TRAUMATIC BRAIN INJURY (TBI)

Prepared by R.M. Tappin for Helmets To Hardhats © 2009.

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WHAT IS TBI?WHAT IS TBI?

A term that describes sudden and physical damage and trauma to the brain

Traumatic Brain Injury:

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THE BRAIN & Its FunctionsTHE BRAIN & Its Functions

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CONCUSSION: a type of TBICONCUSSION: a type of TBI

4(http://health.allrefer.com/health/head-injury-concussion.html)

CAUSES OF TBICAUSES OF TBI

• A blow or jolt to the head• An injury that penetrates the head and

enters brain tissue• Not all blows/jolts to head cause TBI

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CAUSES OF TBICAUSES OF TBI

• Falls (28%)

• Motor vehicle-traffic crashes (20%)

• Struck by, or against, something (19%)

• Assaults (11%)

(http://www.biausa.org/)

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STATISTICS ON TBISTATISTICS ON TBI

• 50,000 die

• 235,000 are hospitalized

• 1.1 million are treated and released from an emergency department [3]

• About 5.5 million Americans estimated to have long-term care needs as a result of TBI.

• Not known how many are injured, not seen by emergency or other medical facilities, and receive no care.

(Langlois JA, Rutland-Brown W, Thomas KE)

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STATISTICS ON SERVICE STATISTICS ON SERVICE RELATED TBIRELATED TBI

• TBI is the signature wound of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF))

• Most service related TBI caused by blast injuries

• 66% of service personnel in Iraq exposed to or injured by a Blast injury

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STATISTICS ON SERVICE STATISTICS ON SERVICE RELATED TBIRELATED TBI

• 40% of service personnel returning from OIF & OEF show signs & symptoms of TBI due to a blast injury

• The large majority (80%) of combat head injuries sustained in Operation Iraqi Freedom and Operation Enduring Freedom are mild concussions as opposed to severe, debilitating TBI.

National Institute of Neurological Disorders and Stroke.

(http://www.americasheroesatwork.gov)

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SIGNS OF TBISIGNS OF TBI

• Headaches or neck pain that do not go away

• Difficulty remembering, concentrating, or making decisions

• Slowness in thinking, speaking, acting, or reading

• Getting lost or easily confused

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SIGNS OF TBI, cont’dSIGNS OF TBI, cont’d

• Feeling tired all of the time, having no energy or motivation

• Mood changes (feeling sad or angry for no reason)

• Changes in sleep patterns (sleeping a lot more or having a hard time sleeping)

• Light-headedness, dizziness, or loss of balance

• Urge to vomit (nausea)

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SIGNS OF TBI, cont’dSIGNS OF TBI, cont’d

• Increased sensitivity to lights, sounds, or distractions

• Blurred vision or eyes that tire easily

• Loss of sense of smell or taste

• Ringing in the ears

(http://www.cdc.gov/ncipc/factsheets/tbi.htm)

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ESTIMATED FORCE TO ESTIMATED FORCE TO PRODUCE TBIPRODUCE TBI

• Exact figure not known. However:• Plopping down on easy chair = 10g’s• The force of a professional boxer’s hit = 52 g’s • Between 10 and 50 g’s = estimated force

needed to cause permanent brain injury

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TYPES OF TBITYPES OF TBI

Two major types:

1. Penetrating brain injuries

2. Closed head injuries

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TYPE OF TBI: PenetratingTYPE OF TBI: Penetrating

• Foreign object enters brain (e.g. bullet)

• Damage occurs along path of injury

• Symptoms vary according to part of brain that is damaged

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Type of TBI: Closed headType of TBI: Closed head

• Results from blow to the head (e.g. car accident)

• Causes two type of brain injuries:

1. Primary

2. Secondary

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CAUSES OF TBICAUSES OF TBI

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(http://health.allrefer.com/health/head-injury-concussion.html)

Primary Closed Head Injuries:Primary Closed Head Injuries:

