HEAD INJURY

This article is intended for friends and relatives of somebody who is in a hospital ward or an Intensive Treatment Unit (ITU) following a head injury. This is often a worrying time, but other people have been through similar experiences, and there are many ways of helping. However, it is important to realise that every head injury is different and can have a different effect on the individual. Some of this principles mentioned here may not be applicable to every patient; discuss any concerns with nursing or medical staff on the ward.

Introduction

Every year nearly one million people in Britain attend hospitals with head injuries. Many of these people are left with a wide range of serious physical or psychological disabilities, often both. These long-standing disabilities result in considerable social and emotional problems for head injured people and their families. Headway, the National Head Injuries Association, was founded in response to these special needs. According to recent research from the Joseph Rowntree Foundation, help for people with head injury from doctors and other professionals was either slow in coming or non-existent. Headway was regarded as the most approachable and reliable source of advice.

Head injuries

Any injury causing more than brief unconsciousness carries the risk of damage to the brain. Although the bones of the skull act as an essential protective frame for the brain, they can also cause damage. When the head is injured (e.g. in a fall or a car accident), the brain rebounds against the hard internal surfaces of the skull, causing bruising and possibly stretching and tearing of nerve fibres and blood vessels. This may be limited to one or two areas, or it may be more widespread.

In some cases, there may be bleeding either within the brain or on its surface (the medical term for bleeding is haemorrhage, and a haematoma is a collection of blood outside a blood vessel). A haematoma can cause problems in two ways. Firstly, it can prevent blood getting to the areas of the brain near the clot. Secondly, it may result in a build-up of pressure within the skull (raised intra-cranial pressure, or ICP) leading to damage to vital nerve centres.

If the patient has a haematoma, it will probably be removed in an operation performed by a neurosurgeon. If the intra-cranial pressure is raised, it may be treated either surgically or through drugs. These treatments will take place in the ITU. At this stage the patient is unconscious, and may remain in a coma even when moved to a ward. Waking from coma is often lengthy and is followed by a period (longer than the coma period) when the person, though conscious, may be agitated and confused. Though able to talk, he/she may seem a little strange, and will be unable to remember recent conversations.

The time between the injury and the resumption of day-to-day memory is known as Post-Traumatic Amnesia (PTA). Length of PTA is sometimes used as a way of measuring the severity of the injury, though this is only an approximate guide. The patient may have other injuries to the bones or internal organs, as well as to the head. These may require a number of tests and operations, in addition to brain scans and other ways of assessing head injury.

Once through the first critical few hours or days after the injury, thoughts turn to the future. After some accidents (e.g. a broken leg), it is quite easy for doctors to give an opinion on how long recovery will take, and what the eventual outcome will be. Unfortunately, after a head injury this is just not possible. Every head injury, like every person, is unique. Rates of recovery vary enormously, and it is extremely rare (if not impossible) to be able to predict the outcome in the first few days. In many cases it is weeks or even months before any such prediction can be made. This uncertainty can be very stressful for the family and friends.

Probably the best way of coping with this uncertainty is to take each day as it comes, trying not to think about the future too much. Many people make an excellent recovery after a head injury, and a practical, positive approach makes this difficult period a little easier to manage.

The relative or friend

It is very important to maintain physical and emotional strength as much as possible. Some suggestions are:

• try to get enough rest and sleep; for example, arrange a visiting rota of friends and family to be with the patient; it is important to get away from time to time
• keep energy levels up by eating and drinking normally
• if possible, put off any major decisions until feeling less stressed and able to concentrate fully on the issues
• if in need of financial help or other support, speak to the hospital social worker
• ask the GP for a sick certificate for the patient (and, maybe, for yourself)
• make arrangements for dependants to be looked after
• accept help if it is offered; be specific about what you would like others to do
• arrange for a family member or close friend to be the main contact point for information, taking phone calls from other friends and, if necessary, dealing with any enquiries from the press etc.
• share problems and worries; talking to people can stop the stress from building up (e.g. consult family and friends, nurses and therapists caring for the patient, the hospital social worker, or to the chaplain)
• there is probably a local Headway group, with people in the group who have been through similar experiences; talking to them may be a comfort, especially if away from home; ask the social worker or nurse for the local address, or phone the number at the end of this article.

Help

There are many ways in which friends and relatives can help the patient:

• keeping fit and well is probably the most important thing
• assisting with the patient's care (e.g. washing, helping with exercises); ask the nurses or physiotherapists about this
• if the injury happened in a road accident, get information from the police station about witnesses, circumstances of the accident, etc.
• if appropriate, contact a solicitor who specialises in personal injury litigation; it is very important to seek advice from someone who is experienced in this field, and Headway has a list of specialised solicitors; do not wait until after a police prosecution to talk to a solicitor, as vital time may be lost and important evidence missed
• keep a diary of the patient's progress; later, this will be useful to look back on; it may also provide background information for a solicitor, if legal action is required

This can be a confusing time, especially if there are multiple injuries and a number of medical specialists are involved. Make sure that you know what is going on by talking to the ward sister, consultant, or junior doctor. Never feel shy about asking questions; professional people expect them and are usually anxious to share whatever news there is. They will not know how much you know or understand unless you tell them.

Many people benefit greatly from rehabilitation after a serious head injury. Once the patient is conscious and recovering, talk to the therapists or the consultant about this. If you feel that you would like to talk to a therapist but one does not seem to be involved, then ask.

If recovery is slow, or if problems persist, you may want to read about head injury in more depth. The following publications can be obtained from Headway, at a small charge:

• "Coma After Head Injury: How You Can Help"
• "What Is Head Injury?"
• "Claiming Compensation After Head Injury"
• "Head Injury: The Facts" (book)

Other specialised publications are also available; ask Headway for an up-to-date publications list.