>> Interviewer: The Brain Injury Guide and Resources is a tool

for professionals, community members and family

to understand traumatic brain injury as well as how

to promote better living for those who live with a TBI.

In this interview, we will talk with Dr. Christopher Wolf,

a physiatrist in the Department of Physical Medicine

and Rehabilitation at the MU School of Medicine,

to learn some basic information about traumatic brain injury.

And, Chris, thanks very much for being with us.

I appreciate it.

>>Dr. Wolf: I appreciate you having me.

>> Interviewer: First, Chris, give us an overview

of the structure of the brain, if you would.

>> Dr. Wolf: Well, with the brain itself,

a lot of people have seen a lot of different pictures.

This is one we're going to use today.

But it's a very delicate structure.

It's -- basically, what it is is a very soft gelatinous structure

that's kind of hidden inside the skull.

And so the skull is our protection

for this very soft structure.

The overall structure

that you'll see back here is the cerebrum,

which is the overall bigger portion of the brain.

Huddled underneath it is the cerebellum.

And then there's a brain stem that's not actually seen

on there that's continuous with the spinal cord itself.

And those structures kind of make

up the central nervous system with the brain kind

of being the computer that runs the whole system.

>> Interviewer: What's the relationship

of the brain structure to the functions of the brain?

>>Dr. Wolf: Well, we know there's definitely a connection

to all the different structures

and the functions that they provide.

And anyone who tells you that we know everything

about the brain doesn't really know about the brain,

because there's a lot more we don't know than what we do know.

Now, with the brain, it is broken up on this picture

that we have behind us here into the different lobes.

Each lobe serves different functions.

The frontal lobe, which is a commonly injured structure,

seats a lot of judgment and reasoning and motivation.

That is a very common place for what makes us human

and what we call the executive functions,

which kind of incorporates all that is seated there.

The temporal lobe seats a lot of our memories,

and a lot of our ability to think is in that area.

And then the occipital lobe essentially controls a lot

of our visual functions and our ability to see

and helps sub-serve some of the other functions of the brain.

And then you see that central sulcus

where we have the postcentral gyrus and the precentral gyrus,

fancy terms for those little areas of the brain.

But those are going to serve for movement

and initiating movement, being able to move your foot,

move your leg, and that sends the impulses

down through the spinal cord.

But, also, a different portion of it receives information

from the legs and arms and actually allows you to feel

when someone's touching you.

And so those are the ones that you can see on the outside.

But then deeper than that, there's another layer,

and the subcortical layers; and there's areas

such as the basal ganglia and the cerebellum

which you can just see peeking out from underneath it kind

of modify the movements and have purposes to try

to help coordinate and make things work smoother

and better than normal.

And those are -- those are all then connected

into the spinal cord itself.

>> Interviewer: So what happens in a brain injury?

>> Dr. Wolf: Well, in a brain injury, there's multiple things

that happen all at once.

Now, we mentioned that the brain structure itself is very soft

and almost gelatinous.

And there's different areas

and different densities through the brain.

So when the brain is injured, it's essentially this cerebrum

on a stalk or on the brain stem.

And when the head hits in any direction, there's going

to be not only the impact in certain areas of the brain --

usually that frontal lobe which we talked about --

also the temporal lobes are more common

than other places to be injured.

And those are going to essentially hit the side

of the skull and cause bruising or contusions.

But at the same time, those densities

and different densities are going

to rotate at different speeds.

And you're actually going to get a tearing that can occur

or a shearing type of injury that can occur

at different areas throughout the brain,

and that's called diffuse axonal injury,

giving us more widespread effects.

Those tend to occur at what's called the gray white matter

junction, which is where the axons have an insulation on them

where that insulation changes.

But also it can happen at some of the midline structures,

basically where that stalk or the brain stem is coming

into the cerebrum where you get a twisting motion.

And those can tear through the brain stem

and the corpus callosum, which is our only real connection side

to side from the right side of the brain

to the left side of the brain.

And that's essentially what happens

at that moment of impact.

There are some secondary effects that happen after that moment

of impact where the brain then has a lot

of excitatory amino acids, which is basically a lot

of chemicals being released all at once,

causing additional damage and additional cell death.

And that causes swelling,

which causes additional cell problems and death.

So those are quite a few things that still are happening there.

And then whatever is happening to that person at that time,

are they having trouble getting oxygen

to the brain, anything else.

So there's a lot of issues that happen

with that moment of injury.

>>Interviewer: How does the brain recover from an injury?

>>Dr. Wolf: Well, the recovery is kind of the opposite of that.

And so we have all of these --

the secondary effects that I talked about with all

of those excitatory amino acids.

And all the different chemicals being released,

those start to down-regulate and disappear out of the brain.

And with that goes a decrease in the swelling.

And we will see some initial recovery just purely on the fact

that that swelling is going down.

And that over time will decrease some

of the functional ramifications of the injury.

But then, after that,

we're pretty sure there's not a tremendous amount

of actual recovery of dead cells.

Once those cells are damaged, we have to rely

on the brain's healing mechanisms

to essentially compensate for that.

>> Interviewer: So, Chris, could one area

of the brain that's damaged, could one area of it compensate

for another area that is damaged?

>>Dr. Wolf: Somewhat.

They can't take on tremendous new roles,

but there's usually quite a few essentially double wiring,

more or less.

And so, yes, there is some of that

where the brain shifts its focus a little bit.

But oftentimes we have to substitute and relearn

and teach it, basically get the wires

to reconnect in a different way.

>>Interviewer: All right, Chris.

Thank you very much for being with us.

We appreciate your insight.

>> Dr., Wolf: Well, thank you.

>>Interviewer: And thank you for watching this interview

on an overview of TBI, a service

of the Brain Injury Guide and Resources.

[ Music ]