Abstract
Traumatic brain injury is an acquired injury to the brain that results from an external blunt or penetrating force to the head while; intentional hypoxia is the loss of oxygen supply to the brain which leads to a continuum of injury severity. A review of current literature on this topic suggests that comparisons can be readily drawn between traumatic brain injury and hypoxic brain injury in a rehabilitation setting. Even so, diagnosis of hypoxic brain injury and traumatic brain injury is essential in providing guidance on decisions of treatment. Treating intentional hypoxia, however, involves an establishment of the desired airway a short duration, with the help of enough oxygen that saturates the blood, as well as support for the cardiovascular system necessary. The main aim of this paper is to provide an empirically based research paper addressing traumatic brain injury and cognition with regards to intentional hypoxia. Particularly, the paper will address suicide thoughts and actions following traumatic brain injury
Introduction
Traumatic Brain Injury (TBI) is among the leading causes of incapacitation as a result of injury and has a significant impact on the affected individual as well as his or her family both emotionally, physically and socioeconomically (Faul, et al. 2010). TBI can take place in any age group and brings long-lasting challenges affecting every area of function. Even though considerable attention has been given to the functional consequences of brain injury in adults, less attention has been paid to the functional consequences that children sustain as a result of brain injury (Rutland-Brown et al., 2006).
TBI is not the result of a disease, is not congenital in origin, and is nondegenerative. Rather, it is an acquired injury to the brain that results from an external blunt or penetrating force to the head. Primary causes of TBI, in general, are such as falls, accidents, assault and violence such as gunshots to the head. For soldiers in combat, blast injuries are a major cause of TBI, while sports- and bicycle-associated injuries are major causes of injury in children, young adults, and adolescents. Even so, TBI can be as a result of hypoxic brain injury.
Hypoxic brain injury is considered the global disturbance in brain function as a result of decrease or loss of supply of oxygen to the brain. The resulting effect of brain hypoxia depends on the amount of reduced tissue in the oxygen, as well as the duration of the reduction. Intentional limitation of oxygen to the brain thus leads to a continuum of injury severity. The diminished oxygen supply to the brain can have significant cognitive physical as well as emotional impairments. For this reason, hypoxic injury can have profound impacts on the functional deficit, the related treatment costs and the associated disruption to the lives of individuals and their families. The common cause of hypoxia includes heart attack, asthma attack, seizures, poisoning, blood loss, accidents, or attempted suicide.
Literature Review
The adult brain uses almost 15 percent of the output of oxygenated blood through the heart (Graham, 1977, p.170). Hypoxia is considered the condition of having low than the normal amount of oxygen required in the blood. Anoxia is also considered an extreme form of hypoxia where the amount of oxygen in the blood is completely absent. In any case, the supply of oxygen in the blood is minimized below a critical level; the results is often an increased loss of consciousness as well as an irreversible occurrence of brain damage.
An immediate global loss of oxygen to the brain- a situation where the residual oxygen is found in the blood or lungs is not released to the brain, can result in a state of unconsciousness for almost eight to ten seconds, and the loss of electrical output through the brain will take place after a few seconds. The heart can constantly beat for a few more minutes even when the brain is no longer in function.
There seem to be high possibilities of suicide thoughts and actions following TBI. A study examining TBI mortality from 1979 through 1986 identified that suicide was a major cause of up to 63 percent of the firearm –associated deaths, homicides for almost 29 percent and almost 5 percent were accidental. In 1998, suicide was considered the eighth leading cause of death in the United States and homicide was the eleventh. Even though suicide rates and homicide because of guns have recently increased, accidental deaths by guns reduced at an average rate of almost 3 percent per year from 1970 to 1984.
Various studies have found higher risks of disorders such as depression, panic disorder, substance abuse, and obsessive-compulsive disorder as well as increased risks of suicidal ideation and attempts in TBI patients. Teasdale and Engberg (2001) in their observation conducted a regression analysis for patients who had serious brain injuries such as cerebral contusions. The researchers found this group of people to be highly exposed to risks of suicide compared to patients with concussions and cranial fractures. It is important, however, to take note of the fact that even patients with more than a concussion or cranial fracture are at a high risk of suicide.
