Modern Techniques in Treating Acquired Brain Injuries

In the UK there are about 1.4 million people living with a brain injury. According to Headway,  there were 356,699 UK admissions to hospital with acquired brain injury in 2019-20. Males were 1.5x more likely than females to be admitted for a head injury.

Acquired brain injuries cost the UK economy £15 billion per annum. This figure is based on premature death, health and social care costs, continuing disability and lost work contributions.

What are acquired brain injuries

An acquired brain injury is a brain injury that is not present at birth, but which happens at a later stage in a person’s life. Acquired brain injury is not an uncommon occurrence, with around 350,000 people admitted to hospital every year with an acquired brain injury. This is usually as a result of a traumatic head injury or a stroke. It can also be as a result of other diseases, drug or alcohol use or the brain being starved of oxygen.

The effects of acquired brain injury can range from mild to completely debilitating. Even after a mild head injury brain functioning can be affected temporarily. This is called concussion. This can lead to symptoms such as headaches, dizziness, mood swings, anxiety, depression, fatigue, irritability and problems with memory. Most people with a mild head injury will be symptom free within weeks; however, some people can take much longer to fully recover. The more severe the injury is, the more serious the symptoms are likely to be. People with more severe brain injuries are likely to have more complex, long-lasting symptoms which can include:

• Changes in behaviour and personality.
• Difficulties in their existing relationships or ability to form new ones.
• Being unable to lead an independent life.

There are several possible causes of an acquired brain injury. A traumatic brain injury is where the brain is injured as a result of a trauma or injury to the head. Examples of a traumatic brain injury include:

• A road traffic accident.
• A fall.
• A violent assault.
• An accident in the workplace or at home.

Other forms of an acquired brain injury can include:

• A tumour.
• A stroke.
• Brain haemorrhage.
• Encephalitis (an inflammation of the brain usually caused by an infection).

The brain is a complex organ that controls thoughts, memory, emotion, touch, motor skills, breathing, vision and hunger. It is the part of the body that interprets signals and sends instructions to the rest of the body. Every sense we have relies completely on the brain functioning well. This means that damage to the brain can affect every part of the body.

The symptoms depend on which brain area is affected and the severity of the injury. Some of the causes of acquired brain injury can include:

• A lack of oxygen to the brain – this is called anoxic brain injury. An example of this could be brain injury caused by nearly drowning.
• Disease – this could include Alzheimer’s disease, dementia, cancer, multiple sclerosis or Parkinson’s disease.
• A stroke – a stroke is a serious and life-threatening medical condition that happens when the blood supply to part of the brain is cut off.
• A physical injury – this could happen due to an impact or blow to the head, for example in a car crash, sporting accident, or a fight or fall.
• Alcohol or drug use – this can poison the brain.

Different parts of the brain control different parts of the body. Depending on which part of the brain is injured and how serious the damage is will determine how the person is affected and what symptoms they will present with. Injuries to the front, back, left or right of the brain all have very different effects. Within the brain there are lots of complex, subtle parts which can be damaged.

Brain injuries usually result in some form of cognitive impairment and can result in:

• Loss of language.
• Problems with memory.
• Problems with visual-perceptual skills.
• Reduced concentration abilities.
• Reduced motivation.
• Difficulties processing information.
• Impaired reasoning skills.
• Difficulties with empathy.

Changes in behaviour and personality are common in people with certain types of brain injury. Personality changes after brain injury are some of the most difficult symptoms to deal with for both the person with the brain injury and their family members. The location of the brain injury can change how the person behaves. An example of this is the orbitofrontal cortex which helps control impulsive behaviour and plays a role in someone’s empathy towards others. If this area becomes damaged, the person may struggle to empathise with other people and might engage in more reckless, risk-taking behaviour.

A head injury can also affect a person’s mood and emotions. This can make them seem more depressed, angry or irritable than they were pre-injury, causing others to believe that the person has had a change in personality. Treating the emotional and behavioural effects of a brain injury can often help the person return to their old self again.

Emotional and behavioural changes after a head injury can include:

Traditional treatment approaches

Medical professionals treating someone with a suspected brain injury will need to know about how the injury occurred, the person’s medical history and symptoms, and will complete a physical examination. This will include shining a light into the patient’s eyes in order to assess their consciousness, cognition, and control over movement and sensation in different areas of the body. Diagnosing a brain injury will require a combination of medical assessments and investigations. There are various tests available, including X-rays and CT brain scans which can help pinpoint the exact areas of the brain that are damaged. In some cases, surgery may be required.

