Brain injury ( BI ) is the destruction or degeneration of brain cells . Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage.
79-423: The Glasgow Coma Scale ( GCS ) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury . The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. These three behaviours make up the three elements of the scale: eye, verbal, and motor. A person's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score
158-453: A German neuroscientist, Carl Wernicke , consulted on a stroke patient. The patient experienced neither speech nor hearing impairments, but had a few brain deficits. These deficits included: lacking the ability to comprehend what was spoken to him and the words written down. After his death, Wernicke examined his autopsy that found a lesion located in the left temporal region. This area became known as Wernicke's area . Wernicke later hypothesized
237-521: A brain injury depend on location and the body's response to injury. Even a mild concussion can have long term effects that may not resolve. Another misconception is that children heal better from brain damage. Children are at greater risk for injury due to lack of maturity. It makes future development hard to predict. This is because different cortical areas mature at different stages, with some major cell populations and their corresponding cognitive faculties remaining unrefined until early adulthood. In
316-541: A healthcare provider should be consulted. Brain injuries can result from a number of conditions, including: Chemotherapy can cause brain damage to the neural stem cells and oligodendrocyte cells that produce myelin . Radiation and chemotherapy can lead to brain tissue damage by disrupting or stopping blood flow to the affected areas of the brain. This damage can cause long term effects such as but not limited to; memory loss, confusion, and loss of cognitive function . The brain damage caused by radiation depends on where
395-535: A hole in the skull may be necessary. Medicines used for traumatic injuries are diuretics , anti-seizure or coma -inducing drugs. Diuretics reduce the fluid in tissues lowering the pressure on the brain. In the first week after a traumatic brain injury, a person may have a risk of seizures, which anti-seizure drugs help prevent. Coma-inducing drugs may be used during surgery to reduce impairments and restore blood flow. Mouse NGF has been licensed in China since 2003 and
474-456: A jury, and presentation skill of a speaker. Variation across raters in the measurement procedures and variability in interpretation of measurement results are two examples of sources of error variance in rating measurements. Clearly stated guidelines for rendering ratings are necessary for reliability in ambiguous or challenging measurement scenarios. Without scoring guidelines, ratings are increasingly affected by experimenter's bias , that is,
553-427: A long time. There are documented cases of lasting psychological effects as well, such as emotional changes often caused by damage to the various parts of the brain that control human emotions and behavior. Individuals who have experienced emotional changes related to brain damage may have emotions that come very quickly and are very intense, but have very little lasting effect. Emotional changes may not be triggered by
632-407: A mild incident can have long-term effects or cause symptoms to appear years later. Studies show there is a correlation between brain lesion and language, speech, and category-specific disorders. Wernicke's aphasia is associated with anomia , unknowingly making up words ( neologisms ), and problems with comprehension. The symptoms of Wernicke's aphasia are caused by damage to the posterior section of
711-448: A patient with a head injury. Their work resulted in the 1974 publication of the first iteration of the GCS. The original scale involved three exam components (eye movement, motor control, and verbal control). These components were scored based on clearly defined behavioural responses. Clear instructions for administering the scale and interpreting results were also included. The original scale
790-408: A person is unable to remember things. Aphasia is the loss or impairment of word comprehension or use. Apraxia is a motor disorder caused by damage to the brain, and may be more common in those who have been left brain damaged, with loss of mechanical knowledge critical. Headaches, occasional dizziness, and fatigue—all temporary symptoms of brain trauma—may become permanent, or may not disappear for
869-477: A person obeys commands only on their right side, they get a 6 for motor. The scale also accounts for situations that prevent appropriate testing (Not Testable). When specific tests cannot be performed, they must be reported as "NT" and the total score is not reported. The results are reported as the Glasgow Coma Score (the total points from the three tests) and the individual components. As an example,
SECTION 10
#1732797710817948-482: A person's score might be: GCS 12, E3 V4 M5. Alternatively, if a patient was intubated, their score could be GCS E2 V NT M3. Children below the age of two struggle with the tests necessary for assessment of the Glasgow Coma Scale. As a result, a version for children has been developed, and is outlined below. Individual elements as well as the sum of the score are important. Hence, the score is expressed in
