He was discharged after a few days. His injuries had healed, but those who knew him well could notice subtle changes in his behaviour: he was forgetful, he struggled to plan things and he lost his temper at the slightest provocation.

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With the help of a neuropsychologist and a neurologist, Fred followed a rehabilitation programme to improve his mental and physical functions after his moderate brain damage.

An 18-month window period for the brain to recover
However, it is crucial to start rehabilitation as soon as possible, and definitely within the first 18 months after an injury. "The brain can never repair completely, but during the 18-month period after injury, new connections can form. Whether or not brain cells can regenerate or new cells can be formed, remains a controversial topic," says psychiatrist Dr Frans Hugo.

"In the past people were convinced that it was impossible for brain cells to regenerate, but nowadays there seems to be an indication that it is possible to some extent."

The quality of life of someone who has been injured therefore depends on

• how soon rehabilitation starts – ideally as soon as the person has regained consciousness and is no longer confused, and other life-threatening injuries have been attended to;
• how serious the brain damage is. The milder the damage, the better the degree of improvement.

Unfortunately, many people wait until it is way too late before they have a proper assessment done. Those who wait two years or longer before they start rehabilitation have missed the crucial time in which intervention should have occurred.

How the brain is hurt
Strokes, tumors, disease, toxins, near drowning, electric shock, lightning strikes, and head injuries sustained in car accidents, assault and in sport (particularly boxing and rugby) can all damage the brain. Even mild head injuries, such as concussion, particularly if they happen repeatedly, can result in brain damage.

The above can injure the brain through bruising (bleeding), tearing and swelling.

Bruising (and bleeding) of the brain: A common cause of bruising/bleeding injuries is car accidents. In a head-on collision, the brain is propelled against the front of the skull when the person’s head is flung forwards, and then backwards against the skull. The sudden forward/backward motion can result in bruising and bleeding to the front part of the brain as well as to other areas.

Tearing of the blood vessels: When blood vessels tear during a brain injury, it will result in bleeding in the brain. Since the skull cannot expand, the blood will press on areas of the brain. This pressure can cause damage to brain tissue.

Swelling of the brain: Injury to the brain may cause it to swell, resulting in an increase in pressure inside the skull, a life-threatening situation.

Tearing of the brain tissue: A head injury can also cause microscopic tearing of the brain tissue, a very serious injury and one that is difficult to detect with MRI or CT Scans, which are usually done after an injury. Tearing severs the "wires" and interconnections in the brain. This injury is common in boxers. In fact, even schoolboy boxers may already show signs of brain damage.

- (Ilse Pauw, Health24, July 2006)

Read more:
How brain injury affects you
 

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