February 21

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What is Traumatic Brain Injury (TBI)?

Traumatic brain injury (TBI) describes a type of acquired brain injury. A TBI occurs when an injury to the head, like a car accident or physical assault, damages the brain. While a mild traumatic brain injury might be treated with rest and therapy, a severe brain injury could require surgery and long hospitalization.

The brain is the powerhouse of our bodies. It is a complex function that controls important things like breathing, blood circulation, communication, and decision-making. Our brains allow us to function while also determining who we are as a person. When the brain suffers an injury, it often affects more than the brain itself. It can also affect an individual’s coordination, decision-making, mood regulation, and overall mental health.

Defining a TBI Medically

While our skulls protect our brains, the sudden impact of a motor vehicle or sporting accident can cause the skull to hit the brain, leading to damage. A traumatic brain injury can also occur from an external object penetrating the brain, such as a sharp item or bullet. As the brain undergoes excessive damage, an axonal injury is also possible as the connecting axons also become damaged.

Damage to the blood vessels and cells in the brain can affect the brain’s ability to function correctly. The symptoms vary, depending on the portion of the brain that is injured. In more severe cases, the brain can bleed, and blood clots are possible, leading to more dangerous and life-threatening symptoms.

“The brain is the powerhouse of our bodies. It is a complex function that controls important things like breathing, blood circulation, communication, and decision-making.”

Defining a TBI Medically

While our skulls protect our brains, the sudden impact of a motor vehicle or sporting accident can cause the skull to hit the brain, leading to damage. A traumatic brain injury can also occur from an external object penetrating the brain, such as a sharp item or bullet. As the brain undergoes excessive damage, an axonal injury is also possible as the connecting axons also become damaged.

Damage to the blood vessels and cells in the brain can affect the brain’s ability to function correctly. The symptoms vary, depending on the portion of the brain that is injured. In more severe cases, the brain can bleed, and blood clots are possible, leading to more dangerous and life-threatening symptoms.

Symptoms of TBI

The individual symptoms of a TBI will differ, depending on the type of injury and its location. Also, symptoms will usually fall into one of four categories, and include:

Thinking

  • Memory loss
  • Loss of consciousness
  • Constant confusion
  • Cognitive difficulties
  • Difficulty communicating

Physical

  • Physical bleeding
  • Dilated pupils
  • Nausea or vomiting
  • Dizziness
  • Headaches
  • Blurry vision
  • Breathing difficulties

Emotional

  • Poor emotion regulation
  • Feelings of irritability
  • Often nervous or anxious

Sleep

  • Lethargy
  • Chronic fatigue
  • Difficulty falling asleep
  • Difficulty staying asleep

Traumatic brain injury symptoms can appear immediately following the injury, or an individual might not notice them for days or weeks. Certain symptoms, like a worsening headache, loss of coordination, nausea, or slurred speech, indicate that immediate medical care is needed.

TBI Symptoms Based on Location of the Injury

The symptoms of a traumatic brain injury will also vary, depending on the part of the brain that is injured.

The different areas of the brain include:

Frontal lobe

 The frontal lobe controls things like concentration, communication, motor planning, and organization. The symptoms of a frontal lobe injury might include the inability to control emotions or impulses. The patient might also have difficulty with communication and may feel increasingly irritable.

Parietal lobe

The parietal lobe controls the sense of touch, depth perception, visual perception, and size identification. The symptoms of parietal lobe damage might include difficulties with writing, language, calculations, and the ability to perceive objects. Parietal lobe damage can also lead to Gerstmann’s Syndrome, which is a rare disorder that leads to the loss of all four functions listed.

Temporal lobe

The temporal lobe controls things like memory, language, hearing, and sequencing. The symptoms of a temporal lobe injury include difficulty effectively communicating or recalling events.

Cerebellum

The cerebellum controls balance and coordination and skilled motor movements. Damage to the cerebellum will lead to a loss of coordination and the inability to determine distance. Individuals with cerebellum damage might also have movement tremors.

Occipital lobe

The occipital lobe controls vision. Damage to the occipital lobe will affect the vision and its ability to identify colors or accurate images. A severe brain injury can lead to complete vision loss.

Brain stem

The brain stem controls important bodily functions like breathing, consciousness, arousal, and heart rate. Brain stem injuries tend to be more severe as things like breathing and heart rate is affected. In most cases, symptoms from the brain stem are due to swelling.

Severe damage to the brain can lead to more significant conditions, including a cerebrospinal fluid buildup in the brain (hydrocephalus), seizure, infections, and damage to the blood vessels. A TBI can also lead to different levels of consciousness. An individual with significant brain damage can lead to a coma, vegetative state, minimal consciousness, or brain death.