1027-446: A result, the six-point motor scale is now considered the standard. Teasdale did not originally intend to use the sum score of the GCS components. However, later work demonstrated that the sum of the GCS components, or the Glasgow Coma Score, had clinical significance. Specifically, the sum score was correlated with outcome (including death and disability). As a result, the Glasgow Coma Score is used in research to define patient groups. It
1106-405: A set of items (e.g., do two interviewers agree about the depression scores for all of the items on the same semi-structured interview for one case?) as well as raters x cases (e.g., how well do two or more raters agree about whether 30 cases have a depression diagnosis, yes/no—a nominal variable). Kappa is similar to a correlation coefficient in that it cannot go above +1.0 or below -1.0. Because it
1185-532: A specific event, and can be a cause of stress to the injured party and their family and friends. Often, counseling is suggested for those who experience this effect after their injury, and may be available as an individual or group session. The long term psychological and physiological effects will vary by person and injury. For example, perinatal brain damage has been implicated in cases of neurodevelopmental impairments and psychiatric illnesses. If any concerning symptoms, signs, or changes to behaviors are occurring,
1264-468: A variety of factors; such as severity and location. Testing is done to note severity and location. Not everyone fully heals from brain damage, but it is possible to have a full recovery. Brain injuries are very hard to predict in outcome. Many tests and specialists are needed to determine the likelihood of the prognosis. People with minor brain damage can have debilitating side effects; not just severe brain damage has debilitating effects. The side-effects of
1343-695: Is a common debilitating experience and may not be linked by the patient to the original (minor) incident. Cognitive symptoms include confusion, aggressiveness, abnormal behavior, slurred speech , and coma or other disorders of consciousness . Physical symptoms include headaches that worsen or do not go away, vomiting or nausea, convulsions , brain pulsation, abnormal dilation of the eyes , inability to awaken from sleep, weakness in extremities, and loss of coordination . Symptoms observed in children include changes in eating habits, persistent irritability or sadness, changes in attention, or disrupted sleeping habits. Symptoms of brain injuries can also be influenced by
1422-998: Is a critical step in medical management for several reasons. First, a reliable assessment allows doctors to provide the appropriate treatment. Second, assessments let doctors keep track of how a patient is doing, and intervene if the patient is doing worse. Finally, a system of assessment allows researchers to define categories of patients. This makes it possible to determine which treatments are best for different types of patients. A number of assessments for head injury ("coma scales") were developed, though none were widely adopted. Of 13 scales that had been published by 1974, all involved linear scales that defined levels of consciousness. These scales posed two problems. First, levels of consciousness in these scales were often poorly defined. This made it difficult for doctors and nurses to evaluate head injury patients. Second, different scales used overlapping and obscure terms that made communication difficult. In this setting, Bryan Jennett and Graham Teasdale of
1501-606: Is a matter of a practical assessment in each case. Krippendorff's alpha is a versatile statistic that assesses the agreement achieved among observers who categorize, evaluate, or measure a given set of objects in terms of the values of a variable. It generalizes several specialized agreement coefficients by accepting any number of observers, being applicable to nominal, ordinal, interval, and ratio levels of measurement, being able to handle missing data, and being corrected for small sample sizes. Alpha emerged in content analysis where textual units are categorized by trained coders and
1580-442: Is a reliable agreement between raters. There are three operational definitions of agreement: These combine with two operational definitions of behavior: The joint-probability of agreement is the simplest and the least robust measure. It is estimated as the percentage of the time the raters agree in a nominal or categorical rating system. It does not take into account the fact that agreement may happen solely based on chance. There
1659-405: Is also common with brain damage, as is temporary aphasia , or impairment of language. As time progresses, and the severity of injury becomes clear, there are further responses that may become apparent. Due to loss of blood flow or damaged tissue, sustained during the injury, amnesia and aphasia may become permanent, and apraxia has been documented in patients. Amnesia is a condition in which
SECTION 20
#17327977108171738-598: Is also used in clinical practice as shorthand for the full scale. The Glasgow Coma Scale was initially adopted by nursing staff in the Glasgow neurosurgical unit. Especially following a 1975 nursing publication, it was adopted by other medical centres. True widespread adoption of the GCS was attributed to two events in 1978. First, Tom Langfitt, a leading figure in neurological trauma, wrote an editorial in Journal of Neurosurgery strongly encouraging neurosurgical units to adopt
