traumatic amnesia not persisting for more than 24 hours and,
- severe: resulting in comatose for more than 6 hours and most traumatic amnesia persisting for more than 24 hours.
How many people affected
In the Western world, Traumatic Brain Injury (TBI) stands as one of the leading causes of death of people younger than 45 years of age (Okonkwo, 2008), with the United States having an estimated 235 000 nonfatal traumatic brain injury cases yearly (Corrigan et al., 2010). In sub-Saharan Africa, studies found that TBI rates are, on average, higher than in more developed countries (Corrigan et al., 2010; Schrieff et al., 2013), with sub-Saharan countries TBI incidences ranging from 150-170 per 100 000 people compared with a global average of 106 per 100 000 (Kong et al., 2017). South Africa has a population of 60 million people, which implies that there are approximately 100 000 people affected by some severity of head injury.
Awareness
Causes
Head injuries can result from numerous instances with varying prevalence’s depending on demographics and geographical location. An early study published in the University of South Africa in Johannesburg (Nell & Brown, 1991) found that of nonfatal TBI; 45% of causes were from interpersonal violence, almost 35% of causes resulted from motor vehicle collisions and pedestrian vehicle collisions (MVC’s and PVC’s), almost 4% were from falls and approximately 16% from other causes.
Another study conducted by the Pietermaritzburg Metropolitan Trauma Service (PMTS) (Laing et al., 2014) found similar results; 40% of causes were from interpersonal violence, almost 45% of causes resulted from MVCs and PVCs, just over 10% were from falls, and approximately 5% from other causes.
A similar study conducted by Red Cross War Memorial Children’s Hospital (Schrieff et al., 2013) focused on children (aged 0-15 years of age) found that; almost 80% (~55% as pedestrians, ~21% as occupants and ~4% as other) of children suffered TBI’s as a result of motor vehicle accidents (MAV’s), just over 5% were as a result of falling, approximately 9.5% from a form of violence, with the remaining 5,5 % being other causes of head injury.
A study conducted in 2007 aimed to provide an estimation of the magnitude of head injury in SA (Norman, 2007). The study estimated that 46% of injuries would result from interpersonal violence, ~27% from MVA’s, and almost 2% from falls. The study’s estimate was rather accurate, with the exception of MVAs, supporting that MVAs, interpersonal violence and accidental falls are some of the primary causes of TBI’s.
When observing and interpreting the studies, it can be deduced that the primary three causes of TBI are motor vehicle accidents (MVA’s), violence of some form, and accidental falls.
Symptoms
Mild head injury
- Headache
- Areas of swelling (possible superficial cut)
- Audio and visual sensitivity (as well as blurred vision, drowsy eyes, and tinnitus)
- Irritability
- Problems with memory or concentration (as well as confusion)
- Balancing problems
- Nausea
- Change in sleep patterns (as well as fatigue)
Moderate to severe head injury
- Loss of consciousness
- Severe persisting headache
- Repeated nausea and vomiting
- Pale skin colour
- Short-term memory loss, such as events of the traumatic event
- Impedances (Slurred speech, walking difficulties)
- Sweating
- Behavioural changes, including irritability
- Blood or clear fluid draining from the ears or nose
- Unequal pupil size and does not constrict with light exposure
- Deep cut or laceration in the scalp, open head wound, or foreign object in the head
Complications
Cognitive
- Coma
- Vegetative state
- Locked-in Syndrome
Physical
- Seizures
- Fluid buildup
- Infections
- Vertigo
Challenges
Survivors of TBI usually experience one or more challenges as a result of impairments suffered from injury. However, these challenges are not exclusive to the survivor, but also the individuals surrounding the survivor.
Emotional
Survivors found it difficult to come to terms with occurred events and/or accepting of the outcome of the traumatic event, seemingly questioning outcomes and changes associated with TBI (Chembeni & Nkomo, 2017). These can lead to emotional changes such as depression, anxiety, mood swings, irritability, lack of empathy and anger (Morton & Wehman, 1995).
