Acquired Brain Injuries and Cerebral Palsy

Fact Checked

An acquired brain injury (ABI) is brain damage that may affect a person of any age, from infancy through old age. Cerebral palsy, in some cases, may be the result of an acquired brain injury when damage comes after birth. Treatments and therapies can help people recover and learn to live with permanent disabilities.

Acquired Brain Injuries Defined

A brain injury that is acquired occurs after birth. Some kind of external trauma like a blow to the head or an internal cause like an infection or stroke causes damage to the brain that results in an ABI.

An ABI can occur at any point in a person’s life, from infancy through adulthood. Any damage to or malformation in the brain that occurs before a baby is born is considered congenital rather than acquired. Damage to the brain caused by a degenerative disorder, like Alzheimer’s or Parkinson’s, is not considered an acquired brain injury.

Traumatic Brain Injuries, Definition, and Causes

Acquired brain injuries can be roughly divided into two main types:[1]

• Traumatic brain injuries (TBI) are caused by some external force or damage.
• Non-traumatic brain injuries result from something inside the body, such as a stroke or an infection like meningitis.

The causes of injury define these two types of ABI, but there are many potential causes within each category.

In both children and adults, the causes of TBI may be any force that strikes the head or causes the brain to impact against the inside of the skull.

Car accidents are among the most common causes of TBI in adults and children. Other causes may include violence and abuse or falls. In young children, shaking is a common cause of TBI. It is sometimes referred to as shaken baby syndrome and results from abuse.

Older children, teens, and adults may also be vulnerable to injuries caused by concussions from athletics. Football is a hazardous sport in terms of TBI. A player does not need to be hit on the head, only struck forcefully to cause a concussion that may lead to TBI.

A concussion occurs when the brain strikes the inside of the skull. One concussion may not cause TBI, but accumulated damage from multiple concussions can.

Military veterans are also particularly vulnerable to traumatic brain injuries. It is estimated that 22 percent of casualties in veterans of the conflicts in Afghanistan and Iraq are TBIs. The Veterans Administration has estimated that over 200,000 veterans enrolled in the VA healthcare system have some degree of TBI.

The number is likely higher as this includes only those who have sought treatment through the VA. Causes of TBI in the military can include falls, assaults, vehicle accidents, and damage caused by explosive devices.

TBI Statistics

According to the Centers for Disease Control and Prevention (CDC), more than two million people develop a TBI every year in the U.S. Most of these are treated and released, but 52,000 die from their injuries.

Approximately 75 percent of TBIs are mild and are related to concussions. Falls are one of the most common causes of TBI. Other common causes are motor vehicle accidents and assaults.[2]

Adolescents are especially vulnerable to TBIs, as are older adults. The age groups most likely to sustain a traumatic brain injury are teenagers between 15 and 19 and adults over the age of 65. Adults over 75 are most likely to die from a TBI, but nearly 500,000 hospital visits each year for TBI are children.[3]

Among children from birth to the age of four, the most common cause of a fatal TBI is assault.[4] TBI in babies and young children causes more immediate swelling.

Causes of Non-Traumatic Brain Injuries

An acquired brain injury not caused by an external force or action is considered non-traumatic but can be just as damaging. As with a TBI, this kind of injury can range from mild to severe. In children, the most common cause of a non-TBI is infection.

The most common infections that cause brain injury in children are meningitis, an infection of the membrane around the brain and spinal cord, and encephalitis, an infection in the brain.

A non-TBI may also be caused by a brain tumor, either benign or malignant, as it grows and puts pressure on the brain.

Anoxia and hypoxia, the absence of oxygen or too little oxygen to part of the brain, can also cause an acquired brain injury—possible causes of anoxia and hypoxia are drowning, smoke inhalation, carbon monoxide poisoning, heart defects, or severe asthma. Poisoning by a toxic substance, such as lead, can also cause brain damage.

Strokes, aneurysms, and hemorrhages in the brain may also cause a non-TBI. A stroke is a more likely cause in an adult and occurs when blood is cut off to part of the brain because of a blocked or ruptured blood vessel. A brain aneurysm is a bulging blood vessel that may burst and cause a stroke and hemorrhaging or bleeding in the brain.

Non-TBI Statistics

Non-traumatic injuries are less common. While millions of people suffer TBIs every year, approximately 800,000 non-traumatic acquired brain injuries occur. In a study of children with non-TBI, the rate in the general population was found to be 82.3 per 100,000 children. The leading cause was a toxic substance, followed by brain tumors and meningitis.

Acquired Cerebral Palsy

About ten percent of diagnosed cerebral palsy cases in children are considered acquired. This means that damage occurred in the brain after a baby was born but before the brain finished developing. The period between birth and whole brain development is between two and five years of age.

Any acquired injury that occurs in a child after the brain is fully developed may result in symptoms and neurological conditions, but these are not diagnosed as cerebral palsy. Even if it is not diagnosed as cerebral palsy, symptoms may be similar, and a child with ABI may be treated similarly to a child with cerebral palsy.

Symptoms of ABI

If a child suffers a brain injury before the brain is fully developed, they are likely to be diagnosed with cerebral palsy. They will have symptoms characteristic of CP:

• Stiff muscles
• Abnormal movements
• Speech difficulties
• Repetitive motions
• Poor posture
• Difficulty walking
• Unsteady balance
• Tremors

There are many possible symptoms for a child or adult who develops an ABI after full brain development. They can range from mild to severe, depending on the injury. Symptoms may be related to movement, or they may be cognitive, sensory, related to communications, function, personality, socializing, and many other factors. Some of the possible symptoms include:

• Coma
• Short attention span
• Difficulty problem-solving
• Judgment impairment
• Paralysis or muscle weakness
• Memory deficits
• Spastic muscles
• Tremors
• Poor coordination
• Loss of sensation
• Slowed speech
• Trouble choosing correct words or forming sentences
• Vision problems
• Hearing deficits
• Inability to complete ordinary activities
• Impaired social interactions
• Fatigue
• Dizziness
• Loss of control of bowels or bladder
• Headaches
• Apathy
• Irritability
• Anxiety or depression
• Lowered inhibitions
• Epilepsy

Treatment

Treatment for ABIs, much like treatment for cerebral palsy, is highly dependent on the individual, symptom types, and severity. Like cerebral palsy from any cause, brain damage is not reversible.

Depending on the severity of the damage, other parts of the brain may be able to compensate for the damage, and full to nearly full recovery may be possible.[5]

Much of the treatment for ABIs is based on rehabilitation, using therapeutic strategies to help a patient recover as much function as possible or to live with the ongoing symptoms.

Types of treatment may include physical and occupational therapy, speech therapy, educational interventions, vocal training, management of pain, adaptive equipment, and psychological counseling and therapy.

Treatment and therapy may involve a range of specialists, including neurologists, psychiatrists and psychologists, physical and occupational therapists, massage therapists, educators, audiologists, pediatricians, nutritionists, speech therapists, nurses, and others. Family support is also crucial to help a patient achieve an optimal outcome.