1817-425: Is an improvement over Pearson's r {\displaystyle r} and Spearman's ρ {\displaystyle \rho } , as it takes into account the differences in ratings for individual segments, along with the correlation between raters. Another approach to agreement (useful when there are only two raters and the scale is continuous) is to calculate the differences between each pair of
1896-463: Is defined as, "the proportion of variance of an observation due to between-subject variability in the true scores". The range of the ICC may be between 0.0 and 1.0 (an early definition of ICC could be between −1 and +1). The ICC will be high when there is little variation between the scores given to each item by the raters, e.g. if all raters give the same or similar scores to each of the items. The ICC
1975-575: Is identical to the current scale except for the motor assessment. The original motor assessment included only five levels, combining "flexion" and "abnormal flexion". This was done because Jennett and Teasdale found that many people struggled in distinguishing these two states. In 1976, Teasdale updated the motor component of the Glasgow Coma Scale to differentiate flexion movements. This was because trained personnel could reliably distinguish flexion movements. Further research also demonstrated that normal and abnormal flexion have different clinical outcomes. As
2054-499: Is no "intrinsic" agreement and (b) to increase as the "intrinsic" agreement rate improves. Most chance-corrected agreement coefficients achieve the first objective. However, the second objective is not achieved by many known chance-corrected measures. Kappa is a way of measuring agreement or reliability, correcting for how often ratings might agree by chance. Cohen's kappa, which works for two raters, and Fleiss' kappa, an adaptation that works for any fixed number of raters, improve upon
2133-409: Is no connection between their working visual cortex and language areas—as is demonstrated by the fact that people with pure alexia can still write, speak, and even transcribe letters without understanding their meaning. Lesions to the fusiform gyrus often result in prosopagnosia , the inability to distinguish faces and other complex objects from each other. Lesions in the amygdala would eliminate
2212-566: Is one of the most astonishing brain injuries in history. In 1848, Phineas Gage was paving way for a new railroad line when he encountered an accidental explosion of a tamping iron straight through his frontal lobe. Gage observed to be intellectually unaffected but was claimed by some to have exemplified post-injury behavioral deficits. Ten years later, Paul Broca examined two patients exhibiting impaired speech due to frontal lobe injuries. Broca's first patient lacked productive speech. He saw this as an opportunity to address language localization. It
2291-433: Is ordinal. If more than two raters are observed, an average level of agreement for the group can be calculated as the mean of the r {\displaystyle r} , τ , or ρ {\displaystyle \rho } values from each possible pair of raters. Another way of performing reliability testing is to use the intra-class correlation coefficient (ICC). There are several types of this and one
2370-420: Is some question whether or not there is a need to 'correct' for chance agreement; some suggest that, in any case, any such adjustment should be based on an explicit model of how chance and error affect raters' decisions. When the number of categories being used is small (e.g. 2 or 3), the likelihood for 2 raters to agree by pure chance increases dramatically. This is because both raters must confine themselves to
2449-412: Is used as a measure of agreement, only positive values would be expected in most situations; negative values would indicate systematic disagreement. Kappa can only achieve very high values when both agreement is good and the rate of the target condition is near 50% (because it includes the base rate in the calculation of joint probabilities). Several authorities have offered "rules of thumb" for interpreting
Glasgow Coma Scale - Misplaced Pages Continue
2528-482: Is used in counseling and survey research where experts code open-ended interview data into analyzable terms, in psychometrics where individual attributes are tested by multiple methods, in observational studies where unstructured happenings are recorded for subsequent analysis, and in computational linguistics where texts are annotated for various syntactic and semantic qualities. For any task in which multiple raters are useful, raters are expected to disagree about
2607-406: Is used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor hospitalised patients and track their level of consciousness. Lower GCS scores are correlated with higher risk of death. However, the GCS score alone should not be used on its own to predict the outcome for an individual person with brain injury. The Glasgow Coma Scale is used for people above
