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Neuroscience Center Traumatic Brain Injury Advocacy Group

 
Feature Story: Traumatic Brain Injury Overview
What is TBI?

Traumatic Brain Injury (TBI) occurs when a sudden trauma causes damage to the brain. Another term commonly used to classify brain injuries, is Acquired Brain Injury (ABI). By definition, ABI occurs when there is damage to the brain acquired after birth. It usually affects cognitive, physical, emotional, social or independent functioning and can result from TBI, (i.e. accidents, falls, assaults, etc.) and non-traumatic brain injury (i.e. stroke, brain tumors, infection, poisoning, substance abuse, etc.). There are two types of TBI: Closed Head Injury (CHI), and penetrating injury. A CHI occurs when the head violently and abruptly hits an object. In the case of CHI the soft brain reverberates within the hard skull. A penetrating injury occurs when an object pierces the skull and enters the brain. A gunshot wound is an example of a penetrating brain injury.

Symptoms

Symptoms of TBI vary from mild to severe depending on the amount of damage to the brain. In the case of Mild Brain Injury, the symptoms may not be immediately evident. Symptoms may surface over the course of weeks or months after the injury. An example of a mild TBI would be a sports related concussion (i.e. got their “bell rung”, “saw stars”).

Mild Symptoms include:

  • May remain conscious or may lose consciousness for a few seconds or minutes
  • Headache
  • Confusion
  • Lightheadedness
  • Dizziness
  • Behavioral or sleep changes
  • Blurred vision or tired eyes
  • Ringing in ears
  • Bad taste in mouth
  • Fatigue
  • Change in sleep patterns
  • Trouble with memory, concentration, attention or thinking


Moderate or Severe Symptoms:
(may have all the symptoms associated with mild plus these symptoms)

  • A headache that gets worse or does not go away
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • An inability to awaken from sleep
  • Dilation of one or both pupils of the eyes
  • Slurred speech
  • Weakness or numbness in the extremities


Causes

For people under 75 years old, more than half of TBI’s are caused by some form of transportation accident. For people older than 75, falls cause the majority of TBIs. Half of TBI incidents involve alcohol use.

The leading causes of TBI are:

  • Falls (35.2%);
  • Motor vehicle-traffic crashes (17.3%);
  • Struck by/against events (16.5%)
  • Assaults (10%)
  • Blasts are a leading cause of TBI for active duty military personnel in war zones.


Treatment

Little can be done to reverse the initial effects of a TBI. Therefore it is imperative to see a doctor as soon as you experience symptoms.

Classification

Patients are ranked on a severity scale depending on whether or not they have a concussion or a coma. The first scale is used in the acute care phase, typically in the first 24-72 hours, or in the unconscious/minimally conscious stages. This scale is called the Glasgow Coma Scale (GCS). Thereafter, the Rancho Los Amigos Cognitive Scale, (Rancho) is utilized. The Rancho scale consists of ten levels of functioning.

Prevention

Prevention techniques for TBI’s are general safety procedures:

  • always wear a seatbelt
  • wear a helmet during any type of potentially dangerous sport
  • use a car seat for young children
  • never drive under the influence of alcohol or drugs
  • keep firearms stored and unloaded in a safe area
  • NEVER shake a baby
  • safe-guard Seniors and balance challenged persons from falls (i.e. remove throw rugs, install sufficient lighting, encourage use of canes/walkers as prescribed by a physician or therapist)


Long Term Effects

A brain injury has long-term effects. It isn't temporary like a broken arm or sprained ankle. New research is showing that new brain cells may be able to reproduce but this research is only in the beginning stages. The following symptoms are quite severe but individuals with mild TBI may show some of these characteristics to a lesser degree.

Physical symptoms:

  • Problems with walking, coordination, use of limbs or body due to loss of muscle control and/or muscle weakness; paralysis, disrupted balance control
  • Lack of strength/endurance, easily fatigued
  • Problems seeing, hearing, smelling, tasting
  • Difficulty eating & swallowing
  • Difficulty speaking clearly
  • Seizures
  • Loss of bladder & bowel control
  • Loss of feeling & sensation
  • Headaches


Cognitive concerns:

  • Problems with concentration, attention, distractibility
  • Difficulty with problem-solving; impaired judgment and reasoning
  • Problems with short and/or long term memory
  • Executive functions, difficulty planning, initiating, or following through on tasks
  • Difficulty retrieving information
  • Difficulty learning new information and difficulty generalizing learning
  • Slower thought processes
  • More easily over-stimulated; diminished tolerance to stimuli
  • Problems with sequencing, organizing and prioritizing
  • Inability to say what is meant or difficulty understanding others
  • Difficulty with language/communication (reading and spelling)
  • Trouble following directions
  • Concrete thinking; diminished abstract reasoning
  • Difficulties with orientation
  • Inability to manage time


And, there are the psychosocial and behavior-emotional concerns:

  • Changes in personality
  • Impulsivity
  • Irritability; diminished frustration tolerance
  • Restlessness, hyperactivity
  • Depression, withdrawal, low motivation
  • Anxiety
  • Anger, aggression, verbal outbursts
  • Lack of energy; fatigue and problems with endurance
  • Lack of energy; fatigue and problems with endurance
  • Rigid, inflexible
  • Changes in control of temper, rapid mood swing
  • Denial of disability
  • Lack of self-esteem
  • Apathy/Euphoria
  • Problems controlling behavior in social situations
  • Poor social judgment
  • Poor social interaction
  • Absence of sensitivity to others which leads to problems forming and maintaining relationships
  • Families often bring home a family member from the hospital after a car accident and wonder if they brought home a stranger.