Understanding Traumatic Brain Injury (TBI)

Introduction What is TBI? How does it occur? Who typically experiences a TBI? How does a normal brain function? What changes emerge after a TBI?

This presentation is an attempt to provide information about traumatic brain injury.

The “normal” workings of the brain will be discussed, and changes that emerge after a traumatic brain injury.

Traumatic Brain Injury is…

Injury to the head from a blunt or penetrating object or even shockwave from a blast.

Injury from rapid movement of the head that causes back and forth movement inside the skull.

Traumatic Brain Injury Is Not... A new onset mental disorder Just emotional stress An acquired mental retardation The effects of prolonged drug/alcohol abuse

TBI is often misdiagnosed. Typically, the person and their family will describe “sudden” changes in the person’s mood, emotional control or thinking abilities; however, they will mislabel the reason.

Traumatic Brain Injury Overview Traumatic Brain Injury (TBI), often called the

signature wound of the Iraq and Afghanistan wars, occurs when a sudden trauma or head injury disrupts the function of the brain.

Common causes of TBI include damage caused by explosive devices, falls and vehicle or motorcycle accidents. Most reported TBI among Operation Enduring Freedom and Operation Iraqi Freedom service members and veterans has been traced back to Improvised Explosive Devices, or IEDs, used extensively against Coalition Forces.

Range of Symptoms Mild Traumatic Brain Injury (MTBI), commonly

referred to as a concussion, is a brief loss of consciousness or disorientation ranging up to 30 minutes.

MTBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration or attention.

Moderate TBI includes a population of patients that falls between the mild and severe spectrum.  Moderate TBI patients have the most variability in the clinical presentation picture.

There is usually loss of consciousness, from an hour to a day; there can be confusion for days to weeks; and mental or physical deficits that can last months or be permanent. 

Cont: Range of Symptoms Severe Traumatic Brain Injury is associated with

loss of consciousness for over 30 minutes, or amnesia.

Symptoms of Severe TBI include all those of MTBI, as well as headaches that gets worse or do not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.

Why is TBI a “Silent Epidemic”?

Most individuals don’t know about brain injury, let alone its consequences or impact on behavior

Minor blows to the head or “concussions” are often not perceived as “brain injuries”, yet 15% of these individuals will have chronic problems post injury

Most people assume one needs to lose consciousness to have a brain injury

Causes of TBI General Population

Vehicle Crashes

50%

Other 7%

Sports/Recreation10%

Firearms/ IEDs/Shock

Wave Blasts12%

Falls21%

Causes of TBI

Blow to the head with any object

Falling and hitting your

head

Pushed against the wall or other solid object

Strangled

Punched in the face

Strenuous shaking of

body

Firearms/ IEDs/Shock Wave Blasts

Near drowning

TBI Gender

Males are two times more likely than females to sustain a brain injury.

Depending on the injury, a severe TBI could impact speech, sensory, vision and cognitive deficits including difficulties with attention, memory, concentration, and impulsiveness.

Mild TBI/Concussion

85% have full recovery within 3-6 months post event.

15% experience chronic symptoms which significantly interfere with their daily functioning.

While most individuals recover from a mild TBI, about 15% of individuals will experience chronic symptoms which interfere with their day to day functioning.

Risk of Repeat Brain Injuries

After 1st TBI, risk of second injury is 3 times greater After 2nd, risk of third injury is 8 times greater

Once an individuals experiences one TBI, they are at increased risk of having another TBI.

The risk of repeat injury increased geometrically with each subsequent injury.

Why? The theory is that several things may be happening after a TBI…

Reaction time is slower• Judgment is off• Inattention- (not paying attention)

AS HEAD INJURIES ACCUMULATE…

Mechanism of Brain Damage

Changes after a Brain InjuryA brain injury affects who we are, the way we think, act and feel. It changes everything about ourselves in a matter of seconds.

In TBI, there is greater damage to the frontal and temporal lobes of the brain.

Frontal Lobe Functions

Planning/anticipation/initiation Problem solving/judgement Awareness Mental flexibility Ability to inhibit responses Personality/ emotions

Temporal Lobe Functions

Memory and learning Organizing and sequencing Hearing Understanding language

What are the most common problems

after a TBI Injury?

Physical Problems Overall slowing Clumsiness Decreased vision/hearing/smell Dizziness Headaches Fatigue Increased sensitivity to noise/bright

lights

Thinking Changes Attention

Reduced concentration Reduced visual attention Inability to divide attention between competing tasks

Processing speed Slow thinking Slow reading Slow verbal and written responses

Thinking Changes Communication

Difficulty finding the right words, naming objects Disorganized in communication

Learning and Memory Information before TBI intact Reduced ability to remember new information Problems with learning new skills

Thinking Changes in “Executive Functioning”

Problems being

organized

Difficulty problem solving

Difficulty prioritizing

Decreased awareness of

thinking changes in self

Difficulty planning/ setting goals

Difficulty being

flexible

Combined TBI Changes Having difficulty remembering or learning

new information. Being inconsistent in performance. Having poor judgment and decision making

abilities. Having difficulty generalizing to new

situations. Lacking awareness of these difficulties.

Emotional/Behavioral/Social ChangesDepression Anxiety

Irritability/agitation

Impatience

Intolerant

Rebellious

Inability to get along with others

Increased impulsivity

Increased risk taking

Rapid loss of emotional control

(short fuse)

Socially inappropriate

behavior

Difficulty with self initiation

Increased self focus

Before-after contrasts

Self-monitoring

Long Term Challenges Post TBI

Vocational and/or school failure Family life/social relationships

collapse Increased financial burden on

families and social service systems Alcohol and drug abuse Chronic depression/anxiety

Ratings for traumatic brain injury are complicated: Injuries to veterans serving in Iraq or Afghanistan

resulting from roadside explosions and other concussive blasts have led to more brain injuries than in other wars.

A disability rating would be determined by evaluating physical, emotional and cognitive behavior, with ratings based on the cumulative result of the evaluations.

Physical problems could include pain, hearing loss and speech problems. Cognitive behavior would include decision making, judgment and social interaction.