Understanding TBI Traumatic brain injury, also known as TBI, is the leading cause of dearth and disability in adolescents

and young adults. TBI is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration, impact, blast waves, or penetration by a foreign object. This include falls, vehicle accidents, and violence. TBI can cause physical, cognitive, emotional, and behavioral effects, and outcome can range from complete recovery to permanent disability or death. A persons brain defines who they are so it is very different than losing a leg or breaking an arm. A broken bone limits the use of that specific area and will heal over time. Unlike breaking a bone, TBI affects a persons personality or even their mental ability and which may never be the same again. Depending on the injury, treatment required may be minimal or may include interventions such as medications and emergency surgery or physical therapy, speech therapy, recreation therapy, and occupational therapy. All brain injuries are very different from one another and the outcomes for two similar injuries can total opposites from each other. Symptoms caused by TBI may appear at any time; It may appear immediately or it may show up a few weeks after the injury. Most people who have TBI don't even realize or remember that a brain injury occurred, they just live their lives as if nothing happened. TBI is classified into two categories: mild and severe. If loss of consciousness and/or confusion and disorientation is shorter than thirty minutes then a brain injury can be classified as mild. The MRI scans can show that everything in the brain is normal but the person may still be experiencing cognitive problems like headaches, difficulty thinking, memory problems, attention deficits, mood swings, and frustrations. It is very common that these symptoms are overlooked and the person may not get the treatment they need. Although this case would be considered mild the effects on the family and the injured person can be devastating. Major depression may be

particularly common following mild traumatic brain injury. A researcher found that subjects with mild traumatic brain injury had higher rates of major depression and post-concussive symptoms than those with severe traumatic brain injury.1 Severe brain injury is classified as having a loss of consciousness for more than thirty minutes and memory loss after the injury or penetrating skull injury longer than twenty-four hours. The person with severe TBI may have a range of effects. The lucky ones may have limited function of their arms or legs, abnormal speech or language, loss of thinking ability or emotional problems. Others may be left in long term unresponsive states. According to the centers for Disease Control and Prevention)CDC), about 1.4 million people in the United States suffer from TBI annually.2 Approximately 235,000 people are hospitalized and about 50,000 people die from TBI each year. There are around 5.3 million Americans living with TBI disabilities today.3 There are many causes that lead a person to have TBI. The three most common ways are car accidents, firearms, and falls. Most of the time the firearm injuries are fatal: one out of every ten survive. The highest causes of brain injury are: open head injury, closed head injury, deceleration injuries, chemical and toxic injuries, hypoxia, tumors, infections, and strokes. Open head injuries result from bullet wounds or penetration of the skull. Closed head injuries can be just as dangerous as open head injuries; this type of brain injury can be caused from a slip or fall, motor vehicle crashes, and damage to the brain axons, where there is no penetration to the skull. Deceleration injuries when the brain is moved inside the skull. The brain is soft like gelatin and
1. Alexander MP: Neuropsychiatric correlates of persistent post concussive syndrome. J Head Trauma Rehabilitation 1992; 7:60-69[CrossRef] 2. Langlois JA, Rutland-Brown W, Wald MW: The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabilitation 2006; 21:375378[Medline] 3. Thurman D, Alverson C, Dunn K, et al: Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabilitation 1999; 14:602615[Medline]

is inside the hard skull. During the movement of the skull through space (acceleration) and the rapid and then the sudden jolt that takes place when the skull stops and hits an object(deceleration) causes the brain to move inside the skull. Because the brain is soft it moves at a different rate than the skull causes direct brain injury. The different movement of the skull and the brain when the head is struck results in direct brain injury, due to diffuse axonal shearing, contusion and brain swelling. Diffuse axonal shearing is when the brain is slammed back and forth inside the skull. It is quickly compressed and stretched because of the gelatinous consistency. The long, fragile axons of the neurons are also compressed and stretched. Axons can be stretched until they are torn with a strong impact, this is called axonal shearing. When this happens, the neuron dies. After a severe brain injury, there is massive axonal shearing and neuron death.4 Harmful chemicals can also lead to brain injury such as insecticides, solvents, carbon monoxide poisoning, and lead poisoning. Lack of oxygen, known as hypoxia, may cause brain injury. If the blood flow is depleted of oxygen, known as anoxia (no oxygen) or hypoxia (reduced oxygen), then brain injury may occur. It doesn't take that long to take effect, it can happen in a matter of a few minutes. This condition may be caused by heart attacks, respiratory failure, drops in blood pressure, and a low oxygen environment. This type of brain injury can result in severe cognitive and memory deficits. Tumors on or over the brain can cause brain injury. The tumor on the brain invades the spaces of the brain, put pressure on the brain, and cause direct damage. Sometimes the tumor itself may not cause brain damage but surgical procedure to remove it may lead to brain injury. The brain and its surrounding membranes are very prone to infections if the special blood protective system is breached and if a virus, bacteria,
4. Understanding Traumatic Brain Injury, http://www.traumaticbraininjury.com/content/understandingtbi/tbiunderstanding-tbi.html (2001)

