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NEUROLOGICAL DISORDERS

Brain injuries usually happen to people over the age of 65. Traumatic brain injuries cause approximately 40% of all deaths from accidents and injuries, and each year approximately 52,000 people die from a traumatic brain injury. Spinal cord injuries are caused by trauma or accidents. Brain injuries and spinal cord injuries can be devastating. Many of the victims who suffer a brain injury or a spinal cord injury do not survive and many of those who do survive have serious, permanent disabilities.

The Nervous System

The brain, the spinal cord and the peripheral nerves are the three major components of the nervous system. The nervous system is the part of the body that controls everything a person does. All of a person’s conscious and unconscious behavior starts with, and is controlled by, the nervous system. Although the brain and spinal cord work together, they have different, special roles.

The brain could be considered the command center of the body, and it is divided into different, specialized regions. Each region is involved in a particular aspect of functioning and behavior that a person controls – speech, emotions, problem solving, and voluntary movements such as walking. There are also specialized regions that initiate and control all of the functions and behavior that are involuntary, such as body temperature, breathing, digestion, and heartbeat.

The spinal cord is a long body of nervous tissue that is located inside the spine. It starts at the base of the brain and ends at the bottom of the spine near the buttocks. The spinal cord has two functions: 1) it helps control some basic body functions, and 2) it acts as the major “power conductor” of the information that the brain sends and receives.

Along the entire length of the spinal cord are peripheral nerves. These are long, thin strands of nervous tissue that are, in a sense, like electrical wires. These peripheral nerves travel to all of the organs, such as the heart, lungs, liver, kidneys, and glands, to receptors to sense pain, heat, or cold, and to every other part of the body. Information and messages from the different areas of the brain travel through the spinal cord and the peripheral nerves to the organs and the body. Information and messages from the organs and the body travel back to the brain through the peripheral nerves and the spinal cord.

Traumatic and Acquired Brain Injuries

There are two basic causes of brain injuries: trauma and acquired conditions. This section will focus on brain injuries caused by complications associated with an acquired condition.

Traumatic brain injuries are caused by a violent force that is applied to the head. Motor vehicle accidents, accidents related to sports, firearm injuries, and falls are common causes of traumatic brain injury. The intensity of a trauma to the head may damage the brain and cause bleeding and swelling.

Due to the brain being enclosed inside the skull, the bleeding and the swelling cause pressure on the brain tissue. If the bleeding, swelling, pressure, and the physical damage caused by the trauma are severe and cannot be treated, the brain will suffer permanent injury.

Stroke

The most common type of brain injury is a stroke. Strokes are one of the leading causes of death in the United States. They are the leading cause of disability, and each year approximately 700,000 people in the U.S., have a stroke. The survival rate after a stroke has improved with better treatment, improved emergency care, and increased public awareness, but strokes are still a major public health problem and are considered a medical emergency.

The technical term for a stroke is cerebrovascular accident (CVA). The word vascular means of or pertaining to the blood vessels and circulation. The prefix cerebro means of or pertaining to the brain. The two together provide the basic definition of a stroke or CVA.

A stroke is defined as a sudden disruption of the blood supply to the brain that may cause permanent damage. There are two types of stroke: 1) ischemic stroke and 2) hemorrhagic stroke. Ischemic strokes are more common than hemorrhagic strokes; approximately 80% of all strokes are ischemic strokes.

Signs and Symptoms of a Stroke

The signs and symptoms of a stroke depend on what part of the brain is affected and how much damage has been done. They may include:

  • Weakness in one side of the body
  • Differing degrees of paralysis
  • Facial droop
  • Decreased level of consciousness
  • Loss of consciousness
  • Confusion
  • Inability to speak or inability to understand speech
  • Sudden vision loss
  • Dizziness
  • Loss of balance
  • Sudden and severe headache

A quick way to determine if someone is having a stroke is to use the acronym FAST. Look at the victim’s Face to see if one side is drooping. Ask the victim to hold up his or her Arms and see if one or both drift down. Check and see if the victim’s Speech is slurred. The T stands for Time, which is critical because the sooner someone receives medical treatment the better chance that person has for recovery. These permanent disabilities caused by a stroke include those listed here.