Psychosocial
After experiencing a TBI survivors exhibit inappropriate or poor social skills towards others that may affect how they are viewed in the community, often with friendships being the first to decay (Morton & Wehman, 1995). Psychosocial challenges are also experienced by close relatives/caregivers as more time and care is dedicated to the survivor. Survivors may have difficulties with self-control, lack of awareness, destructive behaviour, and verbal/physical outbursts (Brain Injury Support, 2014).
Cognitive
TBI survivors commonly exhibit issues surrounding attention, concentration, learning and memory, speech and language, and executive functioning (Chembeni & Nkomo, 2017; Barman et al., 2016).
Communication speech and language
Language and communication problems are common amongst TBI survivors and their families. Problems can include difficulty with understanding speech/writing, speaking, thought organisation, conversing, and reading social cues. These problems can cause frustration, misunderstanding, and possible conflict. (Grayson et al., 2020).
Physical
As the brain mediates most of the body’s functioning when an injury is incurred some functionality may be diminished. Physical activities can be laborious and challenging with survivors not being able to walk due to dizziness, complete routine activities due to fatigue, or complete specific locomotory actions due to decreased neuromuscular activity (Driver et al., 2012; Martin, 2013).
Preventative measures
Accidents
- Wear seatbelts when driving
- Do not drive under the influence
- Use helmets on bicycles and motorcycles
- Be aware of your surroundings (avoid looking down at your phone in busy areas)
Falls
- Use handrails where possible (bathrooms and staircases)
- Install no slip rugs in the bathroom/house
- Insure areas are well lit
- Keep walkway clutter to a minimum
- Stay fit and healthy (optometrist checks)
Head injuries are a devastating condition with the capacity to inflict major damages inducing pervasive wide reaching complications that require the commitment of families, communities and a multidisciplinary approach to address.
To ensue the safety of yourself and those around you, use World Head Injury Awareness Day to spread awareness about head injuries and so that you can help mitigate head injuries, and assist in stigmatising removal of the survivors of head injuries.
[1] Author writes in his capacity as Vice-chairperson of the PsySSA Student Division’s Media and Marketing Subcommittee. The PsySSA Student Division is a division of the Psychological Society of South Africa (PsySSA)
Helpline Numbers
Inkosi Albert Luthuli Central Hospital: Depertment of Neurosurgery
Dr. Basil Enicker
Contact: 031 240 1133
Email: basileni@ialch.co.za
Disability and Rehabilitation Programme
KwaZulu-Natal
Contact: 033 846 7247
Email: daniel.simbeye@kznhealth.gov.za
Mental Health Information Line
Contact: 0800 567 567
Mental Health Info Centre
Cape Town
Contact: 021 938 9229
Email: https://mentalhealthsa.org.za/contact-us/
Website: https://mentalhealthsa.org.za/
Brain Injurt Trust
Cape Town
Contact: 021 447 2382
Email: mirriam.jali@thebraininjurytrust.co.za
Website: https://www.thebraininjurytrust.co.za/
Headway
KwaZulu-Natal
Contact: 031 266 2709
Email: manager@headway.org.za
Website: http://www.headway.org.za
Headway Frienndship Circle
Gauteng
Contact: 011 442 5733
Email: http://www.headwaygauteng.co.za/contact-us-2/
Webiste: http://www.headwaygauteng.co.za/
Barman, A., Chatterjee, A., Bhide, R. (2016). Cognitive impairment and rehabilitation strategies after traumatic brain injury. Indian Journal of Psychological Medicine, 38(3), 172–181. https://doi.org/10.4103/0253-7176.183086
Brain Injury Group. (2021, August 21). Types of brain injuries. https://www.braininjurygroup.co.uk/about-brain-injury/types-of-brain-injury/