2686-566: Is used to promote neurological recovery in a range of brain injuries, including intracerebral hemorrhage. In the case of brain damage from traumatic brain injury , dexamethasone and/or Mannitol may be used. Various professions may be involved in the medical care and rehabilitation of someone with an impairment after a brain injury. Neurologists , neurosurgeons , and physiatrists are physicians specialising in treating brain injury. Neuropsychologists (especially clinical neuropsychologists ) are psychologists specialising in understanding
2765-446: Is usually higher or lower than the other by a consistent amount, the bias will be different from zero. If the raters tend to disagree, but without a consistent pattern of one rating higher than the other, the mean will be near zero. Confidence limits (usually 95%) can be calculated for both the bias and each of the limits of agreement. There are several formulae that can be used to calculate limits of agreement. The simple formula, which
2844-489: The University of Glasgow Medical School began work on what became the Glasgow Coma Scale. Based on their experiences, they aimed to make a scale satisfying several criteria. First, it needed to be simple, so that it could be performed without special training. Second, it needed to be reliable, so that doctors could be confident in the results of the scale. Third, the scale needed to provide important information for managing
2923-496: The simplified motor scale and FOUR score have also been developed as improvements to the GCS. Although the inter-rater reliability of these newer scores has been slightly higher than that of the GCS, they have not yet gained consensus as replacements. Brain Injury A common category with the greatest number of injuries is traumatic brain injury (TBI) following physical trauma or head injury from an outside source, and
3002-475: The superior temporal gyrus . Damage to the Broca's area typically produces symptoms like omitting functional words ( agrammatism ), sound production changes, dyslexia , dysgraphia , and problems with comprehension and production. Broca's aphasia is indicative of damage to the posterior inferior frontal gyrus of the brain. An impairment following damage to a region of the brain does not necessarily imply that
3081-515: The 1 is left out, so the scale reads Ec or Vt. A composite might be "GCS 5tc". This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for "abnormal flexion". The GCS has limited applicability to children, especially below the age of 36 months (when the verbal performance of even a healthy child would be expected to be poor). Consequently, the Paediatric Glasgow Coma Scale
3160-407: The GCS score. Second, the GCS was included in the first version of Advanced Trauma Life Support (ATLS), which expanded the number of centres where staff were trained in performing the GCS. The GCS has come under pressure from some researchers who take issue with the scale's poor inter-rater reliability and lack of prognostic utility. Although there is no agreed-upon alternative, newer scores such as
3239-515: The Glasgow Coma Scale severity is classified as follows, severe brain injuries score 3–8, moderate brain injuries score 9–12 and mild score 13–15. There are several imaging techniques that can aid in diagnosing and assessing the extent of brain damage, such as computed tomography (CT) scan, magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and single-photon emission tomography (SPECT) . CT scans and MRI are
Glasgow Coma Scale - Misplaced Pages Continue
3318-438: The age of two and is composed of three tests: eye , verbal , and motor responses. The scores for each of these tests are indicated in the table below. The Glasgow Coma Scale is reported as the combined score (which ranges from 3 to 15) and the score of each test (E for eye, V for Verbal, and M for Motor). For each test, the value should be based on the best response that the person being examined can provide. For example, if
3397-499: The approach included versions that could handle "partial credit" and ordinal scales. These extensions converge with the family of intra-class correlations (ICCs), so there is a conceptually related way of estimating reliability for each level of measurement from nominal (kappa) to ordinal (ordinal kappa or ICC—stretching assumptions) to interval (ICC, or ordinal kappa—treating the interval scale as ordinal), and ratio (ICCs). There also are variants that can look at agreement by raters across
3476-480: The body. Brain injuries have far-reaching and varied consequences due to the nature of the brain as the main source of bodily control. Brain-injured people commonly experience issues with memory. This can be issues with either long or short-term memories depending on the location and severity of the injury. Sometimes memory can be improved through rehabilitation, although it can be permanent. Behavioral and personality changes are also commonly observed due to changes of
3555-426: The brain can learn to compensate for other damaged areas, and may increase in size and complexity and even change function, just as someone who loses a sense may gain increased acuity in another sense—a process termed neuroplasticity . There are many misconceptions that revolve around brain injuries and brain damage. One misconception is that if someone has brain damage then they cannot fully recover. Recovery depends
