Traumatic Brain Injury

Presented by:
David L Strauss, Ph.D.
ReMed
What is Traumatic Brain Injury
(TBI)?
 Two types of brain injury occur
• Closed brain injury
• Open brain injury
 Closed Head Injury
• Resulting from falls, motor vehicle crashes,
etc.
• 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?
 TBI: A biological event within
the brain
• Tissue damage
• Bleeding
• Swelling
 TBI: Changes in functioning
• Loss of consciousness/coma
• Other changes due to the TBI
• Post-traumatic amnesia (PTA)
 Injured Brain
• Does not mend fully
• Leads to problems in functioning
 What Do We Mean by
Severity of Injury
• Amount of brain tissue damage
 How to measure “severity”?
• Duration of loss of consciousness
• Initial score on Glasgow Coma Scale (GSC)
• Length of post-traumatic amnesia
• Rancho Los Amigos Scale (1 to 10)
Mild injury
0-20 minute loss of consciousness GCS = 13-15
PTA < 24 hours

Moderate injury
20 minutes to 6 hours LOC GCS = 9-12

Severe injury
> 6 hours LOC GCS = 3-8
 What Happens as the Person
with Moderate or Severe Injury
Begins to Recover After Injury?
 Recovery
• A multi-stage process
• Continues for years
• Differs for each person
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
• Cognition
 Cognitive functions
• Attention • Perseveration
• Concentration • Impulsiveness
• Memory • Language Processing
• Speed of Processing • “Executive functions”
• Confusion
 Areas of function affected
• Cognitive
• Sensory/Perceptual
 Sensory/perceptual functions
• Vision • Taste
• Hearing • Touch
• Smell • Balance
• Vestibular
 Areas of function
• Cognitive
• Sensory/perceptual
• Seizures
 Areas of function affected
• Cognitive
• Sensory/perceptual
• Seizures
• Other physical changes
 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
 Areas of function affected
• Cognitive
• Sensory/perceptual
• Seizures
• Other physical changes
• Social-emotional
 Social-emotional
• Dependent behaviors
• Emotional lability
• Lack of motivation
• Irritability
• Aggression
• Depression
• Disinhibition
• Denial/lack of awareness
Recovery vs. “improvement”
 Permanence of change?
• Physical recovery
• Reeducation of the individual
• Environmental modifications
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’
 Mild injury is important to
discuss
• Long-term impact for 15%
• Don’t see that TBI is cause of deficits
• Repeated injury leads to problem
emergence-”second impact syndrome”
• 300,000 sports and recreational injuries
• CT, MRI and EEG are usually normal
 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
How is TBI Different (or the
Same) for Those Injured as
Children.
 Children
• Brain still developing
• Brain more flexible than adult’s
• Fewer educational “building blocks”
• Effects may not emerge immediately
• Follow the child over time
How Common is TBI, and Who is
the Typical Person with TBI?
 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:
highest rate
Aged: second highest
What is the Course of Treatment
for Those with TBI?
 Integrated System of Care
• Inpatient Rehabilitation Programs
• Coma Recovery Programs (rarely used)
• Extended Care Programs ( typically
inappropriate)
• Outpatient Programs
• Community Support Services
Community/Post Acute Services
• Outpatient
In clinic
At home/work/community
Community/Post Acute Services
• Residential
– neurorehabilitation/transitional living
– neurobehavioral intensive
– long-term supported living
 Brain Injury Association of PA
• Biapa.org
• Brain Injury Resource Line 1-866-635-7097
• biausa.org