Certified Brain Injury Specialist

by the Academy of Certified Brain Injury Specialists

Traumatic Brain Injury

What Is a Traumatic Brain Injury (TBI)?

As explained by the U.S. National Library of Medicine, a traumatic brain injury happens when a bump, jolt, or other head injury causes damage to the brain. Half of all traumatic brain injuries are suffered in car accidents. A concussion is the mildest form of a brain injury and occurs when your brain collides violently with your skull. Those suffering from a concussion may not initially notice the symptoms of it, which may include:

  • A lingering and worsening headache
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • Inability to awaken from sleep
  • Slurred speech
  • Weakness or numbness in the arms or legs
  • Dilated pupils

In addition to concussions, there are other types of brain injuries, including:

  • Hematoma: This condition involves clotting of blood outside the blood vessels and can be very serious as it causes pressure to build within the skull.
  • Hemorrhage: Hemorrhages are uncontrolled bleeding, which—when the hemorrhage occurs in the brain—can result in blood collecting in the space around your brain or within the brain tissue itself.
  • Edema: Edema is swelling within the brain due to injury. This also causes pressure to build up within your brain and presses the brain against the skull.
  • Skull fracture: Unlike most of the bones in your body, your skull doesn’t contain marrow. While this makes for a strong bone, if the head is hit hard enough to break it, the inside is likely to suffer damage as well.
  • Diffuse axonal injury: Although not as visible as some types of brain injury, diffuse axonal injuries are among the deadliest. These injuries aren’t caused by bleeding in the brain, but damages brain cells and makes them unable to function.
  • Anoxic brain injury: An anoxic brain injury occurs when the brain is deprived of oxygen and cells begin to die off rapidly. Brain damage can begin within 30 seconds of oxygen deprivation. If a person is deprived of oxygen for two minutes, brain damage almost always occurs. Though every brain is slightly different, on average, a brain can only survive up to about four minutes without oxygen. Anoxic brain injuries are often caused by near-drowning, stroke, oxygen deprivation in babies at birth, choking, anaphylactic shock due to allergies, drug overdose, or a sudden blow to the windpipe.

Treating a brain injury involves a complex regimen of medication and rehabilitation, and no two injuries are the same. An injured victim may face hospitalization, spend time in the Intensive Care Unit, undergo acute rehabilitation to regain as many activities of daily living as possible, spend time at a residential rehabilitation facility, undergo outpatient therapy, and even have to stay at an assisted living facility that provides housing and care for people with brain injuries.

Any number of scenarios involving violent blows to the head can cause a traumatic brain injury. Some of the more common causes include:

How Are Brain Injuries Diagnosed?

When someone seeks medical attention for a brain injury, they’re generally assessed on the Glasgow Coma Scale (GCS). GCS is a common scoring system used to describe a person’s level of consciousness following traumatic brain injury. This simple test helps doctors to determine the severity of the head injury. The GCS measures the following functions:

  • Eye opening: The scale ranges from four, which is spontaneous eye opening, to one, in which the patient will not open their eyes.
  • Verbal response: A number five on the verbal response scale means that the patient’s responses are oriented. A number one means that the patient is not verbal.

Motor response: With six numbers on the motor response scale, the highest—a six—means that the patient obeys commands with the appropriate motor response. A number one means that there is no motor response.

As you can see, the higher the score on the GCS scale, the less severe the brain injury. A brain injury on an individual with a GCS score of 13-15 is considered mild. Those in the 9-12 point range are considered moderate. Scores of 8 or below are considered representative of a severe brain injury. Mild brain injuries may result in temporary or permanent neurological damage that may not show up on CT or MRI tests. Moderate and severe brain injuries often result in long-term impairments in cognition, physical skills, and emotional or behavioral function.

While the GCS scale is typically a very accurate test, there are some factors such as drug or alcohol impairment, shock, or low blood oxygen that can alter the results.

Help for Those Living With a Brain Injury

Because brain injuries so often leave those that suffer with them with motor, sensory, cognitive, and behavioral deficits, the work done to help these individuals regain or relearn as much as possible often starts in the hospital. The initial focus is on helping the patient to regain simple physical, cognitive, and personal self-care skills. However, many individuals require ongoing therapy and rehabilitation even after they’ve left the hospital. One component of brain injury healing is the provision of occupational therapy.

Occupational therapists work with the patient to improve skills needed in everyday life, including the following situations:

  • Self-care
  • Home management
  • Rest and sleep habits
  • Work demands
  • Leisure
  • Social participation

Occupational therapists provide guided activities to improve skills, which may include real-life activities such as going to the grocery store, to the bank, workplace, home, or obtaining transportation on a bus or a train. Occupational therapists are just one part of the team that treats a brain injury patient.

Other members of that team may include physical therapists, speech-language pathologist, neuropsychologist, social workers, and—depending on the patient’s needs—teachers or vocational rehabilitation specialists.

The Problems That Brain Injuries Cause

An injury to any part of the brain may result in damage to all of the brain. However, there are specific issues that present themselves depending on the part of the brain that was injured, including:

  • Frontal lobes: These are the largest lobes in the brain. Injury to the frontal lobes may cause a person to have problems with emotions and impulses, language, memory, and social behavior.
  • Parietal lobes: Damage to this part of the brain may cause a person to have difficulty recognizing and locating parts of the body.
  • Temporal lobes: Damage to the temporal lobes may result in a loss of hearing, language problems, and difficulty with sensory skills such as recognizing a known person’s face.
  • Occipital lobes: Damage to this area of the brain can lead to visual field defects as well as problems perceiving size, color, and shape.
  • Cerebellum: Damage to the cerebellum may lead to uncoordinated movement and loss of muscle tone.
  • Brainstem: Injuries to the brainstem may lead to the inability to control such functions as breathing, swallowing, and heart rate.

More Brain Injury Statistics

What is the leading cause of brain injuries? Who is most likely to suffer from one? Read on to find the answers to these questions and more, according to statistics from Brainline.

  • Every day, 153 people in the United States die from injuries that include a traumatic brain injury.
  • Nearly 90 percent of all people suffering from a traumatic brain injury are treated and released from the emergency department.
  • Brain injuries come with a cost to society of about $60 billion per year.
  • Children aged 0 to 4 years, older adolescents aged 15 to 19 years, and adults aged 65 years and older are most likely to sustain a traumatic brain injury.
  • The leading cause of brain injuries varies depending on the age of the person involved. Falls are the leading cause of brain injuries in individuals aged 45 and older as well as children 0-14 years old. Motor vehicle accidents are the leading cause of brain injuries in adolescents ages 15-19 and adults under 45.
  • For six years (2007–2013), while the rates of brain injury-related emergency department visits increased by 47 percent, hospitalization rates decreased by 2.5 percent and death rates decreased by 5 percent.
  • Brain injuries are a contributing factor of about 30 percent of all injury-related deaths in the U.S.
  • By the numbers, every American has more than a 1:160 chance of sustaining a traumatic brain injury each year.
  • Males are almost twice as likely as females to suffer a traumatic brain injury.
  • The area most often injured is the frontal lobes, which control thinking and emotional regulation.
  • 47 percent of traumatic brain injuries are caused by falls. Being struck by or against an object results in about 15 percent of the brain injuries suffered each year, while 14 percent are caused by motor vehicle crashes.

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