• Skull fracture: breaking of the bony skull

• Contusions/bruises: often occur right under the location of impact or at points where the force of the blow has driven the brain against the bony ridges inside the skull

• Hematomas/blood clots: occur between the skull and the brain or inside the brain itself

(asha.org)

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Primary Closed Head Injuries, Primary Closed Head Injuries, cont’d:cont’d:

Lacerations:

• Tearing of the frontal (front) and temporal (on the side) lobes or blood vessels of the brain

• (the force of the blow causes the brain to rotate across the hard ridges of the skull, causing the tears)

• (www.asha.org)

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Primary Closed Head Injuries, Primary Closed Head Injuries, cont’d:cont’d:

Nerve damage (diffuse axonal injury):

• Arises from a cutting, or shearing, force from the blow that damages nerve cells in the brain's connecting nerve fibers

• (www.asha.org)

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SECONDARY CLOSED HEAD SECONDARY CLOSED HEAD INJURIES:INJURIES:

Evolves over time (after trauma has occurred)

• brain swelling (edema)

• increased pressure inside of the skull (intracranial pressure)

• epilepsy

• intracranial infection

• fever• hematoma (for more info visit: www.asha.org)

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HEMATOMAHEMATOMA

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(http://health.allrefer.com/health/head-injury-prevention.html)

SUBDURAL HEMATOMAS HEMATOMAS

• ACUTE Subdural Hematomas : can occur after serious head injuries

• MILD Subdural Hematomas: can occur after mild head injuries

• SPONTANEOUS Subdural Hematomas: can occur spontaneously

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CLOSED HEAD INJURY ILLUSTRATION

( http://health.allrefer.com/health/head-injury-prevention.html)

COMMUNICATION PROBLEMS COMMUNICATION PROBLEMS CAUSED BY TBICAUSED BY TBI

• Trouble finding words

• Difficulty understanding written & verbal communications

• Difficulty spelling, reading, writing

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COMMUNICATION PROBLEMS, COMMUNICATION PROBLEMS, cont’dcont’d

• Inappropriately interrupting conversations

• Inability to follow conversation

• Using inappropriate tone of voice

• Unable to process subtleties/nuances in language (e.g. difference between tongue-in-cheek and seriousness)

(www.asha.org)

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COGNITIVE PROBLEMS COGNITIVE PROBLEMS CAUSED BY TBICAUSED BY TBI

• Slower processing of information

• Loss of short-term memory

• Poor planning, organizing skills

• Setting goals

• Completing tasks

• May act impulsively

• Difficulty solving problems

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TREATMENT OF TBITREATMENT OF TBI

• Research still being conducted• Treatment dependent on severity of the TBI• In mild TBI cognitive behavioral therapy most

common treatment form• Support treatment:

(a) nutrition (b) education (c) counseling & family support (d) medication for symptomatic relief

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LENGTH OF RECOVERY FROM LENGTH OF RECOVERY FROM TBI TBI

• Recovery varies from person to person

• Can be spontaneous

• 80 – 85% mild TBI recover within 6 months

• 15 – 20% mild TBI will recover in 1 – 2 years

• Most will make full recovery

• Some partial recovery

• Extreme cases may never recover (http://www.af.mil/news/story.asp?id=123124683)

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PLEASE PLEASE SUPPORT OUR SUPPORT OUR

TROOPS…TROOPS…

EMPLOY A VETEMPLOY A VET

We owe our We owe our freedom to them!freedom to them!

sources http://health.allrefer.com/health/head-injury-indications-of-head-injury.html

http://www.nlm.nih.gov/medlineplus/ency/article/000713.htm

http://www.asha.org/public/speech/disorders/TBI.htm

http://www.blackmanlaw.com/images/Image/tbi__big.jpg

http://www.af.mil/news/story.asp?id=123124683

National Institute of Neurological Disorders and Stroke. Traumatic brain injury: hope through research. Bethesda (MD): National Institutes of Health; 2002 Feb. NIH Publication No.: 02-158.

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