A brain injury is by nature a complex wound. The human brain is a delicate organ, responsible for sending messages to the body. It’s the command center for the entire nervous system, with billions of neurons and nerve fibers. When the brain sustains damage, the mental and physical consequences can be minor or drastic, depending on the location and extent of the injury.
Learning the levels of a brain injury is important to understanding a victim’s prognosis and treatment options.
Acquired Brain Injury vs. Traumatic Brain Injury
There are two basic categories of brain injury – acquired and traumatic. An acquired brain injury (ABI) includes traumatic brain injuries (TBIs) and encompasses injuries caused after birth by things such as strokes or loss of oxygen to the brain. A stroke, or a cerebral vascular accident, can cause an acquired brain injury. Conditions present at birth or those progressive in nature, such as Parkinson’s or Alzheimer’s disease, do not constitute an acquired or traumatic brain injury.
TBIs occur when the brain suffers blunt force trauma. This can happen when an object strikes the skull, such as the windshield in a car accident, the pavement in a slip and fall, or falling debris in the construction industry. TBIs can also result from traumatic incidents such as gunshot wounds or assaults. TBIs alter the brain function, but each injury is unique. The type and amount of force on the head during an accident will decide the level of damage to the areas of the brain.
Glasgow Coma Scale
When a traumatic brain injury occurs, physicians rate the level of injury based on the Glasgow Coma Scale (GCS). This scale tests the brain’s initial responses to determine the level of the brain injury. The scale is composed of three scores – best eye response, best verbal response, and best motor response. The physician totals the scores of all three sections to come up with the total GSC, which represents the victim’s level of brain damage.
Best eye response has a score of one to four:
1. No eye opening
2. Eye opening with pain
3. Eye opening to verbal command
4. Eyes open spontaneously
Best verbal response has a score of one to five:
1. No verbal response
2. Incomprehensible noises
3. Inappropriate words
Best motor response has a score of one to six:
1. No motor response
2. Extension to pain
3. Flexion to pain
4. Withdrawal from pain
5. Localizing pain
6. Obeys commands
The higher the final score, the less amount of damage the brain has suffered. The lower the score, the poorer the prognosis is. Scores of 13-15 represent a mild traumatic brain injury. A score of 9- 12 means moderate disability. This can be loss of consciousness greater than 30 minutes and cognitive or physical disabilities that may or may not resolve. A score of 3-8 is a severe disability, and means the patient is an unconscious state or coma. There are no voluntary activities or meaningful responses.
Scores of less than 3 represent a vegetative state, in which the patient shows arousal but no interaction with the environment and no localized responses to pain. Brain death occurs when there is no brain function. A patient must meet specific criteria for a brain death diagnosis. A patient’s prognosis will depend heavily on his or her response to the tests conducted including the Glasgow Coma Scale and other cognitive and physical tests. Repeated traumatic brain injuries over an extended period can result in cumulative brain damage, while repeated traumatic brain injuries in a short time can be catastrophic or fatal.
https://biau.org/types-and- levels-of- brain-injury/