Understanding Traumatic Brain Injury (TBI)

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Understanding Traumatic Brain Injury (TBI)
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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.
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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.

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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 persons mood, emotional control or
thinking abilities however, they will mislabel
the reason.
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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.

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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. 

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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.

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Why is TBI a Silent Epidemic?

• Most individuals dont 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

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Causes of TBI General Population
Other 7
Sports/Recreation10
Firearms/ IEDs/Shock Wave Blasts12
Vehicle Crashes50
Falls21
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Causes of TBI

• Blow to the head with any object

Pushed against the wall or other solid object
Strenuous shaking of body
Punched in the face
Falling and hitting your head
Firearms/ IEDs/Shock Wave Blasts
Strangled
Near drowning
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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.
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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.
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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)

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Head is hit the first time
Head hit a Second time
Each time the head is hit, injuries accummulate
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AS HEAD INJURIES ACCUMULATE
symptoms increase
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Mechanism of Brain Damage
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Changes after a Brain Injury
A brain injury affects who we are, the way we
think, act and feel. It changes everything about
ourselves in a matter of seconds.
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In TBI, there is greater damage to the frontal
and temporal lobes of the brain.
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Frontal Lobe Functions

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

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Temporal Lobe Functions

• Memory and learning
• Organizing and sequencing
• Hearing
• Understanding language

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What are the most common problems after a TBI
Injury?
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Physical Problems

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

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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

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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

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Thinking Changes in
Executive Functioning
Difficulty planning/ setting goals
Difficulty problem solving
Problems being organized
Difficulty prioritizing
Decreased awareness of thinking changes in self
Difficulty being flexible
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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.

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Emotional/Behavioral/Social Changes
Increased impulsivity
Anxiety
Depression
Rebellious
Irritability/ agitation
Difficulty with self initiation
Socially inappropriate behavior
Impatience
Intolerant
Inability to get along with others
Rapid loss of emotional control (short fuse)
Before-after contrasts
Increased risk taking
Increased self focus
Self-monitoring
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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

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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.