Regardless of the area of the brain damages, there are other complications that can arise from a severe brain injury. An axonal injury occurs when the brain’s fibers are torn during impact. An axonal injury often leads to a coma and the need for long-term care.

Children’s Symptoms of TBI

Younger children are more prone to brain injuries because they have weaker necks and torsos, and the brain is not yet fully developed. This also means that they tend to show different symptoms. In some cases, it can be more difficult to determine the existence of a TBI in a child because their difficulty speaking or forming sentences could be attributed to their age.

Typical symptoms of a TBI in children include:

  • Speech and communication difficulties
  • Blurred vision
  • Trouble hearing
  • Chronic headaches
  • Limited attention and inability to focus
  • Frequent/ ongoing mood swings
  • Frequent feelings of depression
  • Slow to think or form conclusions

“Traumatic brain injury symptoms can appear immediately following the injury, or an individual might not notice them for days or weeks.”

Unfortunately, many of the symptoms of TBI in children tend to go unnoticed. Instead, the damage might not be recognized until the kid is older and already showing cognitive deficits and development difficulties. Children can exhibit TBI symptoms with difficulties in controlling mood or emotions or with academic difficulties.

Types of Brain Injuries

TBI describes any type of injury to the brain. A few types of brain injuries include:

  • Concussion: Concussions occur when the brain is injured from a sudden impact or change of movement. A concussion can also include stretched or damaged cranial nerves and an axonal injury.
  • Contusion: A contusion occurs when there is a bruise or bleeding in the brain.
  • Diffuse axonal: Diffuse axonal occurs when the brain experiences sudden movement, such as with Shaken Baby Syndrome. Excessive shaking can damage the nerve tissue and blood vessels.
  • Anoxia: Anoxia occurs when the brain is unable to get any oxygen. The lack of oxygen causes the cells to die off.
  • Hypoxic: A hypoxic brain injury occurs when the brain does not get enough oxygen.
  • Penetration: Penetration occurs when an object pushes through the skull, leading to a skull fracture and damaged nerve cells.

Unfortunately, many TBI patients will have more than one type of injury. A concussion, for example, can lead to anoxia. A contusion can also cause internal bleeding in the brain.

Brain injuries are also categorized based on their level. The levels of TBI include:

  • Mild: With a mild brain injury, the symptoms are less severe, and the physical injury might not show up on diagnostic imaging. Patients with mild TBI tend to be awake. However, they might feel confused, disorientated, misunderstood, or have bouts of a loss of consciousness.
  • Moderate: Moderate brain injuries include moderate symptoms that last a few weeks or a few months. Patients with a moderate type of TBI are lethargic but conscious. They might come in and out of consciousness, with periods of loss of consciousness lasting between 20 minutes and six hours. The patient can usually be awakened.
  • Severe: Severe brain injuries tend to be more significantly life-changing. The damage is often long-lasting or permanent. Patients with severe brain damage are unconscious. They are unable to open their eyes, even with a flashing light, and the loss of consciousness lasts more than six hours.

Your doctor will determine the type and level of brain injury using a physical exam and diagnostic imaging. The treatment plan will also differ, depending on the extent of brain damage.

How to Prevent TBI

While not all occurrences of a TBI can be prevented, there are things that you can do to live a safer lifestyle. These include:

  • Wear protective gear when participating in sports
  • Limit alcohol consumption
  • Never drink and drive
  • Always wear a seatbelt
  • Design an environment of safety for the elderly population
  • Use gates and safety equipment with small children in the household

If you do experience an injury to the head, then it is important to receive medical treatment as soon as possible. Chronic swelling left untreated can lead to a worsening of TBI symptoms.

When to Visit a Doctor for a TBI

It is crucial to visit a doctor immediately following the suspicion of brain damage. If you are in an accident and suffer a direct impact to the head, it is crucial that you call 911 immediately. Failing to get medical treatment for a TBI can lead to permanent brain damage or even death.

It is also important to keep in mind that symptoms from a TBI do not immediately show up. It is possible to experience the symptoms many weeks or even months later.

Whether you visit the nearest emergency room or you consult with a TBI specialist, you can expect a few things during your exam. First, your doctor will complete a physical examination, as well as a few diagnostic tests to determine the likeliness of a brain injury. During the physical exam, your doctor will look at motor responses, the ability to open the eyes, and the clarity of vocal responses.

The doctor will keep track of and measure these using a Glasgow Coma Scale. You can obtain a copy of the Glasgow Coma Scale from the Centers for Disease Control. Depending on the added value of each category, the scale can determine the existence of, and the level of a brain injury. This tool can also be useful when determining the best treatment plan going forward.

