About the Brain

Brain Facts

» Your brain weighs about 3lbs, or just under 1.5Kg

» It has the texture of blancmange

» Your brain is connected to your spinal cord by the brain stem

» Behind your brain stem is the cerebellum

» The cerebral cortex is the largest part of your brain. It contains the frontal lobes, the motor cortex, sensory cortex and parietal lobes

» The brain is made up of around 100 billion nerve cells and even more support cells, which provide nourishment to the nerve cells.

The diagram below shows which areas of your brain control different activities.

Damage to a particular area can affect that activity.

We also know that the left side of your brain controls your right side. So if someone had a stroke, which affected the left side of their brain, it would be likely that the right side of their body would be affected. For most of us, the left side controls speech, while the right side controls our artistic skills such as drawing and music.

Cranium and Brain Stem

The brain is completely surrounded by a hard, protective, rounded shell of bone, known as the skull or cranium. The important thing to remember about the skull is that underneath the front there are a number of bony ridges. When the soft tissue of the brain is shaken around, these ridges have the unfortunate effect of lacerating and damaging the underside of the front of the brain.

On the floor of the skull is a hole where the lower part of the brain or brain stem is connected to the spinal cord, and from there to the whole of the nervous system and the rest of the body. The brain stem is rather like a thick telecommunications cable, with countless nerve fibres like wires, carrying messages backwards and forwards. This brain stem area is also known to control such bodily functions as wakefulness, consciousness, tiredness, heartbeat and blood pressure. Damage to this area is thought to cause concussion and loss of consciousness.

Texture and Blood Vessels

The texture of the brain is rather like soft blancmange, but is held together in the skull by a number of layers of membrane called the dura, pia and arachnoid.

Between the pia and arachnoid membranes is the subarachnoid space, in which run the blood vessels supplying and draining the brain. Like any organ, the brain is dependent on blood from the heart, and is criss-crossed by a network of large arteries, which divide into progressively smaller branches. When the brain is shaken about in a head injury, these vessels tear and bleed. As people get older, the blood vessels become more brittle and more likely to tear if shaken around. This bleeding leads to a build-up of blood clots, which pressurises and damages the delicate tissue of the brain.

The brain in its membranous sack floats in a sea of cerebrospinal fluid, which fills in all the gaps around the brain and offers some protection and cushioning. Just behind the brain stem sits a curved lump of tissue called the cerebellum. This area regulates all of a person’s fine motor co-ordination which is involved in such skills as balancing, moving quickly and gracefully, dancing, threading a needle, or climbing a ladder.

Cerebral Cortex

The largest part of the brain is known as the cerebral cortex and is shaped like a large wrinkled walnut. It is divided into two halves and joined by a bridge in the middle. The two halves are known as the right and left cerebral hemispheres. It is known that the right side controls the left side of our body and the left side controls the right side of our body.

Damage only to the right side may affect movement in the left arm and leg or hearing in the left ear. There is also evidence that for most people the left hemisphere contains the language centres involving speech, while the right hemisphere tends to control non-language, spatial skills such as drawing or musical ability.

If a person received injuries only to the left side of the brain, by for example having a stroke, it is likely that speech would be affected, as would the ability to move the right side of the body.

Strokes tend to affect a specific area, whereas a head injury due to a road traffic accident usually involves more general damage.

Nerve Cells

The make up of the brain consists of billions of microscopic nerve cells. Under a powerful microscope these cells look like small dots with a network of hair like tentacles (axons and dendrites). They communicate with each other by passing electrical and chemical impulses between these tentacles. Highly complex patterns of communication, or pathways, build up as the brain develops throughout childhood. The effect of a head injury on this delicate substance is similar to that of vigorously shaking a plate of blancmange – it shears and tears, disrupting those pathways of communication.

Apart from dividing into a left and right hemisphere, the cerebral cortex can be further divided into a number of areas known as lobes.

Frontal Lobe

The frontal lobe is the area behind the forehead and is heavily involved in intellectual activities such as planning and organising, as well as being involved in personality and the control of emotions and behaviour.

Motor and Sensory Cortices

Between the frontal and parietal lobes is the motor cortex which controls movement and the sensory cortex which controls sensation.

Temporal Lobes

Nestled behind the ears, this area holds the bulk of our memories and our ability to understand things and speak.

Parietal Lobes

Located at the back of the brain above the ears, these have an important role to play in our ability to understand spatial relationships.

Occipital Lobe

At the very back of the head are the occipital lobes, which are responsible for sight. Any injury to this area can cause partial or complete blindness.

Hidden in the middle of this walnut-like cerebral cortex are a number of small white nerve centres, collectively known as the diencephalon. In this area lies the small pea-sized hypothalamus, which controls appetite regulation, sexual arousal, thirst and temperature control, and some aspects of memory.

Close to this area is another important set of nuclei, referred to as the limbic system. Damage to this area can play havoc with emotions, leaving the individual with dramatic and sudden mood swings.

