Severe Brain Injury, Treatment and Care

Severe Brain Injury, Treatment and Care

By William Bill Hurst

Brain injuries can be classified in mild, moderate and severe categories.  The Glasgow Coma Scale (GCS) is the most commonly used system used for classifying traumatic brain injury severity. The GCS grades a person’s level of consciousness on a scale of 3 to 15 based on the verbal, motor and eye opening reactions to stimuli.  It is generally agreed that a GCS of 13 or above is mild, 9 to 12 moderate and 8 and below is severe.  The most common causes of traumatic brain injury in the U.S. include violence, vehicular accidents, construction accidents and sports injuries.  Bicycles and motorbikes are a major cause with the latter increasing in frequency in developing countries.  There are estimates of between 1.6 and 3.8 million traumatic brain injuries each year.  These injuries are caused by the direction, intensity, and duration of the forces involving significant acceleration or deceleration of a persons head.  Diagnosis of these injuries involves a neurological examination, CAT scans, magnetic imaging; and with neuropsychological tests and assessments which can be ultimately performed to evaluate the long term cognitive issues and aid in the planning of rehabilitation.

Once a person is medically stable and recovered from the acute stage of the injury, they are generally institutionalized in rehabilitation hospitals for a period of time to attempt rehabilitation.  While it depends on the patient, various modalities of treatment such as physiotherapy, speech and language therapy, cognitive rehabilitation therapy and occupational therapy may be essential to a person’s rehabilitation.  People who have the more severe cases cannot live independently and disabled person may require care in a supportive living facility such as group homes.  As a result of the emotional issues which are often associated with severe brain injuries, trauma logical treatment may be needed to manage psychiatric or behavioral problems. Permanent disability is thought to occur in 10% of mild injuries, 66% in moderate injuries and 100% in severe injuries.  Coma is closely related to the severity as a strong predictor of a poor outcome.

Severe Brain Injury, Treatment and CareCognitive deficits that follow severe traumatic brain injuries involve various aspects of the cognitive function including impaired attention, disruptive insight and judgment, reduced processing speed, distractibility and deficits in executive functions such as abstract reading, planning and problem solving.  People with these types of injuries are often at risk for early onset dementia.

In addition to the cognitive defects that may result from severe traumatic brain injury, speech and language may also be severely impacted as may the person’s sensory functions.  This includes loss of function in vision, hearing, smell and taste. Physical changes can also include chronic pain, bowel and bladder dysfunction, sleep disorders, appetite issues and may also in personality changes including aggression, depression or a total lack of awareness.

Severe Brain Injury, Treatment and Care

The Brain Trauma Foundation was created to help improve the outcome of traumatic brain injuries for patients worldwide by developing practice guidelines and conducting clinical research and educating medical professors and consumers.  This Foundation created the first training program to free hospital TBI carrier care, established the first New York TBI trauma center, and was involved in the first research funded by the McDonald Foundation to study the neuro biology of concussion and develop diagnosis and methods for therapeutic interventions. For a source listing of various associations and organizations relating to traumatic brain injury see

Severe Brain Injury, Treatment and CareIn 1998, the NIH held a Consensus Development Conference on Rehabilitation for Persons with Traumatic Brain Injuries.  The Panel recommended that moderate to severe injured patients receive rehab treatment that draws on the skills of many specialists.  This involves individually tailored treatment programs in the area of physical therapy, occupational, speech, psychiatry, psychology and social.  The National Institute of Neurological Disorders and Stroke (NINDS) conducts and supports research to understand these injuries and the biological mechanisms which underlie damage to the brain.  NINDS develops strategies and interventions to limit primary and secondary brain damage that occurs within days of head trauma.  One area of research which shows promise is the study of the role of calcium ion influx into the damaged neurons as a result of cell death and general brain tissue swelling.  Calcium enters the nerve cells through damaged channels in the axon’s membrane.  The excess calcium inside the cell causes the axon to swell and activates chemicals called protesis that break down proteins.  Excess calcium within the cells is destructive to the cell structures that produce the cells energy.  In a general sense, calcium influx that causes problems in the brain is diminished with the use of  ion influx.

The use of stem cells to repair damaged brain tissue is a new and exciting avenue of research.  Researches are investigating the ability of stem cells to develop into neuro transmitter-producing neurons specifically dopamine producing cells.  One study has shown that bone marrow stem cells can develop into neurons, demonstrating that neural stem cells are not the only type of stem Severe Brain Injury, Treatment and Carecells that could be beneficial in the treatment of brain and nerve injury disorders.  At the moment stem cell research for traumatic brain injuries is in its infancy.

Researches are investigating into the mechanics of neural connectors in the brain allowing one part of the brain to take up the function of an injured part, called “plasticity” and researches theorize that children have an over abundance of hardwire neural networks, many of which naturally decrease through a process called “pruning”.  When an injury destroys an important neural network in children another less-useful neural network that would have eventually died takes over the responsibilities of the damaged networks.  Researches are looking into the role of plasticity and memories while others are using imaging technologies such as MRIs to map regions of the brain and record evidence of this “plasticity”.  “Plasticity of the brain” in its simplest meaning is the ability of the brain to adapt to deficits and injury.  With regard to identification of various institutes involved in brain research see

According to the Journal of Head Trauma Rehabilitation there are at least 5.3 million Americans living with a disability as a result of a traumatic brain injury.  Over 80,000 each year will experience long term disability as a consequence of their brain injury.  To care for these individuals there will be significant financial demands.  In addition to Social Services through a hospital or rehab facility it Severe Brain Injury, Treatment and Caremay be necessary to consult with legal professionals to help brain injury survivors in the areas of Social Security, Medicare, Medicaid, guardianship, estate planning and the like.  It is important that an experienced attorney be brought in early in the process to make sure the legal rights are protected by preserving evidence, conducting investigations, and reviewing and analyzing all benefits available under the insurance policies and public benefits available.  The more severe injured may be required to live in transitional living programs which are non-medical residential programs that teach living skills for community living.  However, in many instances residential facilities in long term care and supervision for the more severely injured are needed for those who cannot live independently.  Some useful resources in this regard include the Centers for Independent Living (CIL) at; Social Security and Disability Insurance (SSDI) and Supplemental Security Income (SSI) at; Brain Injury Association of America (BIAA) at; The National Disability Rights Network Protection and Advocacy for Individuals with Disabilities at and the Head Injury Hotline at   The American Residential Treatment Association has approximately 30 members listed in their Directory of Residential Facilities at  For a listing of treatment systems for traumatic brain injury also see  Various resources and search engines for residential programs for those with severe brain injuries in Florida and Michigan see Neuro International at Center for Brain Injury Rehab at  Most states have what are known as “ombudsmen” to advise the disabled on long term care.  These people are advocates for residents of nursing homes and special care facilities.  An ombudsman may provide information on how to find a facility and what to do to get quality care.  This program is administrated by the Administration on Aging (AOA) and the network has 87,000 volunteers certified to handle complaints and programs in various states.

If you or a loved one has suffered a severe brain injury as a result of the negligence of another, contact William “Bill” Hurst, an experienced attorney for a free consultation at (800) 636-0808 or online.

Severe Brain Injury, Treatment and

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Indianapolis Personal Injury Law William W. Hurst
William W. Hurst

Bill Hurst has successfully represented hundreds of accident victims, and has limited his practice to personal injury cases for over thirty-five (35) years.

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1 Comment

  1. Todd Tracy says:

    “According to the Journal of Head Trauma Rehabilitation there are at least 5.3 million Americans living with a disability as a result of a traumatic brain injury” interesting fact!

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