This can produce bruising or even major bleeding in parts of the brain. For example, if you hit your forehead on the windshield during a car accident, you can get some damage in the front of the brain, but also damage to the back of the brain when it bumps into the back of the skull.

You can also sustain injuries through tearing or shearing of nerve fibers as the brain twists inside the head.

For very minor bumps on the head, you don't have to rush to the emergency room, says Lindgren. "However, if there is confusion, sleepiness, loss of consciousness, motor or speech problems, vomiting, double vision, or severe headaches, it's important to get medical attention right away.

"And if you're unsure, be safe and get things checked out. A physician can treat brain swelling, bleeding, seizures, or other problems that can develop from a major blow to the head."

Because of the brain regions that are most susceptible to damage from trauma (i.e., the frontal and temporal lobes), brain injuries produce lots of problems with memory (especially new learning) and with concentration and self-control, says Lindgren. "These self-regulation functions (like self-control) are the kinds of skills we call "executive" functions. We can also see changes in speech patterns, gait, speed of processing information, mood, or personality. But memory deficits and problems with executive functions seem to cause the most significant long-term disabilities."

The first critical step in treatment is to stabilize things medically and to treat any complications, says Lindgren. If there is sustained loss of consciousness, medical care while the patient is in a coma can help improve long-term outcome.

After a patient is conscious and better oriented, he may require speech therapy, occupational therapy, or counseling to help with emotional adjustment. "Family members may also need information and support," says Lindgren. "Patients often need cognitive rehabilitation to re-train their memory and reasoning skills. For children, this usually means finding ways to help them return to school as soon as possible. We even provide some academic instruction before they leave the hospital."

Lindgren says adults tend to have pretty well-developed personalities, skills, interests, and habits prior to the injury so they have lots of "old learning" to fall back on. Children are still developing and their abilities and personalities are more in flux. "Many people used to think children were so adaptable and their brains so "plastic" that an early brain injury was easy to Ôgrow out of.'

"We've now learned that a severe brain injury in a young child is a very serious event that can't always be easily overcome as the child grows and develops. Both adults and children require support and treatment to bypass or work around problem areas and to learn or re-learn skills that have been affected by the injury."

Because every patient is different, recovery depends on the severity of injury, the brain regions injured, and the support provided by family and therapists. Very mild concussions typically improve in a week or two and most are resolved within two to three months, says Lindgren. In more severe injuries, a lot of recovery occurs in the first three to six months, but many patients can continue to recover functions up to several years post injury. "Obviously, not everyone can return to their pre-injury status, so long-term changes in work or school activities may be required," says Lindgren.

"Several departments at The University of Iowa have supported research on brain injuries. At the Center for Disabilities and Development, we have studied children who come to our Pediatric Brain Injury Clinic - even several years after an injury - as well as newly injured children.

"We also have an inpatient unit at the Center that provides neurotrauma rehabilitation for children and young adults who've had a brain injury, and some of these patients have participated in our research.

"We've found that developmental or behavioral problems that existed prior to an injury can increase the risk for additional executive or behavioral problems, even several years after an injury. We've also learned that family stability and support can make a big difference in improving long-term outcomes for children with brain injuries.

"Since last year, the center has collaborated with the Iowa Department of Education to provide training and consultation on brain injury to families and schools around the state. We're trying to help kids succeed when they get back in school and to help parents and teachers work more effectively with these children," says Lindgren.

For more information:

Scott Lindgren, Ph.D.

UI Center for Disabilities and Development