Understanding TBI Traumatic brain injury, also known as TBI, is the leading caus

e of dearth and disability in adolescents and young adults. TBI is defined as da

mage to the brain resulting from external mechanical force, such as rapid accele
ration or deceleration, impact, blast waves, or penetration by a foreign object.
This include falls, vehicle accidents, and violence. TBI can cause physical, co
gnitive, emotional, and behavioral effects, and outcome can range from complete
recovery to permanent disability or death. A person s brain defines who they are so
it is very different than losing a leg or breaking an arm. A broken bone limits
the use of that specific area and will heal over time. Unlike breaking a bone, T
BI affects a person s personality or even their mental ability and which may never b
e the same again. Depending on the injury, treatment required may be minimal or
may include interventions such as medications and emergency surgery or physical
therapy, speech therapy, recreation therapy, and occupational therapy. All brain
injuries are very different from one another and the outcomes for two similar i
njuries can total opposites from each other. Symptoms caused by TBI may appear a
t any time; It may appear immediately or it may show up a few weeks after the in
jury. Most people who have TBI don't even realize or remember that a brain injur
y occurred, they just live their lives as if nothing happened. TBI is classified
into two categories: mild and severe. If loss of consciousness and/or confusion
and disorientation is shorter than thirty minutes then a brain injury can be cl
assified as mild. The MRI scans can show that everything in the brain is normal
but the person may still be experiencing cognitive problems like headaches, diff
iculty thinking, memory problems, attention deficits, mood swings, and frustrati
ons. It is very common that these symptoms are overlooked and the person may not
get the treatment they need. Although this case would be considered mild the ef
fects on the family and the injured person can be devastating. Major depression
may be

particularly common following mild traumatic brain injury. A researcher found th

at subjects with mild traumatic brain injury had higher rates of major depressio
n and post-concussive symptoms than those with severe traumatic brain injury.1 S
evere brain injury is classified as having a loss of consciousness for more than
thirty minutes and memory loss after the injury or penetrating skull injury lon
ger than twenty-four hours. The person with severe TBI may have a range of effec
ts. The lucky
ones may have limited function of their arms or legs, abnormal speech o
language, loss of thinking ability or emotional problems. Others may be left in
long term unresponsive states. According to the centers for Disease Control and
Prevention)CDC), about 1.4 million people in the United States suffer from TBI
annually.2 Approximately 235,000 people are hospitalized and about 50,000 people
die from TBI each year. There are around 5.3 million Americans living with TBI
disabilities today.3 There are many causes that lead a person to have TBI. The t
hree most common ways are car accidents, firearms, and falls. Most of the time t
he firearm injuries are fatal: one out of every ten survive. The highest causes
of brain injury are: open head injury, closed head injury, deceleration injuries
, chemical and toxic injuries, hypoxia, tumors, infections, and strokes. Open he
ad injuries result from bullet wounds or penetration of the skull. Closed head i
njuries can be just as dangerous as open head injuries; this type of brain injur
y can be caused from a slip or fall, motor vehicle crashes, and damage to the br
ain axons, where there is no penetration to the skull. Deceleration injuries whe
n the brain is moved inside the skull. The brain is soft like gelatin and
1. Alexander MP: Neuropsychiatric correlates of persistent post concussive syndr
ome. J Head Trauma Rehabilitation 1992; 7:60-69[CrossRef] 2. Langlois JA, Rutlan
d-Brown W, Wald MW: The epidemiology and impact of traumatic brain injury: a bri
ef overview. J Head Trauma Rehabilitation 2006; 21:375 378[Medline] 3. Thurman D, Al
verson C, Dunn K, et al: Traumatic brain injury in the United States: a public h
ealth perspective. J Head Trauma Rehabilitation 1999; 14:602 615[Medline]

is inside the hard skull. During the movement of the skull through space (accele
ration) and the rapid and then the sudden jolt that takes place when the skull s
tops and hits an object(deceleration) causes the brain to move inside the skull.
Because the brain is soft it moves at a different rate than the skull causes di
rect brain injury. The different movement of the skull and the brain when the he
ad is struck results in direct brain injury, due to diffuse axonal shearing, con
tusion and brain swelling. Diffuse axonal shearing is when the brain is slammed
back and forth inside the skull. It is quickly compressed and stretched because
of the gelatinous consistency. The long, fragile axons of the neurons are also c
ompressed and stretched. Axons can be stretched until they are torn with a stron
g impact, this is called axonal shearing. When this happens, the neuron dies. Af
ter a severe brain injury, there is massive axonal shearing and neuron death.4 H
armful chemicals can also lead to brain injury such as insecticides, solvents, c
arbon monoxide poisoning, and lead poisoning. Lack of oxygen, known as hypoxia,
may cause brain injury. If the blood flow is depleted of oxygen, known as anoxia
(no oxygen) or hypoxia (reduced oxygen), then brain injury may occur. It doesn'
t take that long to take effect, it can happen in a matter of a few minutes. Thi
s condition may be caused by heart attacks, respiratory failure, drops in blood
pressure, and a low oxygen environment. This type of brain injury can result in
severe cognitive and memory deficits. Tumors on or over the brain can cause brai
n injury. The tumor on the brain invades the spaces of the brain, put pressure o
n the brain, and cause direct damage. Sometimes the tumor itself may not cause b
rain damage but surgical procedure to remove it may lead to brain injury. The br
ain and its surrounding membranes are very prone to infections if the special bl
ood protective system is breached and if a virus, bacteria,
4. Understanding Traumatic Brain Injury, http://www.traumaticbraininjury.com/con
tent/understandingtbi/tbiunderstanding-tbi.html (2001)