3634-416: The brain depending on the size of the lesion and location relative to the calcarine fissure . Lesions to V4 can cause color-blindness , and bilateral lesions to MT/V5 can cause the loss of the ability to perceive motion. Lesions to the parietal lobes may result in agnosia , an inability to recognize complex objects, smells, or shapes, or amorphosynthesis , a loss of perception on the opposite side of
3713-508: The brain structure in areas controlling hormones or major emotions. Headaches and pain can occur as a result of a brain injury, either directly from the damage or due to neurological conditions stemming from the injury. Due to the changes in the brain as well as the issues associated with the change in physical and mental capacity, depression and low self-esteem are common side effects that can be treated with psychological help. Antidepressants must be used with caution in brain injury people due to
3792-775: The brain tumor is located, the amount of radiation used, and the duration of the treatment. Radiosurgery can also lead to tissue damage that results in about 1 in 20 patients requiring a second operation to remove the damaged tissue. Wernicke–Korsakoff syndrome can cause brain damage and results from a Vitamin B deficiency (specifically vitamin B1, thiamine ). This syndrome presents with two conditions, Wernicke's encephalopathy and Korsakoff psychosis . Typically Wernicke's encephalopathy precedes symptoms of Korsakoff psychosis. Wernicke's encephalopathy results from focal accumulation of lactic acid , causing problems with vision, coordination, and balance. Korsakoff psychosis typically follows after
3871-424: The case of a child with frontal brain injury, for example, the impact of the damage may be undetectable until that child fails to develop normal executive functions in his or her late teens and early twenties. The foundation for understanding human behavior and brain injury can be attributed to the case of Phineas Gage and the famous case studies by Paul Broca. The first case study on Phineas Gage's head injury
3950-417: The damaged area is wholly responsible for the cognitive process which is impaired, however. For example, in pure alexia , the ability to read is destroyed by a lesion damaging both the left visual field and the connection between the right visual field and the language areas (Broca's area and Wernicke's area). However, this does not mean one with pure alexia is incapable of comprehending speech—merely that there
4029-479: The effects of brain injury and may be involved in assessing the severity or creating rehabilitation strategies. Occupational therapists may be involved in running rehabilitation programs to help restore lost function or help re-learn essential skills. Registered nurses , such as those working in hospital intensive care units , are able to maintain the health of the severely brain-injured with constant administration of medication and neurological monitoring, including
SECTION 50
#17327977108174108-501: The efficacy of sit to stand training, arm ability training and body weight support systems (BWS). Overall, studies suggest that patients with TBIs who participate in more intense rehabilitation programs will see greater benefits in functional skills. More research is required to better understand the efficacy of the treatments mentioned above. Other treatments for brain injury can include medication , psychotherapy , neuropsychological rehabilitation , and/or surgery . Prognosis, or
4187-417: The enhanced activation seen in occipital and fusiform visual areas in response to fear with the area intact. Amygdala lesions change the functional pattern of activation to emotional stimuli in regions that are distant from the amygdala. Other lesions to the visual cortex have different effects depending on the location of the damage. Lesions to V1 , for example, can cause blindsight in different areas of
4266-400: The exposed brain or commonly by infusion of excitotoxins to specific areas. Diffuse axonal injury is caused by shearing forces on the brain leading to lesions in the white matter tracts of the brain. These shearing forces are seen in cases where the brain had a sharp rotational acceleration, and is caused by the difference in density between white matter and grey matter. Unlike some of
4345-410: The form "GCS 9 = E2 V4 M3 at 07:35". Patients with scores of 3 to 8 are usually considered to be in a coma. Generally, brain injury is classified as: Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached (e.g. "E1c", where "c" = closed, or "V1t" where t = tube). Often
4424-436: The joint probability in that they take into account the amount of agreement that could be expected to occur through chance. The original versions had the same problem as the joint-probability in that they treat the data as nominal and assume the ratings have no natural ordering; if the data actually have a rank (ordinal level of measurement), then that information is not fully considered in the measurements. Later extensions of
4503-447: The level of agreement, many of which agree in the gist even though the words are not identical. Either Pearson 's r {\displaystyle r} , Kendall's τ , or Spearman 's ρ {\displaystyle \rho } can be used to measure pairwise correlation among raters using a scale that is ordered. Pearson assumes the rating scale is continuous; Kendall and Spearman statistics assume only that it
