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Traumatic Brain Injury

Presented by:
David L Strauss, Ph.D.
ReMed
What is Traumatic Brain Injury
(TBI)?
Two types of brain injury occur
Closed brain injury
Open brain injury
Closed Head Injury
Resulting from falls, motor vehicle crashes,
etc.
Focal damage and diffuse damage to axons
Effects tend to be broad (diffuse)
No penetration to the skull
Open Head Injury
Results from bullet wounds, etc.
Largely focal damage
Penetration of the skull
Effects can be just as serious
What Happens Immediately After
TBI?
TBI: A biological event within the
brain
Tissue damage
Bleeding
Swelling
TBI: Changes in functioning
Loss of consciousness/coma
Other changes due to the TBI
Post-traumatic amnesia (PTA)
Injured Brain
Does not mend fully
Leads to problems in functioning
What Do We Mean by
Severity of Injury
Amount of brain tissue damage
How to measure severity?
Duration of loss of consciousness
Initial score on Glasgow Coma Scale (GSC)
Length of post-traumatic amnesia
Rancho Los Amigos Scale (1 to 10)
Mild injury
0-20 minute loss of consciousness GCS = 13-15
PTA < 24 hours

Moderate injury
20 minutes to 6 hours LOC GCS = 9-12

Severe injury
> 6 hours LOC GCS = 3-8
What Happens as the Person
with Moderate or Severe Injury
Begins to Recover After Injury?
Recovery
A multi-stage process
Continues for years
Differs for each person
What is the Long-term Impact of
a Moderate or Severe TBI in the
Persons Functioning?
Impact depends on
Severity of initial injury
Rate/completeness of physiological
recovery
Functions affected
Meaning of dysfunction to the individual
Resources available to aid recovery
Areas of function not affected by TBI
Areas of function affected
Cognition
Cognitive functions
Attention Perseveration
Concentration Impulsiveness
Memory Language Processing
Speed of Processing Executive functions
Confusion
Areas of function affected
Cognitive
Sensory/Perceptual
Sensory/perceptual functions
Vision Taste
Hearing Touch
Smell Balance
Vestibular
Areas of function
Cognitive
Sensory/perceptual
Seizures
Areas of function affected
Cognitive
Sensory/perceptual
Seizures
Other physical changes
Other physical changes
Physical paralysis/spasticity
Chronic pain
Control of bowel and bladder
Sleep disorders
Loss of stamina
Appetite changes
Regulation of body temperature
Menstrual difficulties
Areas of function affected
Cognitive
Sensory/perceptual
Seizures
Other physical changes
Social-emotional
Social-emotional
Dependent behaviors
Emotional lability
Lack of motivation
Irritability
Aggression
Depression
Disinhibition
Denial/lack of awareness
Recovery vs. improvement
Permanence of change?
Physical recovery
Reeducation of the individual
Environmental modifications
What Happens With Mild
(or Minor) TBI?
Mild TBI
Lesser levels of brain damage
Brief or no loss of consciousness
Often referred to as concussion
Mild injury is important to
discuss
Long-term impact for 15%
Dont see that TBI is cause of deficits
Repeated injury leads to problem
emergence-second impact syndrome
300,000 sports and recreational injuries
CT, MRI and EEG are usually normal
Effects of mild TBI: outcomes
Problems disappear on their own in about
85% of cases
Compensatory skills acquired
Education prevents emotional upset
(shattered sense of self)
Effects of mild TBI: outcomes
Problems are not attributed to TBI
Compensatory skills are not learned
Best approach is early education and
information
Best rehab assessment is neuropsychology
How is TBI Different (or the
Same) for Those Injured as
Children.
Children
Brain still developing
Brain more flexible than adults
Fewer educational building blocks
Effects may not emerge immediately
Follow the child over time
How Common is TBI, and Who is
the Typical Person with TBI?
Who is the typical person with
TBI?
4:1 ratio, males to females
15 to 25 years of age
1.5 million brain injuries per year in US
Alcohol is the leading risk factor
Adolescents and young adults:
highest rate
Aged: second highest
What is the Course of Treatment
for Those with TBI?
Integrated System of Care
Inpatient Rehabilitation Programs
Coma Recovery Programs (rarely used)
Extended Care Programs ( typically
inappropriate)
Outpatient Programs
Community Support Services
Community/Post Acute Services
Outpatient
In clinic
At home/work/community
Community/Post Acute Services
Residential
neurorehabilitation/transitional living
neurobehavioral intensive
long-term supported living
Brain Injury Association of PA
Biapa.org
Brain Injury Resource Line 1-866-635-7097
biausa.org

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