Traumatic Brain Injury TBI By : Dani mamo

What is Traumatic Brain Injury (TBI)?  is an insult to the brain, not of a degenerative or congenital nature, but caused by external physical force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning.

Two types of brain injury occur Closed brain injury Open brain injury

Closed Head Injury Resulting from falls, motor vehicle crashes. 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? 1: A biological event within the brain Tissue damage Bleeding Swelling 2: Changes in functioning Loss of consciousness/coma Other changes due to the TBI Post-traumatic amnesia (PTA)

How to measure “severity”? Amount of brain tissue damage is the severity of the injury How to measure “severity”? Duration of loss of consciousness Initial score on Glasgow Coma Scale (GCS) Length of post-traumatic amnesia Rancho Los Amigos Scale (1 to 10)

1- Mild injury 2- Moderate injury 3- Severe injury 0-20 minute loss of consciousness GCS = 13-15 PTA (Post-traumatic amnesia) < 24 hours 2- Moderate injury 20 minutes to 6 hours LOC GCS = 9-12 3- Severe injury > 6 hours LOC GCS = 3-8

What is the Long-term Impact of a Moderate or Severe TBI in the Person’s 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 Cognitive Sensory/perceptual Seizures Other physical changes Social-emotional

Cognitive functions Attention Concentration Memory Speed of Processing Confusion Perseveration Impulsiveness Language Processing “Executive functions”

Sensory/perceptual functions Vision Hearing Smell Vestibular Taste Touch Balance

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

Social-emotional Dependent behaviors Emotional lability Lack of motivation Irritability Aggression Depression Disinhibition Denial/lack of awareness

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’

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

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 have highest rate Aged: second highest

Treatment of TBI It is important to begin emergency treatment within the so-called "golden hour" following the injury. People with moderate to severe injuries are likely to receive treatment in an intensive care unit followed by a neurosurgical ward.

Treatment of TBI Treatment depends on the recovery stage of the patient. In the acute stage the primary aim of the medical personnel is to stabilize the patient and focus on preventing further injury because little can be done to reverse the initial damage caused by trauma.

Treatment of TBI Rehabilitation is the main treatment for the subacute and chronic stages of recovery. International clinical guidelines have been proposed with the aim of guiding decisions in TBI treatment, as defined by an authoritative examination of current evidence.

Mild injury Mild traumatic brain injuries usually require no treatment other than rest and over-the-counter pain relievers to treat a headache. However, a person with a mild traumatic brain injury usually needs to be monitored closely at home for any persistent, worsening or new symptoms. It's best to limit physical or thinking (cognitive) activities that make things worse until the doctor advises that it's OK. Most people return to normal routines gradually.

Immediate emergency care Emergency care for moderate to severe traumatic brain injuries focuses on making sure the person has enough oxygen and an adequate blood supply, maintaining blood pressure, and preventing any further injury to the head or neck.

Medications Diuretics. These drugs reduce the amount of fluid in tissues and increase urine output. Diuretics, given intravenously to people with traumatic brain injury, help reduce pressure inside the brain. Anti-seizure drugs. People who've had a moderate to severe traumatic brain injury are at risk of having seizures during the first week after their injury. An anti-seizure drug may be given during the first week to avoid any additional brain damage that might be caused by a seizure.

Medications Coma-inducing drugs. Doctors sometimes use drugs to put people into temporary comas because a comatose brain needs less oxygen to function. This is especially helpful if blood vessels, compressed by increased pressure in the brain, are unable to supply brain cells with normal amounts of nutrients and oxygen.

Surgery Emergency surgery may be needed to minimize additional damage to brain tissues. Surgery may be used to address the following problems: Removing clotted blood (hematomas). Repairing skull fractures. Bleeding in the brain.  Opening a window in the skull.