The most important thing initially will be to medically stabilise the person, before the long-term recovery and rehabilitation can begin. The focus in treating an acquired brain injury is the cognitive, physical, emotional or behavioural impairments that have caused the changes in the functioning of the brain. The treatment plan will depend upon the type of injury and how severe it is. Some traditional treatment approaches include:

• Rehabilitation therapy – this typically includes physical therapy, occupational therapy and speech therapy. These therapies aim to improve mobility, strength, coordination, balance, fine motor skills, communication and swallowing abilities.
• Cognitive rehabilitation – this involves various techniques and exercises designed to improve cognitive functions such as attention, memory, problem-solving and executive function. Cognitive rehabilitation may include activities such as memory drills, attention exercises and problem-solving tasks.
• Psychological support – acquired brain injuries can have significant psychological effects on patients and their families. Psychologists or counsellors may provide individual or family therapy to help patients cope with the emotional impact of the injury, adjust to life changes and develop coping strategies.
• Educational support – for people who have sustained brain injuries during childhood or adolescence, educational support may be necessary to address any learning difficulties or academic challenges that arise as a result of the injury.
• Vocational rehabilitation – for people of working age, vocational rehabilitation may be necessary to help them re-enter the workforce or transition to alternative employment that is compatible with their abilities post-injury. This may involve vocational assessments, job coaching, and training in adaptive skills.
• Community reintegration – as people progress in their recovery, efforts are made to reintegrate them into their communities and support their participation in meaningful activities. This may involve helping people access community resources, recreational activities and social support networks.
• Family education and support – family members play a crucial role in the recovery process and may require education and support to understand the effects of the brain injury, assist with caregiving responsibilities, and advocate for their loved one’s needs.

Advanced imaging and diagnosis

Advanced imaging techniques play a crucial role in the diagnosis and management of acquired brain injuries. Some of the most commonly used advanced imaging techniques include:

• MRI (Magnetic Resonance Imaging) – structural MRI provides detailed images of brain anatomy and can detect abnormalities such as haemorrhages.
• Diffusion Tensor Imaging (DTI) – this measures the diffusion of water molecules in brain tissue, allowing visualisation of white matter tracts.
• Functional MRI (fMRI) – this measures brain activity by detecting changes in blood flow. fMRI is used to assess functional connectivity and activation patterns in response to tasks or stimuli.
• Susceptibility Weighted Imaging (SWI) – sensitive to blood products, SWI can detect micro haemorrhages and small vascular abnormalities.
• Magnetic Resonance Spectroscopy (MRS) – this provides information about the chemical composition of brain tissue, helping to identify metabolic abnormalities associated with acquired brain injuries.
• CT scan – CT can detect haemorrhages, fractures and gross structural abnormalities in the brain.
• CT Angiography (CTA) – this can visualise blood vessels and can identify vascular lesions or abnormalities.
• PET (Positron Emission Tomography) – a PET scan measures metabolic activity in the brain by detecting the distribution of radiotracers. PET can assess glucose metabolism, neurotransmitter function and blood flow, providing valuable information about brain function and dysfunction.
• Electroencephalography (EEG) – while not strictly imaging, EEG measures electrical activity in the brain and can aid in the diagnosis of ABI-related conditions such as seizures and epilepsy.
• Functional Near-Infrared Spectroscopy (fNIRS) – this measures changes in cerebral blood oxygenation and can assess brain function, particularly in prefrontal cortex regions. fNIRS is portable and non-invasive, making it suitable for bedside monitoring.
• Optical Coherence Tomography (OCT) – this is primarily used for assessing the structural integrity of the retina, and can detect things such as optic nerve damage or retinal abnormalities.

Neurorehabilitation and therapy

Neurorehabilitation and therapy for acquired brain injuries include a broad spectrum of interventions aimed at maximising recovery and improving the quality of life for people who have experienced damage to their brain due to traumatic or non-traumatic causes. Effective neurorehabilitation typically involves a multidisciplinary team consisting of neurologists, physiatrists, neuropsychologists, occupational therapists, physical therapists, speech-language pathologists, and social workers. Each professional brings unique expertise to address various aspects of the individual’s needs.

Comprehensive assessment is crucial for understanding the extent and nature of the brain injury’s impact on cognitive, physical and emotional functioning. This assessment helps in developing tailored treatment plans.

Some of the interventions include:

• Physical rehabilitation – physical therapy focuses on improving mobility, strength, balance and coordination.
• Occupational therapy – occupational therapists help people regain skills needed for activities of daily living, such as washing, dressing and meal preparation.
• Speech and language therapy – speech and language therapists work on improving communication skills, including speech production, language comprehension and social communication. They also address difficulties with swallowing that may result from brain injury.
• Cognitive rehabilitation – neuropsychologists and other professionals offer cognitive rehabilitation to address deficits in attention, memory, executive function and other cognitive abilities.
• Psychological support – coping with the physical, cognitive and emotional challenges of having an acquired brain injury can be overwhelming. Psychologists or counsellors can provide support and coping strategies to help people and their families adjust to life after a brain injury.
• Technology-assisted interventions – advancements in technology, such as virtual reality, robotics and brain-computer interfaces, are increasingly being used to enhance treatment outcomes and engage people in therapy.
• Community reintegration – rehabilitation extends beyond clinical settings to include community-based programmes and support services. This may involve vocational rehabilitation, leisure activities and support groups to facilitate social participation and independence in the community.
• Long-term management and follow-up – recovery from an acquired brain injury can be a lifelong process. Long-term management involves periodic assessments, adjustments to treatment plans, and ongoing support.