In a recent U.S based study of mortality after traumatic brain injury, Harrison-Felix et al. (2009) presented evidence supportive of increased risk of suicide in TBI patients. These observers associated every patient admitted to rehabilitation centers over a period of 40 years to the Social Security Administration’s Death Index. They discovered that TBI patients were at higher risks of committing suicide than people in general population of similar race, age and sex. The cause of increased suicide risk in patients with TBI is complex but might likely involve cognitive, emotional, psychological, and neurobiological changes. Within a clinical environment, it is essential to be aware of the risks, especially of those with serious TBI.
Vauhkonen (1959) identified several high rates of suicide in soldiers with TBIs. In his prolonged follow-up- observation of 43 patients with severe TBIs, Petrie & Brook (1992) noted that after a year 10 percent had mentioned suicide, and 2 percent had attempted suicide. Five years after the follow-up, 15 percent had suicide attempts and expressed their view that their condition was hopeless and there was nothing worth living for.
Fleminger et al. (2003) carried out an analysis of the expected suicide rates in brain injury populations based on standardized mortality ratio which provides a comparison between suicide rate in the sample of brain injury individuals with what was expected for the population from where the sample was drawn, taking into consideration the contribution of various other demographic factors that contribute to the explanation of suicide frequency such as gender age, and sociocultural background.
In another analysis of five studies of civilians’ brain injuries, Harris and Barraclough (1997) took note of an incident of five suicides in the total sample of 650 patients; three times more compared to the expected ratio of 4:1. They mentioned that standardized mortality ratio for suicide when brain injury had occurred was 350, an indication that the presence of head injury brought up the risk for suicide by three times the national rate.
Teasdale & Engberg (2001) articulated that in their sample of 896 patients who had been admitted to a rehabilitation unit, 8 committed suicide. As Teasdale & Engberg (2001) notes in the major epidemiological study, after 15 years of follow-up, the standardized mortality ratio of cases of concussions were 3.0, 2.0 for a skull fracture, and 4.1 for intracerebral hemorrhage. While interpreting this observation, Fleminger et al. (2003, p.78) note that “over a 15 year period after head injuries the rate of suicide is almost 1 percent, which is at least three times the standard rate.”
Discussion
Perhaps, to begin with, Suicide by hypoxia is considered the most often recommended techniques of human euthanasia by right-to-die advocates. The popular trend of using an ‘exit bag’ with an inert gas such as helium or nitrogen probably started with the publication of Final Exit by Derek Humphry (1996). The author of this publication was aimed at identifying techniques of death that were considered, simple, swift, painless, inexpensive, failure-proof, non-disfiguring and one that did not require the perception or assistance of a physician.
Indeed, the method is simple. It involves a clear plastic bag which is placed over the head, two tanks of helium filled in the bag through the vinyl tubing as well as an elastic band placed at the bottom of the bag to provide support for the bag from slipping off the head. The parts required to create the bag are not expensive, and locally available without perception. Death reports observed through this method suggests that the process is painless. It is, however, important to take note of the fact that deviations from the initial procedures have not often been a success. When covered masks, instead of using helium bags over the head, reports have been passed that some issues have transpired. This is particularly as a result of the mask not being tightly sealed to the face, which further results in small amounts of oxygen being inhaled by the person. This extends the time of unconsciousness and death. Further study will be essential to determine the best delivery system.
In the literature, depression noted after TBI was determined significantly by the neuroanatomical effects of the brain injury unlike the sociocultural as well as clinical phenomena which arise from the injury including loss of self-esteem, physiological reactions or pain, then it would be approximated that a distinct pattern of impairment seen in depression is in relation to brain injury as opposed to depression independent of the injury. Abnormalities in brain structure and function have often observed in patients with affective disorder and scanning of such patients has shown various ventricular enlargement in bipolar disorder, unipolar depression, and mixed effective disorder. Several studies have shown that elderly depressed people have values similar to those with irreversible dementia than to normal.
