Understanding Traumatic Brain Injury (TBI)

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.

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.

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 person’s mood, emotional control or thinking abilities; however, they will mislabel the reason.

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.

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.

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.

Why is TBI a “Silent Epidemic”?  Most individuals don’t 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

Causes of TBI General Population Vehicle Crashes 50% Other 7% Sports/Recreation 10% Firearms/ IEDs/ Shock Wave Blasts 12% Falls 21%

Causes of TBI Blow to the head with any object Falling and hitting your head Pushed against the wall or other solid object Strangled Punched in the face Strenuous shaking of body Firearms/ IEDs/Shock Wave Blasts Near drowning

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.

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.

Risk of Repeat Brain Injuries  After 1 st TBI, risk of second injury is 3 times greater  After 2 nd, 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)

AS HEAD INJURIES ACCUMULATE…

Mechanism of Brain Damage

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.

In TBI, there is greater damage to the frontal and temporal lobes of the brain.

Frontal Lobe Functions  Planning/anticipation/initiation  Problem solving/judgement  Awareness  Mental flexibility  Ability to inhibit responses  Personality/ emotions

Temporal Lobe Functions  Memory and learning  Organizing and sequencing  Hearing  Understanding language

What are the most common problems after a TBI Injury?

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

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

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

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

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.

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

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

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.