Traumatic Brain Injuries

Angela Babcock, Yazen Esmail, Shavon Johnson, Aliyah Tullis, Tarah Rinehart(tr)
 Our research question (tr)
● In patients with traumatic brain injuries how does age affect rehabilitation progress over one
year?
Topics we are going to discuss(tr)
● What is a traumatic brain injury
● Traumatic brain injuries in older adults
● Traumatic brain injuries in young adults and adolescents
● How both sustain these injuries
● Prognosis of younger and older adults after a traumatic brain injury
● Rehabilitation
● What affects their healing after sustaining a TBI
● Glascow coma scale
What is a TBI(tr)
● anytime there is damage to brain tissues that is caused by an external force
● loss of consciousness
● patient can’t recall the actual traumatic event (amnesia)
● the person has a skull fracture
● posttraumatic seizure
● an abnormal brain scan due to trauma
Older adults how they sustain injuries(Tr)
● falls 51%
● motor vehicle accidents at 9%
● vision problems
● slow reflexes
● decreased bone density
● comorbid conditions
● Frailty
● cognitive impairment
● alcohol and medication use(Thompson, Mccormick, Kagan 3)
 Older adults comorbidities(tr)
● 48% of persons aged 65 years or older have arthritis
● 36% have hypertension
● 27% have coronary disease
● 10% have diabetes
● 6% have had a cerebrovascular accident
● Hypertension
● diabetes mellitus
● cardiac arrhythmias
● fluid and electrolyte disorders
● Dementia
● depression
● Parkinson’s disease (Thompson, Mccormick, Kagan 3)
Older Adults risk factors

● Ages 60 years and older have higher mortality rates when it comes to TBI’s and those 75
years of age and older have twice as high rates.
● Physical and biological aging that may lead to other underlying conditions making the elderly
more prone to injuries.
CRASH Study
● A study that evaluated the functional outcome and mortality in old and very old people
sustaining traumatic brain injuries.
● The criteria for this study were individuals with severe trauma to the head that were admitted to
the hospital within 72 hours of sustaining an injury.
● These individuals also had to be at least 65 years old.
● There were 97 participants to start off with in this study.
CRASH Study Results
● The most common causes of injury were transport accidents, falls, violence, or some type of
sport-related injuries.
● Of the 97 patients in this study, 48 died in the first two weeks and 12 within the first 3 months.
● This study concluded that TBI hospitalizations were associated with high rates of nursing home
admissions and also the elderly population that live alone because those that lived at home with
their families had much lower rates of falls, accidents, and sustaining a head injury.
● Nursing home patients have a high risk to fall and hit their head when nobody is around to help
them right away.
CRASH Study cont.

● The number of head injuries divided by the patients years in age was a measure they used in
this study for admission to the hospital related to a TBI.
● The older you are the more problems there are with traumatic brain injuries, and elderly
populations show to be the most vulnerable to fall and present to the ED with a TBI.
Preventing TBI’s
● Keeping all of our elderly relatives in a safe, injury free environment and if they are getting to the
point where they can’t perform ADL’s themselves, we need to intervene.
● Have them move in with a younger, capable relative that can help them out or if it comes down
to it they may need to go to a nursing home because that is more safe than them living alone.
● We want to prevent falls! (Wearing non-skid socks or shoes around the house, utilizing the
wheelchair, walker, or cane)
● Monitoring the elderly’s daily activities.
 Young adults(tr)
● Children’s mortality after Traumatic brain injury is low, ranging from 0% to 0.25%”
● The Glasgow Coma Scale or GCS
● GCS is used to measure the outcomes after a TBI
● GCS has five categories:
● Dead
● Vegetative
● severely disabled (conscious but dependent)
● moderately disabled (independent but disabled)
● good recovery (mild residual effects)
● Children aged 3-12 years with a gcs score of 13-15 showed in their 12 month follow up appointment, no
deficits and were at baseline.
 Young adults(tr)
● Children older than 16 had a good prognosis at one year
● Very few had long lasting effects from their injury
● regardless of how severe the injury, they usually have good prognosis after one year
● many have little to no permanent damage(carroll et.al)
Rehabilitation (AB)
Physiatrist, Neuropsychologist, Physical therapist, Occupational therapist, and rehabilitation nurse are
part of the rehab team that cares for TBI patients
Goals of rehab:
● Stabilize the medical and rehabilitation issues related to brain injury and other injuries.
● Prevent secondary complications. Complications could include pressure sores, pneumonia and
contractures.
● Restore lost functional abilities. Functional changes could include limited ability to move, use the
bathroom, talk, eat and think.
● The staff will also provide adaptive devices or strategies to enhance functional independence.
● Identify and discuss with the family and the patient what changes might be required when the
person goes home.
Rehabilitation cont.
Medications may be used to help the rehab process:

