“The brain is a wonderous and delicate organ that controls and coordinates our functioning, and an injury to the brain can impact not only the person’s physical functioning but their understanding, actions, emotions and ability to express themselves,” says Professor Andre Mochan, a neurologist who practises at Netcare Rehabilitation Hospital, ahead of World Head Injury Awareness Day on Saturday, 20 March. 

Car accidents, interpersonal violence, falls and workplace injuries are among the most common causes of traumatic brain injury (TBI) in South Africa. TBI may be as simple as a concussion with brief loss of consciousness or as extensive as a massive blow to the head leading to coma and potentially lifelong neurological consequences and disability. 

“Depending on the degree and extent of injury, and which part of the brain is affected, the physical, cognitive, emotional and psychosocial effects of a head injury can vary considerably and are not always apparent immediately,” adds Peta-Lyn Foot, an occupational therapist at Akeso Randburg – Crescent Clinic.

Significant brain injuries unfortunately almost always impact daily life. Brain injury survivors may be left with mobility difficulties like weakness or inability to move parts of the body, there may be cognitive impairment, speech and concentration problems, as well as a range of behavioural and emotional disturbances, often in combination.

Immediate care after a head trauma is usually handled in an emergency department and is typically managed by a neurosurgeon. 

According to Dr Anchen Laubscher, group medical director of Netcare, there are a number of factors that are associated with better outcomes. “There is a correlation between quicker emergency medical services response to patients with critical brain injuries and better outcomes, as this results in immediate and appropriate emergency pre-hospital care and rapid transport to the closest most appropriate facility equipped to manage severe head trauma. 

“In trauma care, time is always of the essence and therefore response times are an important key performance indicator for ambulance services. Netcare 911’s median time from answering all calls to arriving at the patient was 16.4 minutes in the past year,” she says. 

Rehabilitation and longer-term support is most effective when it involves input from a multi-disciplinary team, which includes a rehabilitation doctor, neurologist, psychologist, physiotherapist, speech and occupational therapists, social worker, and experienced nursing staff.

“The brain attempts to heal itself, and with the help of rehabilitation there usually is improvement over time. At Netcare Rehabilitation Hospital, we do our best to help each patient to extend their own potential and quality of life as far as possible while they are under our care and beyond. However, it is a lifelong pursuit for the individual to continue their progress towards rebuilding their life,” Prof Mochan says. 

“A patient’s successful return to their home after rehabilitation is an internationally recognised measure of the success of a physical rehabilitation programme. In the last year, 91.1% of patients admitted to Netcare Rehabilitation Hospital with a head injury were discharged to their home,” Dr Laubscher adds.

Foot adds that head injuries can sometimes cause people to become more irritable or aggressive, and their impulse control may be diminished. “At Akeso mental health facilities, our focus when helping people with neurological injuries is to improve their mood and interpersonal functioning. We also assist them to learn skills that help them cope to their fullest potential in their particular circumstances,” Foot says. 

“We work with the individual to create structure and routine and, in many cases, we help the person to develop their social skills and compensatory techniques for managing the cognitive challenges of living with a brain injury.

“People who have sustained severe head injuries usually will not be able to work or live independently and require assistance with the tasks in their daily lives. People with mild head injuries, however, can often develop the skills they need to function independently, albeit at a basic level. Most important is to put in place daily action plans. Repetitive tasks help to create familiarity and build confidence,” she says. 

Support is vitally important not only for the individual but also for their family, as the situation can be emotionally very taxing for all concerned. Apart from the mental healthcare services offered by Akeso, non-profit organisations like Headway in Gauteng offer support to survivors and their families.  

“A head injury may change the person’s personality considerably, which can be very difficult for their loved ones to come to terms with. The radical change in relationship dynamics when a person suddenly becomes dependent for their daily needs is often extremely stressful. At Akeso, we therefore also involve families to ensure the brain injury survivor’s social support structure is informed and better equipped to navigate the adjustment,” Foot says.

Prof Mochan and Foot recommend the following precautions to help prevent head injuries: 

• Always wear a seatbelt when travelling in a vehicle
• Buckle up children, use baby seats
• Drive carefully
• Never drink and drive
• Have your eyes tested regularly
• Consult a doctor if you do not feel well, especially if you feel dizzy or unsteady 
• Avoid substance abuse
• Wear a helmet when cycling
• Remove possible trip hazards in your home and environment 

 Foot appealed to the public to be constantly alert to the dangers of head injury. 

“In the blink of an eye, anyone can sustain a head injury. The risk is not confined to people who are ‘reckless’ or have dangerous lifestyles, anyone can be hit by a car, be involved in an accident or injured with life-changing consequences.”