TBI
TRAUMATIC BRAIN
INJURY
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WHO IS AFFECTED BY TRAUMATIC BRAIN
INJURY TBI ?
 1 .5-2 million adults and children suf fer TBI annually
 Approximately 1 .1 . million have mild injuries and do not
require hospitalization
 250,000 will be hospitalized with moderate to severe head
injuries
 50,000 die from their injuries
-Figure 1. Diffuse Injuries. Mayfield Clnic, 2014. Retrieved from
http://www.mayfieldclinic.com/PE-TBI.htm
Figure 2 . Traumatic Brain Injury. Mayfield Clinic, 2014. Retrieved from
http://www.mayfieldclinic.com/PE-TBI.htm
WHAT IS TBI?
 Traumatic brain injury (TBI) can occur when something outside
the body hits the head with significant force. Whether it is a
head hitting the windshield during a car accident, an impact
from a fall, head injuries received during sports or other
recreational activities , or trauma from a nearby blast or
explosion, TBI can cause changes in a person’s ability to
think, control emotions, walk, or speak, and can also af fect
sense of sight or hearing.
WHAT ARE THE CAUSES OF TBI
 a head hitting the windshield during a car accident
 an impact from a fall
 head injuries received during sports or other recreational
activities
 trauma from a nearby blast or explosion
 or assault with or without weapons
LEADING CAUSES OF TBI
The leading causes of TBI:
-Falls (40.5%):
-Motor vehicle – traffic
(14.3%);
-Struck by/against events
(15.5%);
-Assaults (10.7%).1
Figure 3 . Leadings causes of TBI. Center for Disease Control. Retrieved from
http://www.cdc.gov/traumaticbraininjury/get_the_facts.html#causes
LEADING CAUSES OF TBI
 Falls
-Falls continued to be the leading cause of TBI (35.2%) in the
United States.
-Falls cause half (50%) of the TBIs among children aged 0 to
14 years and 61% of all TBIs among adults aged 65 years and
older.
 Motor Vehicle-Traf fic Crashes
-Motor Vehicle Accidents MVA is the leading cause of TBIrelated Death (CDC, 2014)
-Rates of death from TBI from MVA are highest for adults aged
20 to 24 years (CDC, 2014)
LEADING CAUSES OF TBI CONT.
 Struck By/Against Events
-Struck by/against events, which include colliding with a moving
or stationary object, were the second leading cause of TBI
among children aged 0 to 14 years, with 25%.
 Assault
- Assaults produced 10% of TBIs in the general population; they
accounted for only 2.9% in children aged 0 to 14 years and 1%
in adults aged 65 years old and older.
HOW IS TBI CLASSIFIED ?
 TBI can be further classified according to findings from
various imaging tests (CT scan MRI and PET scans)
 Both individual findings from such tests as well the collective
results influence both Prognosis and Treatment for victims of
TBI
 See Primary and Secondary Injury
PRIMARY INJURY IN TBI
 Occurs at the time of the injury
 Relates to the “mechanism of injury” and includes
 Direct impact
 Rapid acceleration and deceleration (see next slide Coup
countercoup)
 Penetrating injury
 Blast waves
All these mechanisms result in trauma to the brain
from mechanical forces including:
 Bruising swelling
 Bleeding
 Actual shearing of the white matter of the brain
(predicts poor outcome)
Figure 4 . Coup Contrecoup Injury. Wikipedia, 2014.
http://en.wikipedia.org/wiki/Coup_contrecoup_injury
SECONDARY BRAIN INJURY IN TBI
 Includes damage that occurs over hours to days and occurs at
the cellular level in the brain such as:
 Free radical injury to cell membranes
 Electrolyte imbalances
 Inflammatory responses
 Cellular death
 Ischemia from vascular injury
It is these secondary injuries that current medical
research is attempting to limit or prevent. No current
treatments have demonstrated clear benefit
DID YOU KNOW?
TBI FACTS:
 TBIs can occur on the battlefield, on the football field, on the
playground, in a car accident, and even at home.