life-threatening diseases of the brain (encephalitis), or meninges(meningitis) g

ets to the brain then it may lead to TBI. A stroke can also lead to brain injury
. If blood flow is blocked then the cells in the area where there is deprivation
of blood will die and that can be very dangerous and cause TBI. Or if there is
bleeding in or over the brain (hemorrhage or hemetoma) from a tear in an artery
or vein, then there is a loss of blood flow and the brain tissue will be damaged
by the blood flow and will cause brain damage. 5 The range of injuries and degr
ee of recovery is very different and varies on an individual basis. Most rehabil
itation for traumatic brain injury is geared at overcoming, minimizing, or worki
ng through disabilities so the person can live as independently as possible. TBI
causes minor and or serious complication. These complications require both imme
diate and ongoing long-term treatment. The first stage of treatment is revolved
around preventing further injury and sustaining life through a combination of re
habilitation and assistive technologies. Right after the injury occurs the patie
nts are rushed to the hospital for immediate acute treatment. This includes chec
king for any dangerous blood clots, clearing the patients airway, give them the
medication they need, monitor and surgically any pressure caused by the buildup
of excess brain fluid in the skull, and put the patient on life support if neces
sary. The patient is then transferred to sub-acute TBI treatment centers. At the
subacute treatment center the medical staff will fully evaluate the patient's i
mpairments, disabilities, and the probability that they will recover. Then the d
octors will decide what treatments are needed and help the patient and his/her f
amily build the right team of medical professionals necessary for rehabilitation
and chronic TBI treatment. Patients with mild to moderate TBI spend little or n
o time in subacute treatment centers. Those with severe TBI usually spend five t
o ten getting critical care in subacute treatment facilities. Those
5. Understanding Traumatic Brain Injury, http://www.traumaticbraininjury.com/con
tent/understandingtbi/tbiunderstanding-tbi.html (2001)

with severe TBI require chronic and long-term rehabilitation. They get counselin
g and/or therapy, medications, physical therapy, speech therapy6, and they may a
lso use assistive technology such as wheelchairs or specialized keyboards. Depen
ding on the patients age, the type and severity of their TBI, and any co-morbid
conditions they may have will result in their recovery and complications that th
ey will encounter. Some have to be retaught how to walk, talk, socialize, and li
ve independently. They also work on overcoming their self-esteem, depression, or
any other emotional issue they may have.7 Mild TBI can have a dramatic impact o
n family, job, social and community interaction. TBI has a huge impact on a pers
on's life. One minute the person is completely fine and the next second their li
ves are completely turned around. The ones that don't even remember having an in
jury are the luckiest in a away because they are not suffering. They are confuse
d as to what is going on but they don't feel different than they did before the
injury. Those who's personalities change are the most confused. Because they may
not remember who they were before the injury took place, they think that they h
ave had that personality their whole lives. There are many ways that a person ca
n get TBI. There are many ways to try to help someone who has a brain injury but
full recovery is very hard and unpredictable. Those who have severe injuries ma
y not even be able to cope by themselves they have to be completely taken care o
f hospitalized. The only way to prevent TBI is just to make sure one is careful
with anything they do. If they are riding a bike then wear a helmet, if driving
then be drive carefully. There is no real prevention but people just have to do
their part and try to protect themselves the best they can.
6. Fann JR, Bombardier CH, Dikmen S, et al: Validity of The Patient Health Quest
ionnaire-9 in assessing depression following traumatic brain injury. J Head Trau
ma Rehabil 2005; 20:501 511[CrossRef][Medline] 7. Rehabilitation and Treatment for T
BI, http://www.brainandspinalcord.org/Treatment-rehab-tbi/index.html, (2011)

Bibliography
1.
Alexander MP: Neuropsychiatric correlates of persistent post concussive syndrome
. J Head Trauma Rehabilitation 1992; 7:60-69[CrossRef]
2.
Fann JR, Bombardier CH, Dikmen S, et al: Validity of The Patient Health Question
naire-9 in assessing depression following traumatic brain injury. J Head Trauma
Rehabilitation 2005; 20:501 511[CrossRef][Medline]
3.
Langlois JA, Rutland-Brown W, Wald MW: The epidemiology and impact of traumatic
brain injury: a brief overview. J Head Trauma Rehabilitation 2006; 21:375 378[Medlin
e]
4.
Rehabilitation and Treatment for TBI, http://www.brainandspinalcord.org/Treatmen
t-rehabtbi/index.html,
(2011)
5.
Thurman D, Alverson C, Dunn K, et al: Traumatic brain injury in the United State
s: a public health perspective. J Head Trauma Rehabilitation 1999; 14:602 615[Medlin
e]
6.
Understanding Traumatic Brain Injury,
http://www.traumaticbraininjury.com/content/understandingtbi/tbi-understanding-t
bi.html
(2001)