Rehabilitation

Overview of Rehabilitation

Headway has had its own statement regarding rehabilitation since the late 1980′s:

‘Rehabilitation is a process of change through which a brain injured person goes, seeking to regain former skills and to compensate for skills lost. Its aim is always to achieve the optimum levels of physical, cognitive and social competence followed by integration into the most suitable environment.’

The greatest visible progress occurs in the first 6 months, after which improvement is often more subtle and less obvious. But it is important to bear in mind that progress does not stop after 2 years, as has been suggested in the past. Rather people continue to improve even 5, 10 or more years after a head injury.

Rehabilitation has two stages, the first being the formal intervention to improve the individual, and the second stage is when the family and carers work to maintain that improvement. Research suggests that patients who make the best recovery are those whose family is actively involved, and can maintain this informal rehabilitation at home.

Who’s Who on the Rehabilitation Team

As the effects of a brain injury can be wide-rangine, there may be a number of different specialists involved in a person’s rehabilitation. This is called a ‘multi-disciplinary team’, and ensures a patient receives proper attention to every effect of their injury.

Some of the most common specialists are described below:

Nurses

Nurses are trained in all aspects of general health care and will help with dressing, washing, feeding and toileting. A ward will be run by a sister or charge nurse, accompanied by a staff nurse and nursing assistants.

Doctors

A consultant will co-ordinate the day-to-day medical care, carrying out examinations and prescribing medication while the patient is in hospital. The consultant is head of a medical team and will be assisted by junior medical staff such as registrars and house officers, who will spend more time on the ward than the consultant.

Physiotherapists

The physiotherapist aims to help patients recover the ability to use their muscles and joints so they can sit or stand without losing balance, co-ordinate movements, walk and use fine hand movements. The physiotherapist will set exercises and activities for improving physical ability, and help with learning techniques for lifting and transferring from a wheelchair.

Occupational Therapists

The occupational therapist (OT) is concerned with helping to develop independence in carrying out everyday tasks such as dressing, cooking, and housework. They will also help the individual develop skills which underlie these activities such as budgeting, planning, improving thinking and finding ways around problems. They may also provide special equipment and adaptations around the home.

Clinical Psychologist

The clinical psychologist will help in assessing the patient’s mental skills and weaknesses, such as memory and concentration (a cognitive problem), using specially designed tests. They may also advise on management, rehabilitation and cognitive retraining programmes, both in hospital and in the community. They may also provide counselling and advice on dealing with the emotional problems involved in adjustment and coping.

Social Worker

Social workers are skilled in helping families receive the practical help that is needed. They can provide information about benefits, accommodation and transport. The social worker is also an experienced counsellor, and is there to talk to about emotions and feelings. If there has been no contact with a social worker in hospital, ask for an appointment to see one.

Speech and Language Therapist

Speech and language therapists aim to help patients communicate more effectively using both the spoken and written word. They may provide structured exercises and activities aimed at improving speech and language skills, or may work with other staff and relatives to improve all-round communication. The speech therapist will also have experience of communication aids.

Helpful Information

Fatigue

Fatigue – This is one of the most common effects of brain injury. It is the most important symptom to control, as being tired affects everything you do. Even simple actions like dressing or chatting can make you tired.

» Think about when you are most tired. If this is in the afternoon then try and do difficult things in the morning.

» Spot things that make you tired. Either stop doing them or give yourself more time to do them.

» Build rest periods into your day.

» Don’t overdo it. Build activities up slowly over time.

» If going back to work, start with fewer hours.

Explain to other people about being tired. Don’t push yourself or you may get into a cycle where you do not get enough rest. In the space of a few days you could become completely exhausted and all other symptoms may get worse.

Headway, the brain injury association have a publication entitled ‘Managing Fatigue after Brain Injury’ – this publication will help people to discover new ways of managing fatigue so that they feel more in control and have greater choice about what they do and how they feel.

Irritability & Anger

Things that wouldn’t bother you before your injury may anger or irritate you. Or perhaps the effects of your injury aggravate or annoy you. This can cause stress to you and those around you, so it is important to manage it.

» Being tired or losing concentration can affect your mood levels, so try and reduce these problems.

» Work out what makes you angry and find alternative ways to deal with the issues.

» If you feel yourself becoming irritable or angry take time to relax.

» If you long-term problems ask your Doctor about referral to a neuropsychologist.

Family & Friends

Throughout the acute stages and during the rehabilitation process, attention will be focused on the person with the brain injury. However, we should not forget that it is the whole family that can develop problems as a result of a single family member being injured. There is considerable strain in the early days and weeks as people spend long hours at the hospital, and during the rehabilitation phase there is often a considerable commitment of time for families and friends and this can have a major disruptive effect on family life. Work may suffer, with financial consequences – parenting issues, marital stress, feelings of anger, and guilt are some of the many things that will crop up.

It is recognised that close relatives of the person with the brain injury, quite often become the main carer of that person. It is also recognised that these family members are at risk of developing psychological and emotional problems themselves. Relatives should not be afraid to discuss worries and difficulties with someone. These feelings are common, and can often be alleviated by sharing concerns with others.

This is just a snapshot of the information that is available from Headway – the brain information. Please contact the National Helpline on 0808 800 2244 for further information or visit the National Website www.headway.org.uk