Other scales might also be used when determining the level of TBI:

  • JFK coma recovery scale (JFK CRS-R): This scale measures patients who are minimally conscious. It looks at the patient’s arousal level, oromotor capacity, motor function capacity, yes-no communication, audition, language comprehension, visuoperception, and expressive speech
  • Galveston orientation & amnesia test (GOAT): The GOAT test is often used to measure the severity of post-traumatic amnesia.
  • Westmead post-traumatic amnesia scale (WPTAS): The WPTAS is also used to measure the occurrence of post-traumatic amnesia.
  • Glasgow outcome coma scale- extended (GOS-E): An extended type of the Glasgow scale might also be used with some patients. This scale measures the patient’s recovery progress over time.

Your medical team might also use an orientation log (O-LOG). This record measures the recovery over a certain period, allowing multiple team members to update progress.

Diagnostic imaging is also an important tool when determining the extent and location of the brain damage. Typical tests include a Computer Tomography (CT scan), Magnetic Resonance Imaging (MRI), and Magnetic Resonance Spectroscopy (MRS). These images will help the medical team determine the best treatment plan for traumatic brain injury survivors.

What is a TBI Survivor?

A TBI survivor is an individual who has suffered a traumatic brain injury and partially or completely recovered from it. Traumatic brain injury survivors are valuable to the research of effective treatment methods. They can also provide emotional support to individuals who are early in their treatment.

A TBI survivor might be left with long-lasting challenges, including cognitive or executive functioning difficulties. TBI survivors might need to continue rehabilitation to strengthen muscles and to overcome certain difficulties. Counseling and therapy can also be helpful when dealing with the difficulties of recovery. Because emotional changes like depression and anxiety are possible, ongoing mental health counseling can be useful.

What Causes TBI?

Whenever the brain is subject to forceful impact, it can lead to damaged brain tissue and a traumatic brain injury. There are numerous things that can cause a traumatic brain injury. They include:

  • Slip and fall: Individuals who fall onto a hard surface are at risk of hitting their head and damaging their brain.
  • Car accident: Motor vehicle accidents tend to lead to the occurrence of traumatic brain injuries. The impact of a vehicle hitting another vehicle or object can cause enough pressure for a concussion.
  • Assault: Physical assault can also lead to a TBI through forceful impact or a penetrating injury.
  • Sports injury: Concussions are on the rise in athletes of all ages. While protective gear can prevent some occurrences of TBIs, athletes can still be at risk of brain damage.

It can also be helpful to understand the two categories of traumatic brain injuries. TBIs are broken down into two cause types, which include:

  • Acquired brain injury (ABI): An acquired brain injury occurs when the injury happens after birth. It is often caused by an external force such as a car accident, slip, and fall, physical assault, or gunshot.
  • Diffuse axonal injury: Diffuse axonal injuries are caused by a sudden shaking of the brain. This is common in motor vehicle accidents or with Shaken Baby Syndrome (Also referred to as Shaken Impact Syndrome).
  • Degenerative brain injury: A degenerative brain injury occurs when the individual has a brain disorder. This is often a genetic condition.

Other individuals, like military members and construction workers, can also be at an increased risk of suffering a TBI. Other high-risk populations include younger children and older adults. Younger children do not have the same developed coordination as adults do. Additionally, their brains are actively developing, and damage to it can be life-changing. Older adults will often have medical conditions that make them uncoordinated and dizzy, leading to a greater chance of falling.

How Long Do TBI Symptoms Last?

It is not always clear on when the symptoms from TBI will present, or when they will go away either. Each individual is different, and in some, TBI symptoms might go away with a little rest and medications. Other individuals, however, might require ongoing rehabilitation and years of recovery.

It is important to work closely with your medical provider to determine the best treatment plan for your TBI symptoms. Additionally, individuals who undergo a rehabilitation program might recover certain functions faster than individuals who don’t.

Can You Recover From TBI?

Depending on the severity of the injury and the damage, it is often possible to recover from a traumatic brain injury. Immediately following the damage, the brain can continue to undergo damage as the brain’s substances flow freely throughout it, causing additional damage.

The recovery from a TBI is long and can often be frustrating. The individual may have personality changes or be forgetful. Post-traumatic amnesia can last for a long time following a brain injury. While many of these symptoms will alleviate over time, the brain may not be able to fully heal. The brain’s neurons do not repair or regrow, meaning the patient can be left with lifelong symptoms of the injury.

Some individuals may also be left with post-concussion syndrome. With post-concussion syndrome, the patient continues to experience symptoms for weeks or months after the occurrence of a mild traumatic brain injury.

