The acquired brain damage (DCA) is a lesion that occurs in a brain that until now had presented normal or expected development. It can be the result of different causes: head injuries (TBI), cerebrovascular accidents (CVA), brain tumors, anoxia, hypoxia, encephalitis, etc. (De Noreña et al., 2010). In some cases, the scientific literature uses the term supervening brain damage (DCS) to refer to this same clinical concept..
When an accident that involves acquired brain damage occurs, different neurological processes will be affected and acute injuries to the individual's nervous system will in many cases involve a situation of significant deterioration of health and functional independence (Castellanos-Pinedo et al., 2012).
It is one of the most important health problems in developed countries. This is due to the magnitude of its incidence and the physical, cognitive and social impact it causes on people who suffer this type of injury (García-Molína et al., 2015).
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Normally, acquired brain damage is associated with head trauma, in fact, in the English-speaking medical literature, the term brain injury is frequently used as a synonym for traumatic brain injury (Castellanos- Pinedo et al., 2012).
But in addition, acquired brain damage can have its origin in stroke, brain tumors or infectious diseases (De Noreña et al., 2010).
Castellanos-Pinedo et al. (2012) show an extensive list of possible causes of acquired brain damage depending on the agent that causes them:
Depending on their incidence, an order of importance of these causes can be established, the most frequent being head injuries and strokes / cerebrovascular accidents. Third, anoxic encephalopathy would be placed. Less frequent would be causes of the infectious type or derived from brain tumors (Castellanos-Pinedo et al., 2012).
Ardila & Otroski (2012) propose that head trauma occurs as a consequence of the impact of a blow on the skull. Generally, the impact on the skull is transmitted both to the meningeal layers and to the cortical structures.
In addition, different external agents can cause the impact: use of forceps at birth, gunshot wound, blow against blow effect, extension of a jaw blow, among many others..
Therefore, we can find open trauma (TCA) in which there is a bill of the skull and penetration or exposure of brain tissue, and closed head trauma, in which a skull fracture does not occur, but can take place serious lesions of brain tissue due to the development of edema, hypoxia, increased intracranial pressure or ischemic processes.
The term cerebrovascular accident (CVA) refers to an alteration of the blood supply of the brain. Within the cerebrovascular accidents we can find two groups: due to obstruction of blood flow (obstructive or ischemic accidents) and hemorrhages (hemorrhagic accidents) (Ropper & Samuels, 2009; Ardila & Otroski, 2012).
In the group of strokes caused by an obstruction of blood flow, we can find the following causes described by Ardila & Otroski (2012):
On the other hand, hemorrhagic accidents are usually the consequence of the rupture of a cerebral aneurysm (malformation of a blood vessel) that may be generating hemorrhagic blood flows at the intracerebral, subarachnoid, subdural or epidural level (Ardila & Otroski, 2012).
Anoxic or hypoxic encephalopathy occurs when there is an insufficient supply of oxygen to the central nervous system, due to respiratory, cardiac or circulatory causes (Serrano et al., 2001).
There are different mechanisms through which oxygen supply can be interrupted: decreased cerebral blood flow (cardiac arrest, cardiac arrhythmia, severe hypotension, etc); due to a decrease in the amount of oxygen in the blood (guda polyradiculoneuritis, myasthenia gravis, pulmonary diseases, chest trauma, drowning or inhalation of toxins); reduced ability to carry oxygen (carbon monoxide poisoning); or due to the inability of brain tissue to use oxygen supply (cyanide poisoning) (Serrano et al., 2001).
When acquired brain damage occurs, most patients have serious consequences that affect multiple components: from the development of a vegetative or minimally conscious state to significant deficits in sensorimotor, cognitive or affective components.
Frequently, the appearance of aphasias, apraxia, motor limitations, visuospatial alterations or heminegligence has been described (Huertas-hoyas et al., 2015). On the other hand, cognitive deficits tend to appear, such as problems with attention, memory and executive functions (García-Molina et al., 2015).
Together, all these deficits will have an important functional impact and will be an important source of dependency, making social relations and labor reintegration difficult (García-Molina et al., 2015).
In addition, there will not only be consequences for the patient. At a family level, suffering from acquired brain damage in one of its members will be the cause of a strong moral blow.
Generally, a single person, the main caregiver, will assume most of the work, that is, he / she assumes most of the care for the dependent patient. Only in 20% of cases, care is assumed by more family members (Mar et al., 2011)
Different authors emphasize that caring for a person in a serious dependency situation involves an effort that can be compared to a working day. Thus, the main caregiver endures an overload of work that negatively affects their quality of life in the form of stress or inability to cope with tasks.
It is estimated that the presence of psychiatric disorders in caregivers is 50%, among them are anxiety, depression, somatizations and insomnia (Mar et al., 2011).
Due to the wide variety of causes and consequences of acquired brain damage, both the involvement of brain systems and its magnitude can vary considerably between individuals..
Despite this, the working group headed by Castellanos-Pinedo (2012) proposes the following definition of acquired brain damage:
"Injury of any origin that occurs acutely in the brain, causing permanent neurological deterioration in the individual, which conditions a deterioration of their functional capacity and their previous quality of life".
In addition, they extract five criteria that must be present for a case to be defined as acquired brain damage:
In the acute phase, the therapeutic measures will be directed fundamentally to the physical sphere. At this stage, individuals are hospitalized and the objective will be to achieve control of vital signs and the consequences of acquired brain damage, such as bleeding, intracranial pressure, etc. At this stage, treatment is developed from surgical and pharmacological approaches.
In the post-acute phase, intervention will be carried out from a physiotherapeutic level to treat possible motor sequelae, as well as at a neuropsychological level to address cognitive sequelae: orientation deficit, amnesia, language deficit, attention deficit, etc..
In addition, in many cases psychological care will be required, since the event and its consequences can become a traumatic event for the individual and their environment..
Acquired brain damage has a strong personal and social impact. Depending on different factors such as the location and severity of the injuries, a series of physical and cognitive consequences will occur that may have a devastating impact on the individual's social sphere..
Therefore, the development of post-acute intervention protocols that try to restore the functional level of the patient to a point close to the premorbid level is essential..
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