 There are four categories of TBI including mild, moderate,
severe and penetrating.
 A mild TBI (mTBI), which is also known as a concussion, is the
most common form of TBI (see Next Slide).
Figure 5. Concussions and Mild TBI. Center for Disease Control,
2007.
TBI SYMPTOMS
 Injuries can range from mild concussions to severe permanent
brain damage.
 The consequences of a brain injury can af fect all aspects of a
person’s life, including physical and mental abilities as well
as emotions and personality.
 TBI can result in changes in a person’s physical functioning,
thinking abilities or cognitive function, and behavioral ef fects
and they are often interrelated. These ef fects sometimes
cause other dif ficulties such as sleeping problems,
depression, and anxiety.
TBI SYMPTOMS CONTINUED
Depending on the type and location of the injury, a
person’s immediate symptoms may include:
 Loss of consciousness
 Confusion and
disorientation
 Memory loss / amnesia
 Headaches
 Visual problems
 Poor attention /
concentration
 Sleep disturbances
 Dizziness / loss of
balance
 Irritability / emotional
disturbances
 Feelings of depression
 Seizures
 Vomiting
SYMPTOMS:
General
 Difficulty speaking
 Blurry eyesight
 Trouble hearing
 Loss of energy
 Change in sense of taste
or smell
 Dizziness or trouble with
balance
Behavioral effects may
include:
 Becoming angry easily
 Getting frustrated easily
 Acting without thinking
Cognitive effects may
include:
Difficulty concentrating
Trouble with attention
Forgetfulness
Difficulty making decisions
Repeating things
Behavioral effects may
include:
Becoming angry easily
Getting frustrated easily
Acting without thinking
SYMPTOMS
Thinking/Rememberi
ng
Difficulty thinking clearly
Feeling slowed
down
Difficulty
concentrating
Sensitivity to noise
or light Balance
problems
Physical
Headache Fuzzy or blurry vision
Nausea or
vomiting (early
on) Dizziness
Emotional/Mood
Irritability
Sadness
More emotional
Sleep
Sleeping more than usual
Sleep less than
usual
Trouble falling
asleep
Figure 6. Symptoms of brain injury. Center for Disease Control, 2014. Retrieved from
http://www.cdc.gov/concussion/signs_symptoms.html
Difficulty
remembering new
information
Feeling tired, having
no energy
Nervousness or
anxiety
HOW IS A DIAGNOSIS MADE?
 When a person is brought to the emergency room with a head
injury, doctors will learn as much as possible about his or her
symptoms and how the injury occurred. The person’s condition
is assessed quickly to determine the extent of injury.
 Diagnostic Imaging Tests:
-Magnetic Resonance Imaging (MRI)
-Magnetic Resonance Spectroscopy (MRS)
-Computed Tomography (CT)
-PET scans
DIAGNOSIS TEAM
 A professional may work with his or her family/caregivers as
part of a team that may also include:
 doctors
 nurses
 Neuropsychologists and clinical psychologists
 occupational therapists
 physical therapists
 social workers
 employers
 teachers
TREATMENT FOR CHRONIC TBI
 Disabilities from TBI may last a lifetime, and dif ferent
interventions may be appropriate even many years later. This
is particularly true for survivors of moderate to severe TBI. It
is essential for survivors, their families, and caregivers to be
involved in designing and implementing the rehabilitation
plan.
 Patients may have residual symptoms that require skilled
management by qualified neurologists, physiatrists, and
neuropsychologists
There are two categories of chronic treatment:
 Community -based rehabilitation and return to work or school,
and
 Treatment of long-term consequences of the injury.
MENTAL HEALTH RELATED EFFECTS OF TBI
 TBI symptoms can af fect people in dif ferent ways and
sometimes symptoms change as people recover.
 Some people may recognize TBI symptoms immediately, and
others may write them of f or minimize what they’re
experiencing.
 The ef fects of mild TBI usually get better on their own and
may be unnoticeable within three months.
 Some moderate to severe TBI symptoms last for a longer
period of time or may be permanent. However, there are
ef fective treatments and support for helping Veterans manage
their symptoms and find a path to recovery.
