Traumatic Brain Injury (TBI) is an insult to the brain caused by an external physical force. It may produce a diminished or altered state of consciousness. It often results in an impairment of cognitive abilities or physical functioning. These impairments may be either temporary or permanent and cause partial to total functional disability or psychosocial maladjustment.

Cognitive ability is the mental process or faculty of knowing, including aspects such as awareness, perception, reasoning, language, memory and judgment. Memory loss is a common disability in TBI persons. Any and all of these functions can be affected by TBI.

Communication includes speaking, listening, reading, writing and gesturing. Any and all of these functions can be affected with a TBI. It is imperative that all TBI persons receive a neuropsychological exam to define their deficits and receive appropriate rehabilitation for them. It is also necessary for the family members to understand these deficits and learn how to deal with them appropriately. Hearing and sight tests are also imperative after TBI.

Phycho-social or 'behavioral problems' are another common disability for TBI persons. These include fatigue, denial, depression, lack of motivation, agitation, restlessness, lack of emotional control and difficulty relating to others.

Coma is a profound state of unconsciousness. It is a world of its own, a planet where lost people grope their way out of a darkness the rest of us cannot imagine. Range of motion exercises and sensory stimulation are necessary to aid in coma recovery.

The Glasgow Coma Scale and the Rancho Los Amigos Scale of Cognitive Functioning are featured in this page as well as in the Appendix of ACKNOWLEDGED A MAN.

Vegetative State (PVS) is a highly provocative diagnosis because it is not a "state" that always remains persistent. With proper therapy, patients sometimes and often do make progressive steps through the stages of coma and come to a full conscious level. The problem is that they cannot do this alone and must have help from outside themselves to accomplish this. Family members are often the patient's best resource since there is a known background with the patient and he/she may be able to more readily respond to someone from their life before TBI.

Organ donation is often brought up after a serious TBI. In some states, doctors have the right to declare a person "brain dead" and disconnect life-saving equipment. This decision is always a difficult one that each family must decide on their own. Correct information is needed to make an intelligent decision. One thing you must know is that some organs cannot be retrieved unless the patient's heart is beating. For some people this does not mean "dead".

A senseless act of violence in a YMCA changed a man's life forever. Barbara tells the inspiring story of her son Nick and his astounding recovery from a Traumatic Brain Injury. Nick's injury was massive enough to make even the most seasoned ER doctor cringe. Barbara describes Nick's losses as great, his courage heroic and his spirit indomitable.

Barbara shares the peace found in forgiving and the triumphs she discovered in home rehabilitation. Barbara can help all of us who deal with tragedy find ways to cope and take charge of our changed lives in a new and wonderful way.

The Rancho Los Amigos Levels of Cognitive Functioning (RLA) were designed to measure and track an individual's progress early in the recovery period. They have been used as a means to develop "level-specific" treatment interventions and strategies designed to facilitate movement from one level to another. A RLA level is determined based on behavioral observations. The RLA scale designates eight levels of function:

I. No Response
The individual appears to be in deep sleep and is completely unresponsive to any stimuli.

II. Generalized Response
The individual reacts inconsistently and non-purposefully to stimuli. Responses are limited in nature and often the same regardless of the stimuli presented. Responses may include gross motor movements, vocalization, and physiologic changes. Response time is likely to be delayed. Deep pain evokes the earliest response.

III. Localized Response
The individual responds specifically but inconsistently to stimulus. Responses are directly related to the type of stimuli presented. For example, an individual's head will turn toward a sound or his/her eyes will focus on an object when presented. The individual may follow simple commands and may respond better to some people (i.e. family and friends) than others.

IV. Confused - Agitated
The individual is in a heightened state of activity with severely decreased ability to process information. Behavior is non-purposeful relative to the immediate environment. Attempts to climb out of bed, remove restraints, and hostility are common. The individual requires maximum assistance to perform self-care activities. An individual may sit, reach, or walk, but will not necessarily perform these activities upon request.

V. Confused - Inappropriate
The individual appears alert and responds to simple commands fairly consistently. Agitation, which is out of proportion, (but directly related) to stimuli may be evident. Lack of external structure results in random or non-purposeful responses. Inappropriate verbalizations and high distractibility are common. Memory is severely impaired, but the individual may self-feed with supervision and requires only assistance for self-care activities.

VI. Confused - Appropriate
The individual shows goal-oriented behavior, but is dependent upon external input for direction. Response to discomfort is appropriate. Responses are incorrect due to memory problems, but are appropriate to the situation. Simple commands are followed consistently and carry-over for relearned activities is evident. Orientation is inconsistent but awareness of self, family, and basic needs is increased.

VII. Automatic - Appropriate
The individual appears appropriate within hospital and home settings, goes through daily routine automatically but is robot-like, with shallow recall of activities performed. Has absent-to-minimal confusion and lacks insight. The individual frequently demonstrates poor judgment and problem solving and expresses unrealistic future plans. With structure the individual is able to initiate tasks or social and recreational activities.

VIII. Purposeful - Appropriate
The individual is alert and oriented, able to recall and integrate past and recent events and is aware of and responsive to the environment. Independence in the home and community has returned. Carry-over for new learning is present, and the need for supervision is absent once activities have been learned. Social, emotional and cognitive abilities may still be decreased.

Help can be found through the Brain Injury Association of America (BIAA) by clicking here, with affiliated associations in each state and internationally.

Contact information for each state is located in the appendix of ACKNOWLEDGED A MAN.

Nick Del Buono, featured in ACKNOWLEDGED A MAN, teaches us constantly how precious life is, and that the body is only the temple of that most marvelous part of our life:  our spirit.