Treatment of hypoxia entails the establishment of the desired airway in the shortest time possible, with the help of enough oxygen that saturates the blood, providing support for the cardiovascular system necessary (Bruns & Hauser, 2003). Treating the cause of minimized oxygen supply to the brain can involve surgical intervention. When a patient’s respiratory as well as cardiovascular system is properly supported, the individual will move into the first phase of recovery. As recovery continues, various physiological, as well as neurological symptoms, can appear, and other people can require support in the secure and secluded environment, when agitation or even confusion is evident, in order to prevent harming other people or even themselves.
Healing, however, depends on the injury severity. Direct recovery is limited and the focus, thus, is position on stabilizing the individual and engaging them in services of rehabilitation. Recovery and rehabilitation may sometimes take a long to reach full potential. A working relationship and a good rapport with the rehabilitation specialist is quite essential. Expectations cannot often match the levels of progress of an individual, and the disappointment or conflict can be high. Of main importance is understanding that the recovery of every person is different and unique outcomes take place for everyone.
In several career counseling theories, the main part of the vocational counseling process involves facilitating choice as a dynamic ability. The content of choice is not the most emphasizes the aspect of the counseling intervention, but the way the person makes a career decision is paramount. The process of decision making is seen as strongly supported by cognition in every approach. What would be the career counseling needs of an individual with cognitive limitations including those due to TBI? There is still necessary research to determine the answer.
According to career development theories, the age period of adolescence and young adulthood is an essential phase for career exploration as well as decision making. Because of the increased incidences of TBI in person 15 to 24 years of age, and common neuropsychological sequelae observed, it is reasonable to provide a hypothesize that this group of individuals might be at a high risk for distributing in their career decision-making process. Besides, the distributing can lead to career or work issues although the adult life as a fast changing world of work often requires career decision-making skills constantly. Studies that have addressed the impact of TBI on career decision making particularly are found in the literature.
Diagnosis, as well as recognition of hypoxic brain injury, is essential in providing guidance on decisions of treatment, the expected projecting outcomes and predicting the recovery course, for instance, when providing responses to questions from families. Several researchers have assessed the results directly from hypoxic brain injury and TBI in a case-controlled design, providing glimpses in differences in results from pure hypoxic brain injury referenced to the expected outcomes from TBI under otherwise equivalent settings.
Conclusion
In conclusion, traumatic brain injury is an acquired injury to the brain that results from an external blunt or penetrating force to the head. Hypoxic injury, on the other hand, is the disturbance of the brain function as a result of decrease or loss of oxygen supply to the brain. Researchers compare TBI with hypoxic patients, but it has been noted that hypoxic injury complicates traumatic brain injury. The resulting effect of brain hypoxia depends on the amount of reduced tissue in the oxygen and the duration of the reduction.
Researchers have observed that moderate-to-severe TBI is normally clinically apparent. Mild TBIs relate with little to no residual impairments, while severe TBIs have relations with reduced general intelligence as well as cognitive functioning which include attention, memory and speed processing. During childhood, the rate of TBI is higher compared to adolescence cases. Diagnosis of hypoxic brain injury and TBI is essential in providing the expected projecting outcomes and predicting the recovery course. For injected hypoxia, treating the cause of minimized oxygen supply to the brain can involve surgical intervention. Of great importance to the patient and his or her family including rehabilitation, the physician is prognostication.
It is my belief that no medical specialty is specifically adept, based on either training or experience, with regards to differential diagnosis of patients who are in the low-level neurologic state following server TBI. That is, even the expert will at times have trouble agreeing as to the state of consciousness that a specific patient has at a particular time. Such lack of agreement simply suggests that current assessment methodologies are lacking and have a limited a degree of both sensitivity and specificity.
References
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