simple presentation of functions of different lobes and consequences of brain injury

1. The Brain,
its Injuries
and their rehabilitation
By: Dora Kukucska (2015)

2. What is the brain?
▪ The brain is the control centre for all the body’s
functions, such as walking, talking, swallowing,
breathing, taste, smell, heart rate and so on. It also
controls all our thinking functions, our emotions, how
we behave and all our intellectual (cognitive) activities,
such as how we attend to things, how we perceive and
understand our world and its physical surroundings,
how we learn and remember and so on.
▪ The brain is a soft, jelly-like centre of the human
nervous system. It is completely enclosed in the skull
and floats in a protective sea of cerebrospinal fluid.
This fluid supports and nourishes the brain and acts as
a shock absorber for rapid head movements.
(TRG,2015)

3. Parts of the brain and their functions
▪ The brain is a bilateral organ that
consists of three main parts
(Cerebrum, Cerebellum and brain
stem).
▪ The cerebrum is composed of 4
cortex (lobes); frontal lobe, parietal
lobe, occipital lobe and temporal
lobe.
▪ Different parts of the brain perform
different functions:

4. • The largest of the brain structures
• Main site of the “higher cognitive
functions” (executive functions)
• Voluntary motor control, inhibition
• Cognition, intelligence, attention,
language processing (Broca’s area)
and comprehension
• Libido, sense of smell
• Skilled movements
• Initiative, creative thought
• Extremely vulnerable to damage.
Due to its large size it is almost
always damaged
• Paralysis
• Inability to express language (aphasia)
Most common cognitive changes
• Loss of spontaneity in social situations
• Atypical social skills and personality
traits
• Problem solving
• Planning and organizing
If damaged
Functions
(Kolb & Winshaw, 1990)

5. • Sense of touch (tactile sensation)
• Appreciation of form through
touch (stereognosis)
• Response to internal stimuli
(proprioception)
• Integration information from
different senses
• Some language and reading
functions
• Some visual functions
• Integrates information from the
ventral (what) and dorsal (where)
visual pathways
• Inability to locate and recognize objects
(hemispatial neglect)
• Inability to recognize parts of the body
(somatosensory agnosia)
• Disorientation
• Lack of coordination
• Inability to recognize objects by touch
• Simultaneous extinction
• Apraxia
Function
If damaged
(Kandel, Schwartz & Jessel, 1991)

6. • Vision
• Reading
• Processes where
objects are
• Movement perception
• Visuo-spatial
orientation
• Hallucinations
• Blindness
• Achromatopsia, Akinetopsia
• Synaesthesia
• Visual agnosia (including prosopagnosia)
• Alexia
• Optic ataxia
Function If damaged
(Kandel, Schwartz & Jessel, 1991)

7. • Auditory memories
• Some hearing
• Visual memories
• Some vision pathways (ventral)
• Other memory
• Music
• Fear
• Some language
• Some speech
• Some behaviour and emotions
• Sense of identity
• Recognition
• Understanding language
(Wernicke’s area)
• Wernicke’s aphasia
• Prosopagnosia
• Agnosia
• Persistent talking
• Long-short term memory loss
• Increased/ decreased sexual behaviour
• Aggression
• Damage to the left temporal lobe is
associated with verbal memory and
processing speech sounds
• Damage to right temporal lobe is associated
with deficit in non-verbal memory (faces,
facial expressions)
Functions
If damaged
Kolb &Wishaw (1990)

8. DON’T take it for granted!
▪ Injuries to your brain, skull, or scalp are all types of head injury. A head injury may be
mild or severe depending on what caused it. Some injuries produce bleeding within
your skull. Others cause damage on the outside of your head.These injuries may be
in the form of lacerations, bumps, or bruises.
▪ In the UK every year 1 million people go to hospital as result of brain injury. Out of
these:
• 150.000 people will suffer from minor brain injury
• 10.000 people will suffer from moderate brain injury
• 11.000 people will suffer major brain injury (about 15% will return to work within 5 years)
• 4.500 will never return to work and will require full time support for the rest of their lives
• 120.000 people are currently suffering from long-term effects of Brain injury

9. Types of Injuries
▪ These mechanisms are the highest causes of brain injury: Open head Injury,
Closed Head Injury, Deceleration Injuries, Chemical/Toxic, Hypoxia, Tumors,
Infections and Stroke.
Stroke
If blood flow is blocked through a cerebral vascular accident (stroke),
cell death in the area deprived of blood will result
If there is bleeding in or over the brain (haemorrhage or hematoma)
because of a tear in an artery or vein, loss of blood flow and injury to
the brain tissue by the blood will also result in brain damage.