Pharmacological interventions

Pharmacological interventions for acquired brain injuries aim to manage symptoms, promote recovery and prevent further damage. Pharmacological interventions should always be tailored to the individual patient’s needs and should be closely monitored for effectiveness and adverse effects. Some examples of pharmacological interventions include:

• Neuroprotective agents – this medication aims to prevent further damage to brain tissue following injury.
• Anticonvulsants – seizures are common after brain injury, and anticonvulsant medications help to control them.
• Analgesics and pain management – acquired brain injuries can often result in pain, which can exacerbate other symptoms.
• Paracetamol – this medication is generally considered safe and effective for mild to moderate pain.
• Opioids – this medication may be used cautiously for severe pain but with awareness of the risk of addiction and other associated risks.
• Nonsteroidal anti-inflammatory drugs – these are used cautiously due to the risk of bleeding and gastric irritation, but they can be effective for pain relief.
• Psychotropic medications – people with acquired brain injuries may experience mood disturbances, anxiety or depression. Psychotropic medications such as antidepressants or antipsychotics may be prescribed.

Assistive technology

Assistive technology plays a crucial role in supporting people with acquired brain injuries in various aspects of their daily lives.

Some examples of these include:

• Communication aids – communication aids such as speech-generating devices can help people express themselves effectively.
• Cognitive assistive technology – if cognitive functions such as memory, attention and executive functioning have been affected, cognitive assistive technology including apps, software and devices designed to support cognitive rehabilitation can be used.
• Mobility aids – some people with an acquired brain injury may experience physical impairments that affect their mobility. Mobility aids such as wheelchairs, walkers, canes or specialised seating systems can help improve independence and safety.
• Environmental control systems (ECS) – ECS can allow people to control various aspects of their environment, such as lighting, temperature, electronic devices and home appliances. These systems can be operated through switches, voice commands or specialised interfaces.
• Computer accessibility tools – for people who have difficulty using traditional computer interfaces, specialised computer accessibility tools can help. This can include screen readers, voice recognition software, alternative keyboards and adaptive mouse devices, allowing users to access and interact with computers more effectively.
• Memory aids – memory impairments are common after ABI. Memory aids such as electronic organisers, digital calendars, reminder apps and wearable devices can assist people in remembering important tasks, appointments and medication schedules.
• Virtual reality (VR) rehabilitation – VR technology is increasingly utilised to provide immersive and interactive experiences for cognitive and physical therapy.
• Wearable health monitoring devices – wearable devices such as smartwatches or fitness trackers equipped with health monitoring features can assist people in tracking vital signs, physical activity levels, sleep patterns and medication adherence.

Stem cell therapy and regenerative medicine

Stem cell therapy and regenerative medicine have shown promising results for treating acquired brain injuries, such as traumatic brain injury and stroke. Stem cells, particularly neural stem cells, have the ability to differentiate into various cell types found in the brain, including neurons, astrocytes and oligodendrocytes. When transplanted into the injured brain, these stem cells can replace damaged or lost cells, contributing to tissue repair and functional recovery.

Stem cells can stimulate the formation of new blood vessels and promote tissue repair processes, enhancing the brain’s capacity for self-repair.

Acquired brain injuries often trigger an inflammatory response, which can exacerbate tissue damage. Stem cells have immunomodulatory properties that can regulate the immune response, reducing excessive inflammation and promoting tissue healing.

The goal of stem cell therapy and regenerative medicine in patients with acquired brain injuries is to improve functional outcomes, including cognitive function, motor skills and quality of life.

The advancement of modern techniques for treating acquired brain injuries has been significant in the field of neuroscience and neurorehabilitation, from innovative pharmacological interventions to cutting-edge technologies such as neuroimaging, neuromodulation and stem cell therapy. The treatment options have expanded significantly, offering hope and improved outcomes for patients with acquired brain injuries.

If you have an acquired brain injury due to a stroke, Stroke Association help people to rebuild their lives after stroke. They also offer local support services and groups and their dedicated Stroke Helpline where you can contact them on 0303 3033 100.

Brain Injury is Big support the severely brain injured and their families.

You can find brain injury support in your area by contacting Headway.