Understanding Acquired Brain Injury (ABI)

Acquired Brain Injury refers to any injury affecting the brain that occurs after birth. This can result from:

• A blow to the head, also known as Traumatic Brain Injury (TBI). This type of injury can happen due to incidents like car accidents, falls, or blunt trauma to the head. There are two primary forms of TBI: closed and penetrating injuries. In a closed injury, no object pierces the brain, but the brain is shaken or knocked within the skull, potentially causing widespread damage, including the opposite side of the impact. In a penetrating injury, an object breaches the skull and directly impacts a specific part of the brain.
• Stroke, which occurs when the brain's blood supply is interrupted or a blood vessel in the brain ruptures.
• Infection, such as meningitis or encephalitis, which can cause inflammation in the brain or the membranes surrounding it.
• A brain tumor, which involves the abnormal growth of cells within the brain, potentially damaging surrounding tissue.
• Oxygen deprivation to the brain, referred to as a ‘hypoxic injury.’ This can occur in situations where the brain doesn't receive enough oxygen, such as during a heart attack, near drowning, or carbon monoxide poisoning.

After the initial injury, the brain may suffer additional complications, known as secondary injuries. Normally, the brain fits snugly within the skull, but following trauma, swelling can occur, leading to increased pressure that can compress surrounding areas and disrupt blood flow.

Other factors that can increase pressure in the brain include brain swelling (cerebral edema), bleeding or clots (known as hemorrhages and hematomas), as well as damage to brain cells or excess cerebrospinal fluid around the brain (a condition called hydrocephalus).

Brain injuries can impact any region of the brain, leading to disruptions in:

• Physical abilities (how our bodies function)
• Cognitive abilities (how we think, learn, and remember)
• Emotional and behavioral responses (how we feel and act)

Arrival at the Hospital

You were likely transported to the hospital by ambulance, where the Emergency Department (ED) doctors assessed your injuries and determined the best course of treatment.

To help doctors understand the nature of your brain injury, you may have undergone imaging tests like a CT scan or MRI. A CT (Computerised Tomography) scan is a special type of X-ray, while MRI (Magnetic Resonance Imaging) provides more detailed images than a CT scan.

These scans help doctors visualize the brain and identify any bleeding or blood clots, which inform the next steps in your treatment. However, they cannot predict how fully you will recover from the injury.

The Neurosurgical Unit

You may have been moved to a neurosurgical unit, a specialized ward dedicated to brain injury care. Here, the neurosurgeon and their team conducted further assessments and continued your treatment.

Sometimes, the neurosurgical unit is located in a different hospital, and you may have been transferred by ambulance to receive the specialized care required.

Surgical Procedures

Surgery might have been necessary if your scans revealed a blood clot, pooling of blood or fluid on the brain, or an injury that penetrated through the skull. Brain surgeries are very delicate and can take several hours to complete.

Intensive Care Unit

After surgery, you were likely transferred to a Critical Care Unit, Intensive Care Unit (ICU), or High Dependency Unit. For simplicity, we'll refer to all these units as "Intensive Care" throughout this section.

Intensive Care is designed for patients requiring specialized hospital care. For brain injury patients, the primary goal is to prevent further brain damage, allowing the swelling and bruising to subside so the brain and body can begin the healing process.

There are several specialized Neurosciences Intensive Care Units in the country, equipped with dedicated staff and technology to care for brain injury patients. Ideally, you would be treated in one of these units, but this may not always be possible.

In Intensive Care:

• Each nurse will look after one or two patients, so you can be carefully watched 24 hours a day. Your pulse, blood pressure, breathing, oxygen levels, and how much liquid you take in and urine you pass are monitored constantly. This is important because staff can assess your condition and adjust your treatment as necessary.
• Staff can provide specialized treatments for injuries to other parts of the body, such as broken bones or damage to organs like the heart and lungs.
• Highly trained doctors, nurses, physiotherapists, and other healthcare professionals will care for you. They will also help your relatives by explaining what is happening and the treatment you are receiving.
• You may have a special tube inserted into your head to help staff monitor the pressure in your brain. This is called an Intracranial Pressure Monitor, and it will leave only a small scar under your hair once it is removed.
• You may have a catheter, a tube placed in your bladder to collect and measure urine output.
• Feeding might be done through a drip or a tube, either through your nose into your stomach (nasogastric tube) or directly into your stomach (gastrostomy tube).
• If needed, you can receive breathing support. Initially, you may have had a breathing tube down your throat. If breathing assistance was required for an extended period, you might have had a tracheostomy, where a small hole is made in the front of your neck for a breathing tube attached to a ventilator.

Early rehabilitation

Rehabilitation involves exercises to begin your recovery. Physiotherapists likely started working with you in the ICU, even if you were unconscious, to prevent issues like chest infections, muscle tightness, or pressure sores from prolonged immobility.

Once conscious, physiotherapists may have worked with you to perform exercises in bed. As you improved, you might have progressed to sitting in a chair or standing. Sitting up can feel challenging after long periods of lying down, and it may have been part of your exercise routine.

Brain injuries can cause various challenges requiring rehabilitation. A speech and language therapist might have helped you with communication or swallowing difficulties. You may have practiced improving your speech and memory, with conversations with family and friends aiding this. Fatigue may have set in quickly, making even simple tasks (such as talking) difficult in the early stages of recovery.

Leaving ICU

Leaving the Intensive Care Unit can feel frightening, even though it signifies improvement. Adjusting to the general ward, where one-to-one nursing is no longer available, can be difficult for you and your relatives. Some hospitals have an Outreach Team that visits you after you leave ICU, answering any questions or addressing concerns.

You may have many questions about your experience, and it’s likely you won’t remember everything that happened. Some hospitals provide patient diaries, and reading these once you feel strong enough may help you piece together events. If you didn’t receive a diary, ask your family for a brief summary of what occurred during your ICU stay.

Once you leave ICU, your medical team will guide you on exercises to help you regain strength. It’s important to proceed slowly, gradually increasing activity while resting when necessary. Avoid frustration over what you can’t yet do and consider writing down daily activities to track your progress.

Please refer to the ‘Further information’ section for additional recovery support.

Having a loved one in the ICU with a brain injury is a deeply worrying time. It's natural to want to know everything about their condition and chances of recovery. The medical staff will keep you informed about their treatment and do their best to answer your questions. However, they may not be able to tell you yet whether your loved one will make a full recovery, as some aspects of recovery are unpredictable.

If you have questions that the nursing staff cannot answer, you can request an appointment with the consultant in charge of your relative's care. It might be helpful to bring a list of questions and have a relative or friend accompany you to the meeting to help absorb the information.