Traumatic Brain Injury

Presented by:David L Strauss, Ph.D.

ReMed

What is Traumatic Brain Injury (TBI)?

Two types of brain injury occur

• Closed brain injury

• Open brain injury

Closed Head Injury

• Resulting from falls, motor vehicle crashes, etc.

• Focal damage and diffuse damage to axons

• Effects tend to be broad (diffuse)

• No penetration to the skull

Open Head Injury

• Results from bullet wounds, etc.

• Largely focal damage

• Penetration of the skull

• Effects can be just as serious

What Happens Immediately After TBI?

TBI: A biological event within the brain

• Tissue damage

• Bleeding

• Swelling

TBI: Changes in functioning

• Loss of consciousness/coma

• Other changes due to the TBI

• Post-traumatic amnesia (PTA)

Injured Brain

• Does not mend fully

• Leads to problems in functioning

What Do We Mean by Severity of Injury

• Amount of brain tissue damage

How to measure “severity”?

• Duration of loss of consciousness

• Initial score on Glasgow Coma Scale (GSC)

• Length of post-traumatic amnesia

• Rancho Los Amigos Scale (1 to 10)

Mild injury0-20 minute loss of consciousness GCS = 13-15

PTA < 24 hours

Moderate injury

20 minutes to 6 hours LOC GCS = 9-12

Severe injury> 6 hours LOC GCS = 3-8

What Happens as the Person with Moderate or Severe Injury Begins to Recover After Injury?

Recovery

• A multi-stage process

• Continues for years

• Differs for each person

What is the Long-term Impact of a Moderate or Severe TBI in the

Person’s Functioning?

Impact depends on

• Severity of initial injury

• Rate/completeness of physiological recovery

• Functions affected

• Meaning of dysfunction to the individual

• Resources available to aid recovery

• Areas of function not affected by TBI

Areas of function affected

• Cognition

Cognitive functions

• Attention• Concentration• Memory• Speed of Processing• Confusion

• Perseveration• Impulsiveness• Language Processing• “Executive functions”

Areas of function affected

• Cognitive

• Sensory/Perceptual

Sensory/perceptual functions

• Vision• Hearing• Smell• Vestibular

• Taste• Touch• Balance

Areas of function

• Cognitive

• Sensory/perceptual

• Seizures

Areas of function affected

• Cognitive

• Sensory/perceptual

• Seizures

• Other physical changes

Other physical changes• Physical paralysis/spasticity• Chronic pain• Control of bowel and bladder• Sleep disorders• Loss of stamina• Appetite changes• Regulation of body temperature• Menstrual difficulties

Areas of function affected

• Cognitive

• Sensory/perceptual

• Seizures

• Other physical changes

• Social-emotional

Social-emotional

• Dependent behaviors

• Emotional lability

• Lack of motivation

• Irritability

• Aggression

• Depression

• Disinhibition

• Denial/lack of awareness

Recovery vs. “improvement”

Permanence of change?

• Physical recovery

• Reeducation of the individual

• Environmental modifications

What Happens With Mild (or Minor) TBI?

Mild TBI

• Lesser levels of brain damage

• Brief or no loss of consciousness

• Often referred to as ‘concussion’

Mild injury is important to discuss

• Long-term impact for 15%

• Don’t see that TBI is cause of deficits

• Repeated injury leads to problem emergence-”second impact syndrome”

• 300,000 sports and recreational injuries

• CT, MRI and EEG are usually normal

Effects of mild TBI: outcomes

• Problems disappear on their own in about 85% of cases

• Compensatory skills acquired

• Education prevents emotional upset

(“shattered sense of self”)

Effects of mild TBI: outcomes

• Problems are not attributed to TBI

• Compensatory skills are not learned

• Best approach is early education and information

• Best rehab assessment is neuropsychology

How is TBI Different (or the Same) for Those Injured as

Children.

Children

• Brain still developing

• Brain more flexible than adult’s

• Fewer educational “building blocks”

• Effects may not emerge immediately

• Follow the child over time

How Common is TBI, and Who is the Typical Person with TBI?

Who is the typical person with TBI?

• 4:1 ratio, males to females

• 15 to 25 years of age

• 1.5 million brain injuries per year in US

• Alcohol is the leading risk factor

Adolescents and young adults: highest rate

Aged: second highest

What is the Course of Treatment for Those with TBI?

Integrated System of Care

• Inpatient Rehabilitation Programs

• Coma Recovery Programs (rarely used)

• Extended Care Programs ( typically inappropriate)

• Outpatient Programs

• Community Support Services

Community/Post Acute Services

• OutpatientIn clinic

At home/work/community

Community/Post Acute Services

• Residential– neurorehabilitation/transitional living– neurobehavioral intensive– long-term supported living

Brain Injury Association of PA

• Biapa.org

• Brain Injury Resource Line 1-866-635-7097

• biausa.org