● Analgesics- used for pain relief and pain management.

● Anti-Anxiety Agents may lesson feelings of uncertainty, nervousness, and fear.
● Anticoagulants-used to prevent blood clots.
● Anticonvulsants- used to prevent seizures.
● Antidepressants- used to treat symptoms of depression.
● Antipsychotics- used to target psychotic symptoms of combativeness, hostility, hallucinations, and sleep
disorders.
● Muscle Relaxants- used to reduce muscle spasms or spasticity.
● Sedative-Hypnotic Agents- used to induce sleep or depress the central nervous system in areas of
mental and physical response, awareness, sleep, and pain.
● Stimulants- used to increase levels of alertness and attention.
Rehabilitation case (AB)

Dijkers, M., Brandstater, M., Horn, S., Ryser, D., & Barrett, R. (2013).
1419 patients admitted to 9 inpatient rehabilitation facilities

Separated into groups <30, 30-44, 45-64, 65-74, 75-84, 85+

In younger individuals cause was commonly motor vehicle accident or violence (83%)

In adults 85 or older, 92% of TBIs were due to falls

Patients underwent psychology, physical therapy, occupational therapy, therapeutic recreation, and
speech and language pathology

Functional Independence measure was used for a 3 month discharge follow-up and 9-month
discharge follow-up.
Rehab Results (AB)
By the time of rehabilitation discharge adults in the 3 oldest age groups had a statistically significant
lower FIM score. This trend continues and is strongest in the 9 month follow-up.

In adults older than 45 years, there was a 26% mortality rate compared to a 1% in patients less than
45 years old.

Even though older adults had a lower brain injury severity, they regained less functional ability during
and after inpatient rehab, and had a higher mortality rate than the younger population.
Effects of Healing (AT)
- TBI’s not only effect current life, but future life
- Communication is very important in adolescents
- The ability to empathize and make judgement based on communication is vital among peers.
- A lot of social relationships are developed among peers.
Effects of Healing (AT)
Social Cognition: the ability to recognize emotions of others and make inferences based on decisions

- Traumatic Brain injuries can put students behind if they do return to school
- TBI’s can cause adolescents to lose social cognition which can cause social isolation.
- Researchers explain that adolescents must be socially and emotionally prepared for school
return.
Effects of Healing(AT)
- A lot of times the proper interventions are not present in schools
- There will be additional challenges for the student
- Researchers suggest that a lot of students returning following a TBI are mismanaged
- Mostly due to lack of resources.
Effects of Healing(AT)
- Teachers and clinicians working in schools must have ways to identify students with prior TBI’s.
- It may be challenging because most equipment in schools are for smaller kids with autism.
- If resources are not available resources should be found for students
- Additional counseling is ideal due to the risk of social isolation and academic workload.
Conclusion
Question -In patients with traumatic brain injuries how does age affect rehabilitation progress over one
year?

● What is a traumatic brain injury

● Traumatic brain injuries in older adults
● Traumatic brain injuries in young adults and adolescents
● How both sustain these injuries
● Prognosis of younger and older adults after a traumatic brain injury
● Rehabilitation
● What affects their healing after sustaining a TBI
● Glascow coma scale
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