There are several ways to categorize brain injury – none of which particularly matter to a HANDLE Practitioner because none describe the person’s life.

  • How it happened
  • Congenital (meaning born with) versus acquired (any time after birth)
  • Traumatic (meaning external source) versus cardiovascular (internal)
  • Head injuries: concussion, fracture, stroke
  • Deficits
  • Hemiplegic: right/left (which side has lost motor &/or sensory function)
  • Intellectual loss including inability to task-focus, confusion
  • Inappropriate behaviors + poor social judgment
  • Language changes (not referenced in other, above) e.g. speech pattern
  • Miscellaneous e.g. weight gain/loss, paranoia, timidity
  • Age at which help is sought
  • Infant (up to 3 years old)
  • Child (3-12)
  • Teenager (13-19)
  • Adult (20-65)
  • Senior/geriatric (65+)

Regardless of any of that, the client presents with skills lost and retained. That’s what interests us. The evaluation identifies those skills and traces root causes of weakened functions, sometimes not recognized by the client or his/her family and friends. The age factor interests us more than how the brain injury happened, to the extent that life-task challenges correspond and that’s where “deficits” show up.

There’s no sure way to group effects of a head injury. It can show up in every area of function – from reflexes all the way up to language and decision-making or problem-solving skills. It’s not even safe to say that if the injury is to the right side of the brain all the left-side motor and sensory functions will be lost… because neuroplasticity means that functional demands can retrain the brain. And regardless of “measurable” effects, impact on lifestyle is usually profound, with emotional responses predictable. [Why are so many others surprised by depression?]

In the “categorization” list, a missing one does matter: what part of the brain was (most likely) damaged. No foregone conclusions from knowing that, but a factor to bear in mind; as important as knowing the nature of family support, for example.

With that clear, let’s try to see what HANDLE “eyes” see:

  • Sensory-motor effects: input and output to/from the brain
  • Sensory – especially:
  • Tactility – ability to identify what’s felt &/or hypersensitive to touch
  • Visual functions: this goes way beyond just vision which is the processing of light, to how both eyes work together (binocularity) and tracking (following anything moving, and moving across static input as for reading) and ability to focus. All may relate to 2, below.
  • Motor
  • Balance
  • Muscle tone
  • Coordination & dexterity
  • Intellectual or cognitive effects
  • Problem-solving
  • Reasoning, logic
  • Memory
  • Language/communication effects (variously influenced by all above)
  • Fluidity
  • Word choice & structure
  • Nonverbal expressiveness
  • Physiological effects (usually relate to all above)
  • Immune system: vulnerability to infection
  • Digestive & elimination systems
  • Cardio-vascular & lymphatic systems

Fitting an understanding of how everything relates to everything else – which often actually begins with specifics of life-task challenges – takes the Practitioner to the factor of age. Given also an understanding of neurodevelopmental change as we mature, there are additional considerations. While not determinant, they do matter.

  • Neuronal connections stabilize proportionate to experience. What’s repeated gets laid down and, the more repeated the less easily re-routed. [Logic behind the adage about old dogs and new tricks.]
  • Interpersonal relations establish social expectations. Babies primarily relate to the immediate family; teens prioritize peers; adults care about partners and job-site factors both as “boss” judgment and co-workers’ opinions.
  • Life-task challenges affect the “impact” brain damage has on self-image, and how the individual and family rank the severity of the effects.