1. Traumatic Brain Injury TBI
By : Dani mamo

2. 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.

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

4. 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

5. Open Head Injury Results from bullet wounds, etc. Largely focal damage
Penetration of the skull
Effects can be just as serious

6. 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)

8. 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)

9. 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

10. What is the Long-term Impact of a Moderate or Severe TBI in the Person’s Functioning?

11. 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

12. Areas of function affected
Cognitive
Sensory/perceptual
Seizures
Other physical changes
Social-emotional

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

14. Sensory/perceptual functions
Vision
Hearing
Smell
Vestibular
Taste
Touch
Balance

15. 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

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

17. What Happens With Mild (or Minor) TBI?

18. Mild TBI Lesser levels of brain damage
Brief or no loss of consciousness
Often referred to as ‘concussion’

19. 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”)

20. 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

21. 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

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.