MENTAL HEALTH RELATED EFFECTS OF
TBI
Feeling tired all the time
Feeling sad and anxious
Getting frustrated or overwhelmed easily
Sleeping much more or less than usual
Feeling irritated or angered all the time
Doing things without stopping to think
Having trouble concentrating, remembering, or focusing on tasks
Drinking more alcohol
Taking more of a prescription or over -the-counter medication
than as directed
 Using illegal drugs
 Smoking or using tobacco more often
 Not feeling like yourself
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PHYSICAL PROBLEMS FROM TBI
 Decreased strength and coordination in the body, arms, and
legs
 Hearing loss
 Tinnitus (ringing or buzzing in the ears)
 Headaches
 Seizures
 Dizziness
 Nausea
 Vomiting
 Blurred Vision
 Decreased smell or taste
COMMUNICATION PROBLEMS FROM TBI
 People with a brain injury often have cognitive (thinking) and
communication problems that significantly impair their ability to
live independently. These problems vary depending on how
widespread brain damage is and the location of the injury .
The person may have trouble with social communication, including:
 taking turns in conversation
 maintaining a topic of conversation
 using an appropriate tone of voice
 interpreting the subtleties of conversation (e.g., the difference
between sarcasm and a serious statement)
 responding to facial expressions and body language
 keeping up with others in a fast -paced conversation
COGNITIVE PROBLEMS FROM TBI
 Trouble concentrating when there are distractions (e.g.,
carrying on a conversation in a noisy restaurant or working
on a few tasks at once).
 Slower processing or "taking in" of new information .
- Longer messages may have to be "chunked," or broken down
into smaller pieces.
- The person may have to repeat/rehearse messages to make
sure he or she has processed the crucial information.
- Communication partners may have to slow down their rate of
speech.
COGNITIVE PROBLEMS CONT.
 Problems with recent memory.
- New learning can be dif ficult .
- Long-term memory for events and things that occurred
before the injury, however, is generally unaf fected (e.g., the
person will remember names of friends and family).
 Executive functioning problems.
- The person may have trouble starting tasks and setting goals
to complete them.
- Planning and organizing a task is an ef fort, and it is dif ficult
to self-evaluate work.
- Individuals often seem disorganized and need the assistance
of families and friends .
- They also may have dif ficulty solving problems, and they may
react impulsively (without thinking first) to situations.
MANAGING THE EFFECTS OF TBI
There are also steps you can take to help manage your TBI symptoms:
 Get enough sleep
 Write things down or use electronic reminders if you have trouble
remembering
 Establish a regular, daily routine
 Check with someone you trust when making decisions
 Avoid alcohol—it could slow down the healing process and make
symptoms wor se
 Avoid caf feine, cold medications that treat nasal congestion, or other
products that contain pseudoephedrine —they may increase the
symptoms
 Recognize trigger s —keep a record to help identify situations that are
more likely to wor sen your symptoms
 Take up a hobby or a recreational activity
 Talk to other s —to keep you from feeling isolated and to give friends and
loved ones a chance to help you
 Remember that symptoms are a normal par t of the recover y, and they
will get better
MORE INFORMATION
 Complete guide to TBI
Brainline Media Webpage
 Living with TBI
Brainline Webpage link
 Blast injuries may be causing TBI in our military
Brainline webpage link
 20 lifesaving apps for those with TBI
Brainline webpage link
 Some are unaware they have suf fered a TBI
-Youtube link to video
REFERENCES
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U n i te d S t a te s : A Re p o r t to C o n g r e s s . A t l a n t a ( G A ) : D e p a r t m e n t o f H e a l t h a n d
H u m a n S e r v i c e s ( U S ) , C D C , N a t i o n a l C e n te r f o r I n j u r y P r ev e n t i o n a n d C o n t ro l ;
1999.
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C e n te r s f o r D i s ea s e C o n t ro l a n d P r ev e n t i o n , N a t i o n a l C e n te r f o r I n j u r y P r ev e n t i o n
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