Effets Physiques

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A brain injury can affect physical abilities such as balance, mobility, coordination and muscle strength, tone and control.  It may also affect the body’s senses (hearing, vision, smell, touch and taste).  In addition, a brain injury can cause fatigue and conditions such as seizures, spasticity and swallowing difficulties.

 

Fatigue

Fatigue is very common during brain injury recovery.  Fatigue may result from the injury (and other injuries in cases of trauma) or from additional physical and mental effort required to do tasks that once were performed with little or no effort. Physical functioning, attention and concentration, memory and communication can be adversely affected by fatigue.

 

When a person with a brain injury first returns home, knowing how much that person can or should do can be difficult.  Often during this transition, the person and family members become discouraged with the slow pace of recovery, changes in responsibilities, or they may try to do or expect too much.  This is just one step in the recovery process.  In time, the person’s stamina and energy level likely will improve, and the ability to engage in activities may be increased.

 

The following strategies may be useful in helping the person with brain injury learn to manage fatigue:

• Encourage use of a calendar or planner to help manage mental fatigue.
• Set a schedule that includes regular rest breaks or naps. (For example, one nap in the morning and one in the afternoon after some activity, physical or mental.)  Rest breaks or naps should not exceed 30 minutes.
• Avoid evening naps.
• Gradually decrease the length and number of breaks as the person’s ability to tolerate activities with less fatigue improves.
• Resume activities gradually, over weeks or even months.
• Start with familiar tasks that the person can complete without fatigue.
• Gradually increase the complexity of the task, encouraging breaks as needed, to slowly increase the length of time.
• Become familiar with indicators of fatigue for the person.
• Watch for signs of fatigue, such as increased inattention or distractibility, repetition of tasks or comments, irritability or increased errors.
• Encourage breaks, every five minutes, during tasks, before or as soon as signs of fatigue appear.
• If the health care team recommends, use assistive aids (for example, a cane for walking) to conserve energy or a wheelchair for long distances.
• Plan ahead for fatiguing activities, such as visitors, trips, going out. Schedule a nap before visitors come or before going out.
• Consider limiting the person’s time with visitors or a rest break during visits.

 

Seizures

A medical condition that may occur after brain injury is post-traumatic seizure. Seizures can be caused by a sudden, excessive, disorderly electrical discharge of brain cell activity. This risk of ongoing seizures is related to the severity and characteristics of the brain injury, such as the type and location of the brain injury.  Risk seems to be greatest in the months after injury, then gradually declines with time.

 

Several types of seizures may occur after brain injury. The most frequent types are generalized (grand mal, tonic/clonic)  and partial (partial complex and simple partial) seizures.

 

Generalized seizures

Grand mal, tonic/clonic  seizures usually involve involuntary jerking or shaking of most or all four limbs, unresponsiveness, and loss of bladder control. Most seizures are self-limited and last only a few minutes. The person may cry out, stiffen and fall, have jerking movements, turn flushed or blue and have some difficulty breathing.  Remain calm and take the following steps:

• Make sure the person is in a safe area and lay the person’s head on something soft if a fall occurred.
• Loosen tight clothing such as a necktie or belt and remove eyeglasses.
• Clear away hazardous objects that may be nearby.
• Position the person lying on his or her side to keep the chin away from the chest. This will allow saliva to drain from the mouth.
• Do not force your fingers or any object into the person’s mouth.
• Do not restrain the person. You cannot stop the seizure.

After the seizure, the person usually will be temporarily confused and drowsy. Do not offer food, drink or medication until the person is fully awake. Someone should stay with the person until fully recovered. Check for a medical identification tag on a bracelet or necklace.

 

Until a predetermined seizure-free interval has been maintained (often six months to one year), driving privileges can be restricted. During this time, extreme caution should be taken if the person will be working around heavy or dangerous equipment.

 

In the following situations you should call your local emergency service:

• Breathing does not resume after the seizure and mouth-to-mouth resuscitation is necessary.
• Before the person recovers from the first seizure and another seizure begins.
• The person has been injured during the seizure.
• The person has awakened and requests an ambulance for emergency medical attention.
• The seizure continues for more than five minutes.

Prompt medical care is also recommended if this seizure is the person’s first or if the person’s level of alertness remains impaired.

 

Partial seizures

Partial complex seizures may involve loss of awareness, inappropriate verbal response, purposeless movement, staring or repetitive chewing, swallowing or lip-smacking motions.

Simple partial seizures are involuntary jerking or shaking of one part of the body without loss of consciousness. These may spread to other body parts and become generalized. In this situation:

• Do not try to restrain the person unless safety is jeopardized.
• Try to remove nearby hazardous or harmful objects.
• Arrange for someone to watch the person until full awareness returns.

Medical assistance generally is not necessary when partial seizures occur except when one seizure follows another in a continuous series, or when a partial seizure develops into a generalized seizure and the person is not recovering.

Even if someone develops seizures following acquired brain injury, the health care team will work on treatment options to effectively manage the seizures.

 

Spasticity

Injury to the part of the brain that controls movement can cause spasticity, an abnormal increase in muscle tone.  (Tone is the amount of tension or resistance to movement in a muscle).  Unlike a normal muscle, when stretched, a spastic muscle does not easily relax.  Instead, the muscle remains stiff or perhaps non-moveable.

