Associate Professor Dr Les Koopowitz discussed at the recent People at Work Conference what a brain injury is, and how best to manage the injury and the person.

The brain's nervous system is aptly named, according to neuropsychologist and Associate Professor Dr Les Koopowitz. Our brains hold more information than we even know about. It's enough to make you nervous.

What do we mean when we talk about a brain injury? How can it impact people, and how can we best manage it?

A brain injury could be the result of a blow to the head or the head being forced to move too quickly, usually followed by some sort of unconsciousness. The injury can occur as the result of a car accident, assault, sporting accident, fall or violent shaking. The brain may be torn, stretched, penetrated, bruised or become swollen; oxygen may not be able to reach brain cells and there may be bleeding.

One of humans' biggest problems is that the human mammal – compared with other mammals – is born about 12 months premature. This means that simple survival mechanisms, like the muscle strength to hold our heads up or walk, are sorely lacking.

“For the first 12 months,” he explained, “we are totally dependent – and that's one of our earliest memories. Our brain connections are fully functioning, but all we can do is scream and arch our backs and hope that someone will come and rescue us and save our lives.”

Such memories affect a pre-injury and post-injury brain.

The main role of the nervous system, explained Dr Koopowitz, is to ensure our survival. “During the course of our development, as people and as a species, various parts of the brain remember threats to our survival,” said Dr Koopowitz, who has a specialist interest in acquired brain injury.

Our brains keep information stored for us even though we might not want it, and even though we might not be aware that the memories exist. After an injury, the brain remembers this information and it has an effect on recovery.

"If it was a vulnerable brain that had trouble connecting in the first place, then – however mild an injury may be – it will have an effect on connectivity,” said Dr Koopowitz. The less pliable the brain, he explained, the less able the brain will be to adapt to changing demands after it is injured.

“What we experience [in recovery from a brain injury] is not necessarily what happened, but what we understand to have happened. We don't only live in the here and now,” said Dr Koopowitz. The was the brain perceives information is affected by past memories and anticipation of future dangers.

The brain needs to be able to establish connections after an injury. Dealing with a ‘hyper-aroused' (post-injury) brain is a procedure that cannot be rushed – the brain has to heal at its own pace. Clinicians, he said, can help patients to take responsibility for that healing, and give hints and help along the way. The injured brain, for example, will find multi-tasking difficult, so focus on one thing at a time; and the patient will need a consistent and predictable environment instead of one that's too hectic, so accommodate this by refining work duties or changing work environments.

When it comes to the rehabilitation of brain injuries, the process is complex as it must consider the different needs of many people, including patients, hospital administrators, and lawyers who may be looking to disprove that the patients with brain injuries have real injuries.

The process is also challenging because of the complex nature of the brain; information processing is not a simple function. An intelligent brain has the ability to deal with complex cognitive tasks and is able to focus on what's important and ignore what's irrelevant. These are the capacities that give us our personalities, and the capacities sought again after injury.

The most important thing to remember, said Dr Koopowitz, is that the implications of the pre-injury brain on post-injury recovery, cannot be over-emphasised. The pre-injury personality, the socio-cultural back ground and the environmental influence all affect the recovery from that injury. The worst aspects of a patient's personality, he said, will often be highlighted as a result of the injury, as the brain seeks to follow the line of least resistance.

The brain that was injured has an effect on the brain injury, he said. If there was weak brain connectivity before the incident, the recovery will be even harder. If a person was used to being impulsive, for example, or withdrawn, they will become more so post-injury. The injured brain, Dr Koopowitz explained, becomes less able to adapt to changing environmental demands.

When dealing with an injured brain, there are multiple factors that provoke the injury. A lot of these factors existed before the accident. The clinician is there, said Dr Koopowitz, to help the patient return to their intelligent brain.

When clinicians deal with someone who has post-injury vulnerability, it's counterproductive, Dr Koopowitz said, to ask what caused it. The best clinicians will integrate rather than separate and categorise the different factors that come together to cause brain injury and affect its recovery. In a clinical context, he said, a clinician's job is not to determine how much money a company owes a patient as a result of the injury sustained there, but to help the patient to recover.