Stroke and Penetrating Head Injuries

Stroke

• Stroke is a leading cause of death in North America each year
• Approximately 1 million people experience a stroke each year
• Stroke occurs when a blood vessel in the brain ruptures and bleeds, or when there is a blockage in the blood supply to the brain
• Symptoms vary depending on the brain region affected
• Without oxygen, brain cells begin to die within minutes
• Slow speed of information processing is common after a stroke
• Memory problems are frequently observed after a stroke, but it may not be clear whether they are a direct or indirect consequence of stroke
• Damage to the left posterior frontal gyrus is often linked to the limitation in spoken output (Broca’s aphasia)
• Damage in the right inferior parietal lobule can lead to visual-spatial neglect, and damage in the right dorsolateral prefrontal cortex can lead to visuomotor neglect

Penetrating Head Injuries

• Penetrating head injury involves any injury that breaches the skull and protective layers of the brain
• Can be caused by gunshot wounds, stabbings, falls, or accidents involving sharp objects
• Less prevalent than closed head injuries, but tend to have a worse prognosis
• Account for approximately 40,000 civilian deaths each year in North America
• The famous case of Phineas Gage (1848) illustrated the role of the frontal lobe in personality and behavior.
• Although he survived the injury, a tamping iron propelled through his brain caused personality changes, including impulsivity, irritability, increased profanity, and inability to follow plans
• A case study on a 45-year-old man provides an example of the impact of penetrating head injuries on cognitive processing, motivation and daily life.
• This individual, despite having a below average IQ and a tenth-grade education, was unable to return to work due to impaired cognitive processing and lack of motivation.

Closed Head Injuries

• A type of traumatic brain injury in which the skull and dura mater remain intact
• Accounts for approximately 250,000 hospitalizations for TBI each year.
• Common cause of physical disability and cognitive impairment in young people.
• Individuals with closed head injuries often experience challenges with selective and sustained attention
• Challenges with executive functions, including categorization, abstraction, systematic memory searching, information retrieval, problem solving, self-direction, and planning are common consequences.
• Apathy, or the lack of motivation, is common in people with closed head injuries.
• Closed head injuries often impact memory.
• Impulsivity, irritability, and affective instability are frequently observed.
• Individuals with closed head injuries may struggle to fully consider the implications of their actions, leading to poor judgement and potentially dangerous outcomes.

Cognitive Behavioral Management Program

• A behavioral management program, delivered in a natural community setting, has proven to be effective in managing disruptitive behaviors in people with acquired brain injury.
• The study by Carnavale et al. (2006) involved participants with TBI or acquired brain injury, who were at least 16 years old and had a presenting behavioral impairment caused by brain injury.
• The study found that rates of disruptive or aggressive behaviors significantly declined in the program with no statistically significant differences in caregiver-rated stress or burden.