Spasticity usually is not immediately present after a brain injury, but may develop gradually over weeks or months.  Spasticity symptoms range from slight to severe muscle stiffness.  Spasticity can impair the ability to dress, eat, write, balance, move and walk. Managing spasticity may be a lifelong process.  Treatment varies depending on the person’s age, severity of symptoms, and related conditions or complications. 

 

Swallowing

Problems that affect swallowing (dysphagia) may occur after brain injury. Swallowing is coordinated by the brainstem and the brain’s frontal lobes.  The brainstem, which connects the brain to the spinal cord, relays messages to and from the swallowing structures (mouth, tongue, throat).  The brain’s frontal lobes control the muscle action of the swallowing structures.

 

Problems that affect swallowing after brain injury can vary widely and may include one or more of the following:

• Poor head or upper body control
• Decreased lip and tongue strength, range of motion and coordination
• Impaired memory or concentration
• Any or all of the above may cause aspiration (inhaling food or liquid into the lungs)

 

If a person seems to have trouble swallowing, a clinical swallowing evaluation and videofluoroscopy (a videotaped X-ray of the swallowing process) may be done. With test results, decisions can be made about treating any swallowing problems.

 

A person who has trouble swallowing, may need nutrition through a nasogastric or gastrostomy tube (feeding tube in the nose or stomach).  Having either tube does not rule out the possibility of eating by mouth, but ensures proper nutrition and hydration (fluid intake).  How long the tube is in place depends on the person’s progress.

 

Exercises, treatment techniques and positioning may help improve a person’s ability to chew and swallow.  An occupational therapist or speech therapist will teach the person with brain injury and caregivers how to perform these exercises and techniques.  As a caregiver, your encouragement and help with the swallowing program are essential.  Most people regain the ability to swallow after brain injury, though it may take longer for some than others.

 

Bowel and bladder  changes

Brain injury may affect bowel and/or  bladder function. The injured person may need help re-establishing and maintaining a pattern of regular bowel and/or bladder emptying.

 

Bowel management

The goals of bowel management include establishing a regular emptying

pattern, maintaining dry, healthy skin, and avoiding incontinence, diarrhea, and

constipation.  Each person is assessed by a physician and recommendations are

made as needed.

 

Bowel problems can occur if the person with brain injury cannot:

• Control bowel emptying voluntarily
• Recognize bowel fullness and the need to have a bowel movement
• Ask for help to the bathroom
• Walk to the bathroom
• Eat enough food with fiber and drink enough fluids
• Plan ahead and allow enough time to get to the bathroom

 

To maintain optimal bowel function, a person with brain injury should eat at regular times, focus on eating foods with fiber, drink the amount of fluids recommended by the dietitian or physician, and be as active as possible. Meeting with a dietitian to discuss a diet plan may be helpful.  The person also may be asked to follow a bowel care schedule, which includes attempting to schedule a bowel movement at the same time daily and establishing regular times for meals.

 

At certain stages of recovery, the person may need to use other methods for bowel emptying (fiber supplements, stool softeners, suppositories, and/or laxatives).  These methods typically are not used regularly because they decrease the colon’s natural abilities, and these methods may be habit forming.  Most individuals with brain injury regain the ability to regularly and effectively empty their bowels.

 

Bladder management

People with brain injury also may have a problem with urination (bladder emptying) during the post-injury period.  Difficulties with urination that were present prior to the injury (an enlarged prostate in men or a pattern of infrequent urination in men or women) may add to bladder problems after brain injury.

 

The goals of bladder management include preserving kidney function, preventing incontinence (accidental urination), preventing bladder overfilling and bladder infections, establishing a regular patter of urination with complete bladder emptying, and maintaining dry, healthy skin in the genital area.

Problems with bladder management may include:

• Urinary retention (an inability to void or pass urine)

• Urinary incontinence
• Increased urgency to urinate
• Increased frequency of urination
• Incomplete emptying of the bladder
• Bladder infections
• Skin problems because of incontinence

 

The most common reason for bladder problems after brain injury is damage to the frontal lobe of the brain.  A less common cause is direct damage to the part of the brain that controls behaviors and memory.  Damage to these areas may result in the inability to:

• Ask for help
• Control urination
• Recall when last urination occurred
• Plan ahead to get to the bathroom
• Walk to the bathroom in time
• Recognize the sensation of bladder fullness or the need to urinate

 

Early in the care of someone with brain injury, the bladder may be drained continuously through an indwelling catheter (a tube that is inserted and left in the bladder).  The urine empties through the catheter into a drainage bag, which also allows for accurate recording of urine output.  As the patient improves, the catheter usually is removed.

 

If the person cannot sense the need to urinate, other approaches to bladder management are considered, including:

• Keeping the indwelling catheter in the bladder
• Intermittent catheterization (inserting and removing a catheter several times a day to regularly empty the bladder)
• Scheduling attempts at urination
• Using an external condom catheter for men
• Using an adult diaper
• Other methods of bladder retraining to control urination may be recommended

 

To maintain optimal bladder function, a person with brain injury should drink fluids as recommended by the dietitian or physician.  It may be helpful to meet with a bladder therapist to develop an individual plan.  The majority of individuals with brain injury regain the ability to regularly and effectively empty their bladder.