Head injury can happen to anyone at any time; it occurs without warning and when it is least expected. It arises from a wide range of causes, from road traffic accidents, falls from ladders, bicycles or horses, violent assaults, sports injuries or simple domestic accidents, but also from non-traumatic events, such as stroke, a tumour, inhalation of toxic gases, meningitis and other diseases, and reactions under anaesthetic. Although exact figures are not available an estimated 1,000,000 people will attend hospital each year with a suspected head injury. Over half of these, in excess of half a million, will be children under the age of 16 years.

At the other end of the scale around 11,000 people annually sustain severe brain injury. They will generally be unconscious for over 6 hours (and often for considerably longer) and are likely to have complex long-term problems affecting their personality, their relationships and their ability to lead an independent life.

How is someone affected by brain injury?

Our brain is a very complex organ. Different parts of the brain control different parts of the body, as well as all the elements of who we are, from our thoughts and memory, to our behaviour and personality. If the head receives a hard knock or a sudden jolt the brain can be bruised, shaken or cut, and this is usually referred to as traumatic brain injury. The resultant effects can depend on which part of the brain has been affected and that is the reason why the symptoms of brain injury vary so much between individuals.

After a brain injury it is possible for a person to experience a wide variety of problems to a greater or lesser degree. Those symptoms may not always be apparent and that is why brain injury is often referred to as the "hidden disability". Physical problems, such as head pain, dizziness and temporary loss of taste and smell are common, but these will often subside and the individual completely recovers. However, they may suffer from relatively minor personality change, a lack of inhibition, ongoing tiredness or some loss of memory.

Minor effects of brain injury are not always immediate. It may be several months, or even years, later before the consequences develop. Relatives may notice a gradual personality change, with sudden, sometimes violent, mood swings. The person may develop mild amnesia, become forgetful, constantly fall asleep or have bad headaches, and doctors often fail to relate these symptoms back to a head injury which may have occurred months before. We have recently undertaken a campaign to bring this issue to the attention of GPs so that diagnosis can be linked to these previous injuries.

Too often, however, the consequences of a brain injury are serious and significantly affect a persons ability to live a normal life. The potential effects of a brain injury can be divided into three categories, physical, cognitive and behavioural / emotional.

Physical effects might include:

· Paralysis
· Deafness
· Inability or difficulty in speaking
· Loss of sight
· Loss of other senses
· Difficulty in walking, grasping or making other movements
· Incontinence
· Poor co-ordination or loss of balance

Cognitive effects include:

· Low tolerance of noise
· Memory problems and inability to learn new skills
· Attention deficit, sustained, divided or switching
· Inability to organise or plan
· Reduced speed of information processing
· Rigid, inflexible thinking
· Language and communication problems, e.g. too verbose or inability to find words
· Perceptual visio-spatial

Behavioural / emotional effects include:

· Disinhibition, impulsive behaviour and lack of behavioural control
· Low tolerance of frustration, irritability and/or explosive anger
· Impaired social judgement, misinterpreting situations, inappropriate and/or childlike behaviour
· Emotional flatness through, for example, rapid mood swings or no depth of emotion
· Lack of insight and poor self awareness
· Egocentricity. Having difficulty imagining how others feel. Loss of love for others.
· Reduced motivation and initiative, apathy and lack of goal-directed behaviour.
· Fatigue, lack of stamina and need for more sleep.
· Secondary psychiatric symptoms, such as anxiety, depression, obsessions, paranoia and phobias.

The more severe the brain injury, the more pronounced the long-term effects are likely to be. Whilst the brain is a marvellous organ and does seem to have some ability to repair itself, once it has become damaged the consequent effects do tend to become permanent. However, some people manage to recover either fully (when the effects are relatively minor) or to a partial extent. With good rehabilitation it is often possible to help people suffering from brain injury to develop strategies to help them cope with their disabilities and to regain some degree of independence.