Brain Injury support. (2014, May 20). Emotional and behavioural Issues for TBI patients. https://www.braininjurysupport.org/living-with-a-traumatic-brain-injury/behavioral-emotional-consequences/
Centers for Disease Control and Prevention. (2021, May 12). Traumatic Brain Injury & Concussion. https://www.cdc.gov/traumaticbraininjury/get_the_facts.html
Chembeni, N., & Nkomo, T. S. (2017). Challenges experienced by survivors of traumatic brain injuries and their families. Social Work, 53(4), 479-495. https://doi.org/10.15270/52-2-594
Corrigan, J. D., Selassie, A. W., Orman, J. A. (2010). The Epidemiology of Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 25(2), 72–80. https://doi.org/10.1097/htr.0b013e3181ccc8b4
Driver, S., Ede, A., Dodd, Z., Stevens, L., Warren, A. M. (2012). What barriers to physical activity do individuals with a recent brain injury face? Disability and Health Journal, 5(2), 117-25. https://doi.org/10.1016/j.dhjo.2011.11.002
Grayson, L., Brady, M. C., Togher, L., Ali, M. (2020). The impact of cognitive-communication difficulties following traumatic brain injury on the family; a qualitative, focus group study. Brain Injury, 35(1), 15-25. https://doi.org/10.1080/02699052.2020.1849800
Jennett, W. B., Murray, A., & MacMillan, R. (1977). Head injuries in Scottish hospitals: Scottish head injury management study. Lancet, 1977,696-8.
John Hopkins Medicine. (n.d.) Head injury. https://www.hopkinsmedicine.org/health/conditions-and-diseases/head-injury
Kong, V. Y., Odendaal, J. J., Bruce, J. L., Laing, G. L., Jerome, E., Sartorius, B., Brysiewicz, P., & Clarke, D. L. (2017). Quantifying the funding gap for management of traumatic brain injury at a major trauma centre in South Africa. South African Journal of Surgery, 55(4), 26-30. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612017000400006&lng=en&tlng=en.
Laing, G. L., Skinner, D. L., Bruce, J. L., Aldous, C., Oosthuizen, G. V., Clarke, D. L. (2014). Understanding the burden and outcome of trauma care drives a new trauma systems model. World Journal of Surgery, 38(7), 1699–1706. https://doi.org/10.1007/s00268-014-2448-8
Martin, J. J. (2013). Benefits and barriers to physical activity for individuals with disabilities: a social-relational model of disability perspective. Disability and Rehabilitation, 35(24), 2030-7. https://doi.org/10.3109/09638288.2013.802377
Morton, M. V., Wehman, P. (1995). Psychosocial and emotional sequelae of individuals with traumatic brain injury: A literature review and recommendations. Brain Injury, 9(1), 81–92. https://doi.org/10.3109/02699059509004574
National Institute for Health and Care Excellence. (2014a). Head injury: assessment and early management (NICE Guideline NG176). https://www.nice.org.uk/guidance/cg176
National Institute for Health and Care Excellence. (2014b). Head injury (NICE Quality Standard QS74). https://www.nice.org.uk/guidance/qs74
Nell, V., Brown, D. S. O. (1991). Epidemiology of traumatic brain injury in Johannesburg—II. Morbidity, mortality, and etiology, 33(3), 289–296. https://doi.org/10.1016/0277-9536(91)90363-h
Norman, R. (2007). The high burden of injuries in South Africa. Bulletin of the World Health Organization, 85(9), 695–702. https://doi.org/10.2471/blt.06.037184
Okonkwo, D. O. (2008). Introduction: Traumatic brain injury. Neurosurgical FOCUS, 25(4), E1. https://doi.org/10.3171/FOC.2008.25.10.E1
Schrieff, L. E., Thomas, K. G. F., Dollman, A. K., Rohlwink, U. K., & Figaji, A. A. (2013). Demographic profile of severe traumatic brain injury admissions to Red Cross War Memorial Children’s Hospital, 2006 – 2011. SAMJ: South African Medical Journal, 103(9), 616-620. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013000900017&lng=en&tlng=en
Teasdale, G., M. (1995). Neurological management: Head injury. Journal of Neurology, Neuros, and Psychiatry, 58(5), 526-539. https://doi.org/10.1136/jnnp.58.5.526
Recent Comments