  • Aphasia: Aphasia means the inability to speak. Aphasia is a common complication of stroke.
  • Coma
  • Paralysis: Paralysis that is caused by a stroke can affect one part of the body (such as, part of the face or one arm), or it may affect one half or one side of the body. Paralysis of one side of the body (face, trunk, arm, and leg) is called hemiplegia. Paralysis affecting the lower half of the body is called paraplegia. Paralysis affecting the upper and the lower extremities is called quadriplegia.
  • Visual deficits.
  • Weakness: The stroke victim may not suffer from paralysis, but the stroke may cause serious muscle weakness.

Spinal Cord Injuries

Spinal cord injuries are almost always caused by a traumatic injury from an automobile accident, a fall, a firearm, or a sports accident such as a collision in football. Spinal cord injuries are less common than brain injuries caused by trauma and they are less common than ischemic and hemorrhagic strokes. Spinal cord injuries can be relatively mild and the patient may recover, or they can be severe and the patient will have a permanent disability. The signs and symptoms of a spinal cord injury are similar to those of a stroke but they tend to be more extensive and more severe. Permanent disabilities are common, and people who have had a spinal cord injury can develop the same complications that are associated with a stroke.

Transient Ischemic Attack

A transient ischemic attack or TIA is defined as a sudden episode of neurological dysfunction that does not cause permanent damage. A TIA is similar to a stroke; it is caused by an interruption in blood flow to the brain, and the patients have many of the same signs and symptoms as do stroke patients. The causes of TIA and the factors that increase the risk of having a TIA are essentially the same as those of a stroke. Women are less likely than men to have a TIA.

The informal term for a TIA is a “mini-stroke” and, as noted above, there are similarities of a TIA to a stroke. However, there are two primary differences between a TIA and stroke that are important to know. In a TIA, the flow of blood is spontaneously restored and brain tissue is not damaged. A patient having a TIA will have many of the same signs and symptoms as someone having a stroke but the clinical presentation is usually less severe and the brain tissue will not be permanently damaged.

Patient Care: Stroke or Spinal Cord injury

Caring for a patient who has had a stroke or a spinal cord injury is very involved. The basics of care should be that an aide should particularly focus on include the following.

Aspiration

The speech therapist will prescribe specific aspiration prevention techniques such as elevation of the head while eating and swallowing exercises. The aide must be aware that the signs of aspiration can be subtle, so any symptoms or unusual behaviors that seem to be associated with eating should be reported.

Nutrition

Adequate nutrition and good hydration are essential for recovery. The Aide has a responsibility to monitor the patient’s food and fluid intake. Complications that are associated with stroke and spinal cord injuries should be known, and the Aide should make sure to observe the patient closely for their development.

Skin Care

Immobility, dehydration, incontinence, and pre-existing medical conditions such as diabetes are common in stroke and spinal cord injury patients. These increase the risk of developing skin breakdown and pressure ulcers.

The Aide must be aware that the signs of aspiration can be subtle, so any symptoms or unusual behaviors that seem to be associated with eating should be reported. Immobility, dehydration, incontinence, and pre-existing medical conditions such as diabetes are common in stroke and spinal cord injury patients.

Neurological Disorders Quiz

    * Required Information

    1. Three important aspects of the care of someone with a neurological disorder are aspiration, nutrition and skin care.*

    TrueFalse

    2. The term TIA is also referred to as a mini stroke.*

    TrueFalse

    3. Spinal cord injuries are almost always caused by a traumatic injury *

    TrueFalse

    4. The most common cause of brain injury is a stroke. *

    TrueFalse

    5. Name the three (3) components of the nervous system *


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