Blog Feb 21, 2024

Brain Injury Frequently Asked Questions

Dr Neil Jasey

Your Questions, Our Expert

Q & A on Brain Injuries 

As part of Brain Injury Awareness Month, we spoke with one of our resident brain injury experts, Dr. Neil Jasey. He provided insights on a range of topics, from the different types of brain injuries to treatments and general information that patients typically ask about. Dr Neil Jasey

Dr. Jasey is the Medical Director at Kessler Institute for Rehabilitation* – West Orange campus and Director of Brain Injury Services. Dr. Jasey also serves as the Medical Director of the Northern New Jersey Traumatic Brain Injury Model System. He is also a clinical associate professor in the Department of Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School.

Q: What is a severe or traumatic brain injury? Are there different types?

A: Traumatic brain injuries are the result of some kind of trauma; something as simple as a concussion or something more severe.

Typically, falls are the number one cause of traumatic injuries as well as assaults and motor vehicle accidents. We see different types of intracerebral hemorrhages as well, some resulting from aneurysm ruptures and arteriovenous malformations in addition to severe strokes.

Despite the mechanism of the injury itself, many of the underlying issues are similar, creating a lot of overlap.

Q: How do doctors know what type of brain problem the patient is experiencing?

A: It begins with what happened to the individual. Was it a fall that resulted in the brain injury? A motor vehicle accident? Some kind of cardiac arrest? Often, people will present with an aneurysm rupture with the worst headache of their life.  That’s a clue to the mechanism of the injury.

Then I ask about their current symptoms. Is it severe -- a coma, vegetative or minimally conscious state? Is it on the milder side with a higher level of cognitive deficits?  Patients can present with different physical and functional issues as well such as weakness or spasticity. People can also present with endocrine issues or dysautonomia – higher heart rate and blood pressure – because of their brain injury.

No two brain injuries are alike; it really depends on the type of injury and the patient.  In other words, did the person have a history of depression or anxiety? Did they have any learning issues? All of these things play a role in how the injury presents itself and the treatment plan.

Q: What is the role of the doctor in helping the survivor recover from a brain injury?

A: From a rehab standpoint, I view the doctor as the hub of the wheel.

A physician sorts through the different factors I've listed earlier, the history, presentation and symptoms. The information flows back and forth. We work as a team that consists of experts in physical therapy, occupational therapy, speech therapy and psychologists.  Add to that the patient and families who play a role in recovery.

There are certain things that we really have to focus on — certainly the medical management and any medical complications and how best to treat those things. There are different techniques in terms of promoting better alertness, concentration and memory — they rely on therapy but medications also play a big role. It's not just giving medications; it's also removing medications that may impede someone’s recovery. Nutrition also plays a role and we manage that.

Q: How does rehabilitation influence outcomes and when does it start?

A: The earlier the intervention, the better. Ideally, rehab would be involved from day one, and in certain circumstances, it is. We see that outcomes, mobility and control are improved, and some of the behavioral issues such as agitation are better. If we can speed the person along, they recover much faster. We apply the right treatment at the right time.

Overall, what we're doing is increasing the pace of and maximizing the person's recovery as much as possible. It’s very much a team effort — everyone from the nursing assistants to the therapists, physicians, nurses, case managers and psychologists

Note: This Your Questions, Our Experts Q & A is not intended to replace professional healthcare advice, diagnosis, or treatment. Always speak to your healthcare provider about any questions you may have regarding your own health.

*Kessler Institute for Rehabilitation is a part of the Select Medical hospital network.