An organized mess or a messy organization?


It is not unknown that my interest in Brain Injury stems from a very personal experience. My younger brother’s road traffic accident  on 27 August, 2006 holds the same historical value in my family’s life as the blasts of Sept 11, 2001 have in the current global political environment. Nothing was ever the same for any of us.

For me it also had profound effects on my career and professional development. Just before this accident I had finished my year long rotation in the acute stroke unit that also required me to be on the neuro-rehabilitation team and attend to chronic and recuperating neurology patients. I came across many head injury patients during this time. But at that stage in my career, this seemed the most unexciting task for me: the charged, enthusiastic,ambitious young doctor that I was, dealing with such patients seemed uninspired and far less interesting than diagnosing complex neurological syndromes. The turn of fate was that a few months later, when faced with my brother’s accident, all those things that I learnt half heartedly in my neuro-rehab rotation became my biggest resource, and ended up having greatest value . I may have had all the pre-requisities of being an able doctor before then: hard work, sincerity, intelligence, problem solving etc. But it was during the time that my brother was battling between life and death, being on the other side of the ICU door gave me the compassion and understanding of the magnitude of this predicament that I was perhaps not aware of before.

Was this divine retribution? Were the unseen forces preparing me for this? These thoughts were constantly part of my inner dialogue when I was the only one in my family who could see ahead and predict what problems my brother will be faced with given his injuries. Everyone in my family figured out that having a severe brain injury was bad news, and in most cases it meant death. But they had no idea that surviving a brain injury was an even greater challenge. When they were all thanking God as my brother came out of coma 2 1/2 months later, I was worrying whether he would ever be able to walk again? It took a while for everyone to understand that the reason he can’t hold his neck up, or use his hand, or walk or   even have control over his bowel movements was because that part of the brain was injured.

And so began our collective journey as a family to discover what different parts of the brain do. This understanding that even the most mundane of movements like holding a spoon require a certain part of the brain to be functioning was an eye opener for my family.

As more and more research is being done in brain science ( and even more expected in view of Obama’s massive brain mapping project ) the concept that different areas of brain have specific functions is fast becoming blurry edged and softer amongst neuroscientists. But nonetheless the traditional model of brain functions is a good place to start and to simplify our understanding.

For starters, the basic thing to know is that there are four important parts of the brain:

1)The largest one is called the cerebrum. It is the part of the brain that is most visible on looking, the one that has all these rough ridges going all over it. It is these folds of the brain that are actually an ingenious way of nature to pack so many millions of neurons in such a small space.

The cerebrum takes up the bulk of the jobs that makes human beings essentially human. It has parts which control movements of our body parts, like arms, legs, faces. It also has parts which store and process our language and understanding. The parts of the cerebrum at the very back of our heads deal with our sight; these work to get information from the eyes and convert it into a picture.  When a person gets an injury at the back of the head they can become blind, although their eyes would still be working. There are other parts that work similarly for the ears, so they process what we hear. Right at the front of the cerebrum, behind our foreheads lies the part of our brain that controls our reasoning and problem solving capacity in addition to components of movement and speech.

2)At the back of the head, just below the cerebrum is a smaller mass called cerebellum, which looks like a little version of the cerebrum. This part controls our posture, control of movements and balance. Problems or injury to this part of the brain can lead to loss of balance and inability to do fine movements.

3) Embedded deep inside and covered by the cerebrum is our limbic system, also sometimes called the emotional brain. As the name suggests it deals with our emotions, and is intimately involved with our memory, arousal and mood.

4) The brain stem: the structure that forms the common connection of the different areas of the brain to the rest of the body, that also connects with the spinal cord, and that is the place where the control of involuntary actions of our bodies like the heart rate and breathing is placed.

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In addition, just remember that the brain has two halves (called hemispheres): the right and the left one, each managing the opposite side of the body. So your right hand movements are coming from a place in your left hemisphere. And your left leg is being moved by an area of your right hemisphere.

I don’t intend to discuss the anatomical description of each part of the brain in detail. But it is important for us all to know that there are parts of the brain that are doing each one of our tasks. The reason why these tasks were designated to different parts of the brain can never be fully understood. Some parts of the brain are very specific to what they do. For instance the control of breathing and heart rate being a function of the brain stem is very definitive. However, some other parts of the brain have an ability to take over functions other than traditionally thought. This ability of the brain, most often seen in parts of the cerebrum (largest part of brain) is called neuro-plasticity. This ability is going to be key in our understanding how survivors of brain injury can manage to continue living and re-equip themselves with skills required to lead meaningful lives.

To make this discussion more relatable, I will once again give my brother’s example. His injuries were multiple and very complex. The fact that he survived is a miracle in itself. But when he woke up, his left hemisphere was severely damaged. This resulted in him being paralyzed on the right side of the body (remember one side of brain controls opposite side of body) and in addition his speech and language were also affected.

I want to leave you to ponder over the complexity of the term speech and language. Since it comes so naturally to us, we don’t give a second thought what an intricate process it is. It includes our ability to understand what we hear, then process the information, then think of a response, then form the response into words, then link the words in a (grammatically correct, if we are lucky) sentence, then speak these words clearly with the muscles of our lungs, throat, mouth and tongue perfectly working.

Aren’t human beings the most magnificent of all creations!


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