4582-436: The likely progress of a disorder, depends on the nature, location, and cause of the brain damage (see Traumatic brain injury , Focal and diffuse brain injury , Primary and secondary brain injury ). In general, neuroregeneration can occur in the peripheral nervous system but is much rarer and more difficult to assist in the central nervous system (brain or spinal cord). However, in neural development in humans , areas of
4661-431: The limited number of options available, which impacts the overall agreement rate, and not necessarily their propensity for "intrinsic" agreement (an agreement is considered "intrinsic" if it is not due to chance). Therefore, the joint probability of agreement will remain high even in the absence of any "intrinsic" agreement among raters. A useful inter-rater reliability coefficient is expected (a) to be close to 0 when there
4740-646: The location of the injury and as a result impairments are specific to the part of the brain affected. Lesion size is correlated with severity, recovery, and comprehension. Brain injuries often create impairment or disability that can vary greatly in severity. In cases of severe brain injuries, the likelihood of areas with permanent disability is great, including neurocognitive deficits , delusions (often, to be specific, monothematic delusions ), speech or movement problems, and intellectual disability . There may also be personality changes. The most severe cases result in coma or even persistent vegetative state . Even
4819-683: The more obvious responses to brain damage, the body also has invisible physical responses which can be difficult to notice. These will generally be identified by a healthcare provider, especially as they are normal physical responses to brain damage. Cytokines are known to be induced in response to brain injury. These have diverse actions that can cause, exacerbate, mediate and/or inhibit cellular injury and repair. TGFβ seems to exert primarily neuroprotective actions, whereas TNFα might contribute to neuronal injury and exert protective effects. IL-1 mediates ischaemic, excitotoxic, and traumatic brain injury , probably through multiple actions on glia, neurons, and
SECTION 60
#17327977108174898-535: The observed target. By contrast, situations involving unambiguous measurement, such as simple counting tasks (e.g. number of potential customers entering a store), often do not require more than one person performing the measurement. Measurement involving ambiguity in characteristics of interest in the rating target are generally improved with multiple trained raters. Such measurement tasks often involve subjective judgment of quality. Examples include ratings of physician 'bedside manner', evaluation of witness credibility by
4977-427: The other imaging techniques are not used in a clinical setting because of the cost, lack of availability. The treatment for emergency traumatic brain injuries focuses on assuring the person has enough oxygen from the brain's blood supply, and on maintaining normal blood pressure to avoid further injuries of the head or neck. The person may need surgery to remove clotted blood or repair skull fractures, for which cutting
5056-475: The potential for undesired effects because of the already altered brain chemistry. There are multiple responses of the body to brain injury, occurring at different times after the initial occurrence of damage, as the functions of the neurons , nerve tracts, or sections of the brain can be affected by damage. The immediate response can take many forms. Initially, there may be symptoms such as swelling, pain, bruising, or loss of consciousness. Post-traumatic amnesia
5135-406: The relationship between Wernicke's area and Broca's area, which was proven fact. Inter-rater reliability In statistics, inter-rater reliability (also called by various similar names, such as inter-rater agreement , inter-rater concordance , inter-observer reliability , inter-coder reliability , and so on) is the degree of agreement among independent observers who rate, code, or assess
5214-651: The same phenomenon. Assessment tools that rely on ratings must exhibit good inter-rater reliability, otherwise they are not valid tests . There are a number of statistics that can be used to determine inter-rater reliability. Different statistics are appropriate for different types of measurement. Some options are joint-probability of agreement, such as Cohen's kappa , Scott's pi and Fleiss' kappa ; or inter-rater correlation, concordance correlation coefficient , intra-class correlation , and Krippendorff's alpha . There are several operational definitions of "inter-rater reliability," reflecting different viewpoints about what
5293-415: The severity of the injury or how much of the brain is affected. The four categories used for classifying the severity of brain injuries are mild, moderate, or severe. Symptoms of a mild brain injury include headaches , confusions , tinnitus , fatigue , changes in sleep patterns , mood or behavior . Other symptoms include trouble with memory , concentration , attention or thinking . Mental fatigue
5372-535: The symptoms of Wernicke's decrease. Wernicke-Korsakoff syndrome is typically caused by conditions causing thiamine deficiency, such as chronic heavy alcohol use or by conditions that affect nutritional absorption, including colon cancer, eating disorders and gastric bypass. Brain lesions are sometimes intentionally inflicted during neurosurgery , such as the carefully placed brain lesion used to treat epilepsy and other brain disorders. These lesions are induced by excision or by electric shocks (electrolytic lesions) to
