What is Acquired Brain Injury?
There is no universally agreed definition of Acquired Brain Injury (ABI). One example is:
"The term ABI includes traumatic brain injuries such as open or closed head injuries and non-traumatic brain injuries such as those caused by stroke, tumours, infectious diseases (e.g. encephalitis or meningitis), hypoxic injuries (e.g. asphyxiation, near drowning, anaesthetic incidents or severe blood loss), metabolic disorders (e.g. insulin shock or liver or kidney disease) and toxic products taken into the body through inhalation or indigestion. The term does not include brain injuries that are congenital or brain injuries induced by birth trauma."
Commission for Accreditation of Rehabilitation Facilities (CARF) (2005)
It is recognised that brain tumours and progressive neurological disease (e.g. multiple sclerosis and Parkinson's disease) may result in complex disabilities similar to those found in ABI. In addition, some forms of alcohol related brain damage can present suddenly. At present the main categories of ABI within the remit of consideration by SABIN are:
- Trauma - due to head injury or post-surgical damage (e.g. following tumour removal)
- Vascular Incident (e.g.stroke or a bleeding in the brain)
- Cerebral Anoxia (i.e. starvation of oxygen to the brain resulting in brain damage)
- Infection (e.g. meningitis, encephalitis) and other inflammation (e.g. vasculitis)
All these causes of brain injury can result in similar complex physical and psychological difficulties and although the care pathways often differ widely, the needs of those affected may be similar. Stroke, the second most common cause, is already being addressed in detail both nationally and locally in Scotland and through other existing Managed Clinical Networks. Brain tumour is also being addressed by The Scottish Adult Neuro-Oncology Network.
ABI often leads to a mixture of physical, cognitive, communicative, emotional and behavioural changes with profound consequences for the individual and their family. The person with such complex disabilities requires specialist multidisciplinary help delivered using a patient or family centered approach and involves many agencies other than health. Services should be provided locally whenever possible and several NHS Boards have planned or implemented improved provision for their population. However nationally there are many ABI patients who receive either little or no rehabilitation.
A proportion of those with what initially look like mild head injuries may have complex problems which include: