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TBITRAUMATIC BRAIN

INJURY

1.5-2 million adults and children suff er TBI annuallyApproximately 1.1. million have mild injuries and do

not require hospitalization250,000 will be hospitalized with moderate to severe

head injuries50,000 die from their injuries

WHO IS AFFECTED BY TRAUMATIC BRAIN INJURY TBI ?

-Figure 1. Diffuse Injuries. Mayfield Clnic, 2014. Retrieved from http://www.mayfieldclinic.com/PE-TBI.htm

Figure 2 . Traumatic Brain Injury. Mayfield Clinic, 2014. Retrieved from http://www.mayfieldclinic.com/PE-TBI.htm

Traumatic brain injury (TBI) can occur when something outside the body hits the head with significant force. Whether it is a head hitting the windshield during a car accident, an impact from a fall, head injuries received during sports or other recreational activities , or trauma from a nearby blast or explosion, TBI can cause changes in a person’s ability to think, control emotions, walk, or speak, and can also aff ect sense of sight or hearing.

WHAT IS TBI?

a head hitting the windshield during a car accident an impact from a fall head injuries received during sports or other

recreational activities trauma from a nearby blast or explosion or assault with or without weapons

WHAT ARE THE CAUSES OF TBI

LEADING CAUSES OF TBI

The leading causes of TBI:

-Falls (40.5%):-Motor vehicle – traffic (14.3%); -Struck by/against events (15.5%); -Assaults (10.7%).1

Figure 3 . Leadings causes of TBI. Center for Disease Control. Retrieved from http://www.cdc.gov/traumaticbraininjury/get_the_facts.html#causes

Falls-Falls continued to be the leading cause of TBI (35.2%) in the United States. -Falls cause half (50%) of the TBIs among children aged 0 to 14 years and 61% of all TBIs among adults aged 65 years and older.Motor Vehicle-Traffi c Crashes-Motor Vehicle Accidents MVA is the leading cause of TBI-related Death (CDC, 2014)-Rates of death from TBI from MVA are highest for adults aged 20 to 24 years (CDC, 2014)

LEADING CAUSES OF TBI

Struck By/Against Events-Struck by/against events, which include colliding with a moving or stationary object, were the second leading cause of TBI among children aged 0 to 14 years, with 25%. Assault-Assaults produced 10% of TBIs in the general population; they accounted for only 2.9% in children aged 0 to 14 years and 1% in adults aged 65 years old and older.

LEADING CAUSES OF TBI CONT.

TBI can be further classified according to findings from various imaging tests (CT scan MRI and PET scans)

Both individual findings from such tests as well the collective results influence both Prognosis and Treatment for victims of TBI

See Primary and Secondary Injury

HOW IS TBI CLASSIFIED ?

Occurs at the time of the injuryRelates to the “mechanism of injury” and includes

Direct impact Rapid acceleration and deceleration (see next slide Coup

countercoup) Penetrating injury Blast waves

All these mechanisms result in trauma to the brain from mechanical forces including:Bruising swelling BleedingActual shearing of the white matter of the brain (predicts poor outcome)

PRIMARY INJURY IN TBI

Figure 4 . Coup Contrecoup Injury. Wikipedia, 2014. http://en.wikipedia.org/wiki/Coup_contrecoup_injury

Includes damage that occurs over hours to days and occurs at the cellular level in the brain such as:Free radical injury to cell membranesElectrolyte imbalances Inflammatory responsesCellular death Ischemia from vascular injuryIt is these secondary injuries that current medical research is attempting to limit or prevent. No current treatments have demonstrated clear benefit

SECONDARY BRAIN INJURY IN TBI

TBI FACTS:TBIs can occur on the battlefield, on the football field,

on the playground, in a car accident, and even at home.

There are four categories of TBI including mild, moderate, severe and penetrating.

A mild TBI (mTBI), which is also known as a concussion, is the most common form of TBI (see Next Slide).

DID YOU KNOW?

Figure 5. Concussions and Mild TBI. Center for Disease Control, 2007.

Injuries can range from mild concussions to severe permanent brain damage.

The consequences of a brain injury can aff ect all aspects of a person’s life, including physical and mental abilities as well as emotions and personality.

TBI can result in changes in a person’s physical functioning, thinking abilities or cognitive function, and behavioral eff ects and they are often interrelated. These eff ects sometimes cause other diffi culties such as sleeping problems, depression, and anxiety.

TBI SYMPTOMS

Loss of consciousness Confusion and

disorientationMemory loss /

amnesia Headaches Visual problems Poor attention /

concentration

Sleep disturbances Dizziness / loss of

balance Irritability / emotional

disturbances Feelings of depression SeizuresVomiting

TBI SYMPTOMS CONTINUED

Depending on the type and location of the injury, a person’s immediate symptoms may include:

GeneralDifficulty speakingBlurry eyesightTrouble hearingLoss of energyChange in sense of taste or

smellDizziness or trouble with

balance

Behavioral effects may include:Becoming angry easilyGetting frustrated easilyActing without thinking

SYMPTOMS:

Cognitive effects may include:

Difficulty concentratingTrouble with attentionForgetfulnessDifficulty making decisionsRepeating thingsBehavioral effects may include:Becoming angry easilyGetting frustrated easilyActing without thinking

Thinking/Remembering

Difficulty thinking clearly Feeling slowed down

Difficulty concentrating

Difficulty remembering new information

Physical Headache Fuzzy or blurry vision

Nausea or vomiting (early on) Dizziness

Sensitivity to noise or light Balance problems

Feeling tired, having no energy

Emotional/Mood Irritability Sadness More emotional Nervousness or anxiety

Sleep Sleeping more than usual Sleep less than usual

Trouble falling asleep

 

SYMPTOMS

Figure 6. Symptoms of brain injury. Center for Disease Control, 2014. Retrieved from http://www.cdc.gov/concussion/signs_symptoms.html

When a person is brought to the emergency room with a head injury, doctors will learn as much as possible about his or her symptoms and how the injury occurred. The person’s condition is assessed quickly to determine the extent of injury.

Diagnostic Imaging Tests:-Magnetic Resonance Imaging (MRI)-Magnetic Resonance Spectroscopy (MRS)-Computed Tomography (CT)-PET scans

HOW IS A DIAGNOSIS MADE?

A professional may work with his or her family/caregivers as part of a team that may also include:

doctorsnursesNeuropsychologists and clinical psychologistsoccupational therapistsphysical therapistssocial workersemployersteachers

DIAGNOSIS TEAM

Disabilities from TBI may last a lifetime, and diff erent interventions may be appropriate even many years later. This is particularly true for survivors of moderate to severe TBI. It is essential for survivors, their families, and caregivers to be involved in designing and implementing the rehabilitation plan.

Patients may have residual symptoms that require skilled management by qualified neurologists, physiatrists, and neuropsychologists

There are two categories of chronic treatment: Community-based rehabilitation and return to work or

school, and Treatment of long-term consequences of the injury.

TREATMENT FOR CHRONIC TBI

TBI symptoms can aff ect people in diff erent ways and sometimes symptoms change as people recover.

Some people may recognize TBI symptoms immediately, and others may write them off or minimize what they’re experiencing.

The eff ects of mild TBI usually get better on their own and may be unnoticeable within three months.

Some moderate to severe TBI symptoms last for a longer period of time or may be permanent. However, there are eff ective treatments and support for helping Veterans manage their symptoms and find a path to recovery.

MENTAL HEALTH RELATED EFFECTS OF TBI

Feeling tired all the time Feeling sad and anxious Getting frustrated or overwhelmed easily Sleeping much more or less than usual Feeling irritated or angered all the time Doing things without stopping to think Having trouble concentrating, remembering, or focusing

on tasks Drinking more alcohol Taking more of a prescription or over-the-counter

medication than as directed Using illegal drugs Smoking or using tobacco more often Not feeling like yourself

MENTAL HEALTH RELATED EFFECTS OF TBI

Decreased strength and coordination in the body, arms, and legs

Hearing lossTinnitus (ringing or buzzing in the ears)HeadachesSeizuresDizzinessNauseaVomitingBlurred VisionDecreased smell or taste

PHYSICAL PROBLEMS FROM TBI

People with a brain injury often have cognitive (thinking) and communication problems that signifi cantly impair their ability to live independently. These problems vary depending on how widespread brain damage is and the location of the injury.

The person may have trouble with social communication, including: taking turns in conversation maintaining a topic of conversation using an appropriate tone of voice interpreting the subtleties of conversation (e.g., the

diff erence between sarcasm and a serious statement) responding to facial expressions and body language keeping up with others in a fast-paced conversation

COMMUNICATION PROBLEMS FROM TBI

Trouble concentrating when there are distractions (e.g., carrying on a conversation in a noisy restaurant or working on a few tasks at once).

Slower processing or "taking in" of new information.

- Longer messages may have to be "chunked," or broken down into smaller pieces.

- The person may have to repeat/rehearse messages to make sure he or she has processed the crucial information.

- Communication partners may have to slow down their rate of speech.

COGNITIVE PROBLEMS FROM TBI

Problems with recent memory.- New learning can be diffi cult.- Long-term memory for events and things that occurred

before the injury, however, is generally unaff ected (e.g., the person will remember names of friends and family).

Executive functioning problems . - The person may have trouble starting tasks and setting

goals to complete them.- Planning and organizing a task is an eff ort, and it is

diffi cult to self-evaluate work.- Individuals often seem disorganized and need the

assistance of families and friends.- They also may have diffi culty solving problems, and they

may react impulsively (without thinking fi rst) to situations.

COGNITIVE PROBLEMS CONT.

There are also steps you can take to help manage your TBI symptoms: Get enough sleep Write things down or use electronic reminders if you have trouble

remembering Establish a regular, daily routine Check with someone you trust when making decisions Avoid alcohol—it could slow down the healing process and make

symptoms worse Avoid caff eine, cold medications that treat nasal congestion, or other

products that contain pseudoephedrine—they may increase the symptoms

Recognize triggers—keep a record to help identify situations that are more l ikely to worsen your symptoms

Take up a hobby or a recreational activity Talk to others—to keep you from feeling isolated and to give friends

and loved ones a chance to help you Remember that symptoms are a normal part of the recovery, and they

will get better

MANAGING THE EFFECTS OF TBI

Complete guide to TBIBrainline Media Webpage Living with TBIBrainline Webpage link Blast injuries may be causing TBI in our militaryBrainline webpage link 20 lifesaving apps for those with TBIBrainline webpage link Some are unaware they have suff ered a TBI-Youtube link to video

MORE INFORMATION

1. Centers for Disease Control and Prevention. Traumatic Brain Injury in the United States: A Report to Congress. Atlanta (GA): Department of Health and Human Services (US), CDC, National Center for Injury Prevention and Control ; 1999.

2. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospital izations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control ; 2010.

3.Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospital izations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control ; 2010

4.Champion HR, Holcomb JB, Young LA. Injuries from explosions. Journal of Trauma 2009;66(5):1468–1476.

5.Hemphi l l C. J . , Phan N., Aminoff A. J . In Aminoff M. J . , Wilterdink J . L. Editor Tramatic Brain Injury: Epidemiology, classifi cation and pathophysiology. Uptodate 2014.

6. Marge K. Introduction to violence and disabi l i ty. In: Marge K, editor. A cal l to action: Ending crimes of violence against chi ldren and adults with disabi l i t ies, a report to the nation. Syracuse: State University of New York, Upstate Medical University; 2003. p. 1-16.

REFERENCES

7. Petersilia, J.R. Crime victims with developmental disabilities: a review essay. Criminal Justice & Behavior 2001;28(6):655–94.

8. Sobsey D, Doe T. Patterns of sexual abuse and assault. Sexuality & Disability 1991;9(3):243–59.