5451-524: The term acquired brain injury (ABI) is used in appropriate circles to differentiate brain injuries occurring after birth from injury, from a genetic disorder (GBI), or from a congenital disorder (CBI). Primary and secondary brain injuries identify the processes involved, while focal and diffuse brain injury describe the severity and localization. Impaired function of affected areas can be compensated through neuroplasticity by forming new neural connections. Symptoms of brain injuries vary based on
5530-539: The two methods (inter-rater agreement), but also to assess these characteristics for each method within itself. It might very well be that the agreement between two methods is poor simply because one of the methods has wide limits of agreement while the other has narrow. In this case, the method with the narrow limits of agreement would be superior from a statistical point of view, while practical or other considerations might change this appreciation. What constitutes narrow or wide limits of agreement or large or small bias
5609-410: The two raters' observations. The mean of these differences is termed bias and the reference interval (mean ± 1.96 × standard deviation ) is termed limits of agreement . The limits of agreement provide insight into how much random variation may be influencing the ratings. If the raters tend to agree, the differences between the raters' observations will be near zero. If one rater
5688-449: The two ratings on the horizontal. The resulting Bland–Altman plot demonstrates not only the overall degree of agreement, but also whether the agreement is related to the underlying value of the item. For instance, two raters might agree closely in estimating the size of small items, but disagree about larger items. When comparing two methods of measurement, it is not only of interest to estimate both bias and limits of agreement between
5767-507: The two techniques widely used and are most effective. CT scans can show brain bleeds, fractures of the skull, fluid build up in the brain that will lead to increased cranial pressure. MRI is able to better to detect smaller injuries, detect damage within the brain, diffuse axonal injury, injuries to the brainstem, posterior fossa, and subtemporal and subfrontal regions. However, patients with pacemakers, metallic implants, or other metal within their bodies are unable to have an MRI done. Typically
5846-420: The use of modalities. There is no evidence to support the efficacy of this intervention. Serial casting and splinting are often used to reduce soft tissue contractures and muscle tone. Evidence based research reveals that serial casting can be used to increase passive range of motion (PROM) and decrease spasticity . Functional training may also be used to treat patients with TBIs. To date, no studies supports
5925-551: The use of the Glasgow Coma Scale used by other health professionals to quantify extent of orientation. Physiotherapists also play a significant role in rehabilitation after a brain injury. In the case of a traumatic brain injury (TBI), physiotherapy treatment during the post-acute phase may include sensory stimulation, serial casting and splinting, fitness and aerobic training, and functional training. Sensory stimulation refers to regaining sensory perception through
6004-505: The vasculature. Cytokines may be useful in order to discover novel therapeutic strategies. At the current time, they are already in clinical trials. Glasgow Coma Scale (GCS) is the most widely used scoring system used to assess the level of severity of a brain injury. This method is based on the objective observations of specific traits to determine the severity of a brain injury. It is based on three traits: eye opening, verbal response, and motor response, gauged as described below. Based on
6083-442: Was developed for assessing younger children. During the 1960s, assessment and management of head injuries became a topic of interest. The number of head injuries was rapidly increasing, in part because of increased use of motorised transport. Also, doctors recognised that after head trauma, many patients had poor recovery. This led to a concern that patients were not being assessed or medically managed correctly. Appropriate assessment
6162-410: Was given in the previous paragraph and works well for sample size greater than 60, is For smaller sample sizes, another common simplification is However, the most accurate formula (which is applicable for all sample sizes) is Bland and Altman have expanded on this idea by graphing the difference of each point, the mean difference, and the limits of agreement on the vertical against the average of
6241-437: Was not until Leborgne, informally known as "tan", died when Broca confirmed the frontal lobe lesion from an autopsy. The second patient had similar speech impairments, supporting his findings on language localization. The results of both cases became a vital verification of the relationship between speech and the left cerebral hemisphere. The affected areas are known today as Broca's area and Broca's Aphasia. A few years later,
#816183