Neurofeedback and Traumatic Brain Injury Recovery

neurofeedback is one of the treatment methods that have proven to be effective in recovery in TBI survivors. By assessing the patient’s symptoms and using an EEG to record brain movement, the neuro therapist can get a better idea of the brain’s functioning. Using comparative information to other individuals without brain damage within the same age can also help the therapist determine any development difficulties.

Neurofeedback then uses a reward and pleasure method to encourage good patterns and disrupt the ones that are not useful. This type of therapy has shown to be effective in individuals with many disorders, including ADHD, OCD, autism, and even a brain injury.

TBI Effects on Aging

Many brain injury survivors wonder how damage to the brain will affect them, physically and mentally, as they continue to age. Older adults are subject to cognitive disorders like dementia and Alzheimer’s disease. Because these disorders are conditions that affect the brain and their ability to function, researchers have suggested that individuals with prior brain damage are more at risk.

Initial research has noticed a connection between cognitive disorders in the older population and prior brain damage. Other studies have identified a connection between TBI and an increased risk of Parkinson’s disease also. More studies and clinical trials are needed to determine how indicative the connection is, though.

Navigating Life With a TBI

Recovering from a TBI can be difficult. But, there are a few things that you can do to navigate life after a TBI, which include:

  • Be sure to get a lot of rest
  • Maintain a healthy lifestyle
  • Follow your doctor’s orders
  • Protect the head from additional injuries
  • Keep up with cognitive activities

Each patient is different. This means that the recovery time will also differ among patients, so it is important to be patient and to follow your doctor’s orders.

Recovering From a Brain Injury

Recovery from certain types of brain injuries is possible. However, the type of TBI and the extent of the damage will determine the best treatment plan. Treatment for a traumatic brain injury will often begin in the hospital. The medical staff will work to prevent further damage and control the symptoms. Depending on how severe the symptoms are, the patient might be placed on life-sustaining machines like an intracranial pressure monitor and a brain oxygen monitor.

Medication might also be used to control symptoms. Medications include:

  • Pain medication: Pain medications can be used to temporarily reduce the pain felt from the accident or injury.
  • Intracranial medication: Intracranial medications work by removing excess water from the brain, which can work to alleviate pressure in the head.
  • Infections: Antibiotics might be used to prevent an infection from occurring, either from the free flow of fluids or from the use of medical devices.
  • Seizure: Because seizures are possible following a TBI, the individual might be given seizure medication to prevent them.

Depending on the type of injury, surgery might be required. Surgery is an option to remove a damaged blood vessel and to control bleeding in the brain. In most cases, the patient is taken into surgery immediately upon presenting to the emergency room. If the hematoma is not yet large enough, the medical team might decide to monitor the patient’s symptoms and then undergo surgery if they do worsen.

Once the patient has regained consciousness and is able to be taken off medical equipment, they may be sent to a TBI rehabilitation center. In a TBI rehabilitation center, the patient’s ability to complete daily tasks is assessed. The patient may re-learn certain movements, or they may learn new ways to accommodate daily tasks. It is possible for acute therapy to begin while the patient is still in the hospital. The goal is to progress the patient toward outpatient therapy.

A pseudobulbar affect is possible when recovering from a TBI. A pseudobulbar affect describes the inability to control emotions. The patient might experience bouts of crying or laughing uncontrollably. Some patients might also experience post-traumatic stress disorder. Thoughts and daily reminders of the incident can trigger ongoing nightmares or vivid recollections.

How You Can Help a Loved One With a TBI

Many TBIs occur from an immediate and sudden accident, which can leave family members feeling confused and unsure of how to help. Fortunately, there are things that you can do to help your loved one as they begin their long road to recovery.

As a family caregiver, it is important to take care of yourself as the road to TBI recovery can be long and tiring. Visiting your loved one in the hospital is important, but they will also need time to rest and recover. They might have a lot of questions as amnesia sets in, and you can help them navigate through things like post-concussion syndrome.

Maintaining a consistent daily routine and a healthy lifestyle is important following a TBI. Helping your loved one with daily errands and transportation to and from medical appointments can be very helpful. Patience is also important as your loved one learns to navigate their new normal. It can also be useful to keep difficulties by age in mind.

Younger children who are recovering from a TBI might struggle with completing academic tasks or expressing their emotions. Young adults might feel frustrated at their lack of independence following new limitations. Recovering from a TBI is all about maximizing the individuals’ quality of life, which means you can help them by filling in any necessary areas.

An injury to the brain is unlike an injury to any other part of the body. Damage to the brain can affect an individual, both physically and psychologically. It is important to seek medical treatment immediately following an injury in which head damage is likely. While the road to recovery following a TBI can be long, there are rehabilitation treatments available to overcome the challenges that come with a TBI.