10. Symptoms of stoke
▪ The signs and symptoms of a stroke vary from person to person but usually begin suddenly.
As different parts of your brain control different parts of your body, your symptoms will
depend on the part of your brain affected and the extent of the damage.
▪ Face – the face may have dropped on one side, the person may not be able to smile or their
mouth or eye may have drooped.
▪ Arms – the person with suspected stroke may not be able to lift both arms and keep them
there because of arm weakness or numbness in one arm.
▪ Speech – their speech may be slurred or garbled, or the person may not be able to talk at all
despite appearing to be awake.
▪ Time – it is time to dial 999 immediately if you notice any of these signs or symptoms.
(NHS, 2015)

11. Precursor and symptoms of stroke
Symptoms in the FAST test identify most strokes, but occasionally a stroke can cause
different symptoms.
Other symptoms and signs may include:
•complete paralysis of one side of the body
•sudden loss or blurring of vision
•dizziness
•confusion
•difficulty understanding what others are saying
•problems with balance and co-ordination
•difficulty swallowing (dysphagia)
•a sudden and very severe headache resulting in a blinding pain unlike anything
experienced before
•loss of consciousness
(NHS,2015)

12. Stroke facts
▪ Stroke kills twice as many women as breast
cancer and more men than prostate and
testicular cancer combined a year.
▪ Black people are twice as likely to have a
stroke compared to white people.
▪ Black and South Asian people have strokes
at a younger age compared to white
people.
▪ Stroke is the largest cause of complex
disability – half of all stroke survivors have a
disability.
▪ Over a third of stroke survivors in the UK
are dependent on others, of those 1 in 5 are
cared for by family and/or friends.
(Stroke Association, 2015)
▪ Stroke occurs approximately 152,000
times a year in the UK; that is one every 3
minutes 27 seconds.
▪ There are around 1.2 million stroke
survivors in the UK.
▪ 3 in 10 stroke survivors will go on to have
a recurrent stroke orTIA.
▪ 1 in 4 strokes are fatal within a year.
▪ Stroke is the fourth single largest cause
of death in the UK and second in the
world.
▪ By the age of 75, 1 in 5 women and 1 in 6
men will have a stroke.

13. What can be done? – early recovery
▪ There's still so much we don't know about how the brain compensates for the
damage caused by stroke. In some cases, the brain cells may be only temporarily
damaged, not killed, and may resume functioning over time. In other cases, the
brain can reorganize its own functioning. Every once in a while, a region of the brain
"takes over" for a region damaged by the stroke. Stroke survivors sometimes
experience remarkable and unanticipated recoveries that can't be explained.
General recovery guidelines show:
▪ 10% of stroke survivors recover almost completely
▪ 25% recover with minor impairments
▪ 40% experience moderate to severe impairments requiring special care
▪ 10% require care in a nursing home or other long-term care facility
▪ 15% die shortly after the stroke
(NSA,2015)

14. Rehabilitation in general
▪ Rehabilitation actually starts in the hospital as soon as possible following a stroke. In patients who
are stable, rehabilitation may begin within two days after the stroke has occurred, and should be
continued as necessary after release from the hospital.
▪ Depending on the severity of the stroke, rehabilitation options can include:
▪ A rehabilitation unit in the hospital with inpatient therapy
▪ A subacute care unit
▪ A rehabilitation hospital with individualized inpatient therapy
▪ Home therapy
▪ Returning home with outpatient therapy
▪ A long-term care facility that provides therapy and skilled nursing care
▪ The long-term goal of rehabilitation is to improve function so that the stroke survivor can become
as independent as possible.This must be accomplished in a way that preserves dignity and
motivates the survivor to relearn basic skills that the stroke may have impaired - skills like bathing,
eating, dressing and walking.

15. Rehabilitation team
▪ Physiatrist. Specializes in rehabilitation following injuries, accidents or illness
▪ Neurologist. Specializes in the prevention, diagnosis and treatment of stroke and other diseases of the brain and spinal cord
▪ Rehabilitation Nurse. Specializes in helping people with disabilities; helps survivors manage health problems that affect stroke (diabetes, high
blood pressure) and adjust to life after stroke
▪ Physical Therapist (PT). Helps stroke survivors with problems in moving and balance; suggests exercises to strengthen muscles for walking,
standing and other activities
▪ OccupationalTherapist (OT). Helps stroke survivors learn strategies to manage daily activities such as eating, bathing, dressing, writing or cooking
▪ Speech-Language Pathologists (SLP). Helps stroke survivors re-learn language skills (talking, reading and writing); shares strategies to help with
swallowing problems
▪ Dietician. Teaches survivors about healthy eating and special diets (low salt, low fat, low calorie)
▪ SocialWorker. Helps survivors make decisions about rehab programs, living arrangements, insurance, and support services in the home
▪ Neuropsychologist. Diagnoses and treats survivors who may be facing changes in thinking, memory, and behavior after stroke
▪ Case Manager. Helps survivors facilitate follow-up to acute care, coordinate care from multiple providers, and link to local services
▪ RecreationTherapist. Helps stroke survivors learn strategies to improve the thinking and movement skills needed to join in recreational activities

16. Thank you for
listening 