What Constitutes a Severe Brain Injury?

The main variant between what may be characterized as a “mild” brain injury and a “severe” brain injury is the degree to which the brain operates differently after the traumatic brain injury. The difference depends upon some or all of the following factors:

The part of the brain that was injured: This is because different parts of the brain control different motor and cognitive functions. For example, an injury to the frontal lobes would implicate motor function, problem solving, spontaneity, memory, speech, and the ability to get started performing a task — which, in turn, requires the recognition of the need to perform the task — judgment, impulse control, social behavior and sexual behavior. A severe catastrophic injury to the frontal lobes may essentially eviscerate some all of these functionalities or, if some remain intact, certainly require specialized rehabilitation that provides care for the rehabilitation of some or all of them to achieve the best possible outcome. At NeuLife, this would involve the development of a customized Client Goal Plan centering upon the nature and extent of the client’s traumatic injury.

The degree to which the individual has made a physiological and cognitive recovery: This includes factors such as the rate and completeness of the physiological recovery and the individual’s remaining independent functions. This implicates the rehabilitation, specialized rehabilitation and training in adaptive therapies that NeuLife can provide to help the client to achieve independence to the greatest degree possible.

How the catastrophic injury has affected the client in more than just a physical way and can include:

• Concentration
• Distractibility
• Memory
• Speed of processing
• Confusion
• Perseveration: the continual involuntary repetition of a mental act, usually exhibited by speaking the same word.
• Impulsiveness
• Language processing

“Executive functions”: A set of mental processes that helps to connect past experience with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details, and managing time and space[1].

In a worst-case situation, one of the following outcomes may result from a severe brain injury, for which family and friends of the individual must be prepared: Full independence may not be a reasonable expectation. While NeuLife’s goal is to achieve successful sustained outcomes for even the most difficult and challenging diagnoses, supported living may be the best, ideal and sometimes the only option for the client. Some of these outcomes in cases of severe brain injury include:

• Coma: Broadly, a coma is a state unconsciousness that is often defined as lasting more than six A person in a coma cannot be awakened and generally fails to respond to external stimuli and does not initiate voluntary actions. There are several frequently used measures of the degree of a coma, including the Glasgow Coma Scale[2]. A score on the Glasgow Coma Scale in the range of three to eight is typically indicative of a severe brain injury. The Ranchos Los Amigos Scale provides similar measures.
• Vegetative state: A clinical condition of complete unawareness of the self and the environment, accompanied by sleep-wake cycles, with either complete or partial preservation of hypothalamic and brain stem autonomic functions. In addition, patients in a vegetative state show no evidence of sustained, reproducible, purposeful or voluntary behavioral responses to visual, auditory, tactile or noxious stimuli; show no evidence of language comprehension or expression; have bowel and bladder incontinence; and have variably preserved cranial nerve and spinal reflexes[3].
• Persistent vegetative state: A vegetative state still present one month after acute traumatic or non-traumatic brain injury or lasting for at least one month in individuals with degenerative or metabolic disorders or developmental malformations[4].
• Minimally responsive state: There are some individuals who have sustained serious, traumatic brain injuries and who have severe alterations in consciousness, but who do not meet the diagnostic criteria for a coma, a vegetative state or a persistent vegetative state. They are often called “minimally responsive.” They demonstrate inconsistent but discernible evidence of consciousness. It is important to distinguish individuals in this group from those in coma and vegetative states because preliminary findings suggest that there are meaningful differences in outcomes[5].

The professionals at NeuLife, including its team of psychologists, psychiatrists neurologists, RNs and therapists are expert in the provision of innovative, clinically relevant services, including the development of a customized Client Goal Plan, and delivery of neurobehavioral and neurorehabilitative services. NeuLife’s goal is to provide post-acute rehabilitation to its clients to achieve the best possible outcome for those who have even the most difficult and challenging diagnoses.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best accomplished in a positive and uplifting therapeutic environment where caring staff encourages, assists and supports each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to increase function and independence. NeuLife seeks to achieve maximized, sustained outcomes that exceed the expectations of all persons served.

NeuLife, in Mount Dora, Florida, is an accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.

2725 Robie Avenue

Mount Dora, Florida 32757

[1] National Center for Learning Disabilities, http://ncld.org/types-learning-disabilities/executive-function-disorders/what-is-executive-function

[2] Weyhenmyeye, James A.; Eve A. Gallman (2007). Rapid Review Neuroscience 1st Ed. Mosby Elsevier. pp. 177–9. ISBN 0-323-02261-8.

[3] New England Journal of Medicine, http://www.nejm.org/doi/full/10.1056/NEJM199405263302107

[4] Ibid

[5] http://www.neurology.org/content/58/3/349.full