life-threatening diseases of the brain (encephalitis), or meninges(meningitis) gets to the brain then it may lead to TBI. A stroke can also lead to brain injury. If blood flow is blocked then the cells in the area where there is deprivation of blood will die and that can be very dangerous and cause TBI. Or if there is bleeding in or over the brain (hemorrhage or hemetoma) from a tear in an artery or vein, then there is a loss of blood flow and the brain tissue will be damaged by the blood flow and will cause brain damage. 5 The range of injuries and degree of recovery is very different and varies on an individual basis. Most rehabilitation for traumatic brain injury is geared at overcoming, minimizing, or working through disabilities so the person can live as independently as possible. TBI causes minor and or serious complication. These complications require both immediate and ongoing long-term treatment. The first stage of treatment is revolved around preventing further injury and sustaining life through a combination of rehabilitation and assistive technologies. Right after the injury occurs the patients are rushed to the hospital for immediate acute treatment. This includes checking for any dangerous blood clots, clearing the patients airway, give them the medication they need, monitor and surgically any pressure caused by the buildup of excess brain fluid in the skull, and put the patient on life support if necessary. The patient is then transferred to sub-acute TBI treatment centers. At the subacute treatment center the medical staff will fully evaluate the patient's impairments, disabilities, and the probability that they will recover. Then the doctors will decide what treatments are needed and help the patient and his/her family build the right team of medical professionals necessary for rehabilitation and chronic TBI treatment. Patients with mild to moderate TBI spend little or no time in subacute treatment centers. Those with severe TBI usually spend five to ten getting critical care in subacute treatment facilities. Those
5. Understanding Traumatic Brain Injury, http://www.traumaticbraininjury.com/content/understandingtbi/tbiunderstanding-tbi.html (2001)

with severe TBI require chronic and long-term rehabilitation. They get counseling and/or therapy, medications, physical therapy, speech therapy6, and they may also use assistive technology such as wheelchairs or specialized keyboards. Depending on the patients age, the type and severity of their TBI, and any co-morbid conditions they may have will result in their recovery and complications that they will encounter. Some have to be retaught how to walk, talk, socialize, and live independently. They also work on overcoming their self-esteem, depression, or any other emotional issue they may have.7 Mild TBI can have a dramatic impact on family, job, social and community interaction. TBI has a huge impact on a person's life. One minute the person is completely fine and the next second their lives are completely turned around. The ones that don't even remember having an injury are the luckiest in a away because they are not suffering. They are confused as to what is going on but they don't feel different than they did before the injury. Those who's personalities change are the most confused. Because they may not remember who they were before the injury took place, they think that they have had that personality their whole lives. There are many ways that a person can get TBI. There are many ways to try to help someone who has a brain injury but full recovery is very hard and unpredictable. Those who have severe injuries may not even be able to cope by themselves they have to be completely taken care of hospitalized. The only way to prevent TBI is just to make sure one is careful with anything they do. If they are riding a bike then wear a helmet, if driving then be drive carefully. There is no real prevention but people just have to do their part and try to protect themselves the best they can.

6. Fann JR, Bombardier CH, Dikmen S, et al: Validity of The Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehabil 2005; 20:501511[CrossRef][Medline] 7. Rehabilitation and Treatment for TBI, http://www.brainandspinalcord.org/Treatment-rehab-tbi/index.html, (2011)

Bibliography
1.

Alexander MP: Neuropsychiatric correlates of persistent post concussive syndrome. J Head Trauma Rehabilitation 1992; 7:60-69[CrossRef]

2.

Fann JR, Bombardier CH, Dikmen S, et al: Validity of The Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehabilitation 2005; 20:501511[CrossRef][Medline]

3.

Langlois JA, Rutland-Brown W, Wald MW: The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabilitation 2006; 21:375378[Medline]

4.

Rehabilitation and Treatment for TBI, http://www.brainandspinalcord.org/Treatment-rehabtbi/index.html,

(2011)

5.

Thurman D, Alverson C, Dunn K, et al: Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabilitation 1999; 14:602615[Medline]

6.

Understanding Traumatic Brain Injury,

http://www.traumaticbraininjury.com/content/understandingtbi/tbi-understanding-tbi.html

(2001)