2 Overview & IncidenceTBI describes damage to the brain caused by a blow to the head.Severity of related symptoms may range from minor to major, even death.Estimated that 100 out of 100k in U.S. incur a TBI each year (approx. 52k deaths)280k per year just in the U.S.$32 billion in hospitalization costs$17 billion in costs associated with fatalities
3 Symptoms Aphasia Loss of memory Loss of coordinated motor functioning Slurred speechBlurry visionDifficulty concentrating or thinking, especially when attention is divided.Anxiety or nervousnessLoss of inhibitionImpulsivityInappropriate laughterIrritabilityHeadacheMuscle Rigidity/SpasticityMuscle WeaknessSeizuresTingling or numbness
4 3 (general) Stages of Symptoms Coma - Loss of consciousness. May display reflexes (gripping a hand) Can be brief or last for days, weeks, or years. The longer a person is unconscious, the more severe the injury.Concussion - brief loss of consciousness (seconds to minutes) with a good prognosis for recover.Post-traumatic amnesiaState of acute confusionAnswering the same question with different responsesCan not perform simple tasks; (reality orientation)Losing train of thoughtStaring blankly at someone
5 Recovery Start to retain current month, year, etc. This stage can last for weeks, months, etc.At times, behavior can become an issue as a pt. becomes aware of his/her loss of ability and experiences frustration and depressionProgress made rapidly initially and then plateaus.
6 Diagnosis Glasgow Coma Scale Ranks quality of response in 3 areas: Eye Opening, Best Motor Response, & Best Verbal ResponseEye-Opening4 - Responds Spontaneously3 - Responds to voice2 - Responds to pain1 - No response
7 Diagnosis cont’dBest Motor Response6 - Follows commands5 - Localizes to pain4 - Withdraws from pain3 - Decorticate (produces an exaggerated posture of upper extremity flexion and lower extremity extension in response to pain2 - Decerebrate (produces an exaggerated posture of extension in response to pain)1 - No response
8 Diagnosis cont’d Scores of 8 or below indicate severe injury Best Verbal Response5 - Oriented and conversational4 - Disoriented and conversational3 - Inappropriate words2 - Incomprehensible sounds1 - No responseScores of 8 or below indicate severe injury9-12 suggest moderate brain injury13 and above indicate mild brain injury
9 Diagnosis cont’d Brain imaging techniques also used CAT or CT (computerized axial tomography)MRI (magnetic resonance imaging)
10 Causes MVA, bicycle, etc. - more than 50% Falls - 25% Violence - 20% Men more than womenyears old and 75+ years
11 Types Blunt or penetrating trauma “Closed head” injury refers to injury not resulting from penetration of the skullFocal injury refers to an injury that is confined to a specific area of the brain causing localized damage.Diffuse injuries are characterized by damage throughout the brain.
12 Types & Causes cont’d Diffuse Axonal Injury Results from a tearing of nerve bundles and/or stretching of blood vessels.Frontal & Temporal lobes are most susceptible.DisorganizationImpaired memoryProblems related to attentionContusionsBruises that cause swelling and bleeding resulting in tissue damageFrontal & Temporal lobesAbnormal sensationsBehavior impairmentProblems related to visionMemory impairment
13 Types & Causes cont’d Hemorrhage Infarction (stroke) Hematoma (SDH) Bleeding into brain tissueInfarction (stroke)Occipital/Temporal lobesOccur when an artery is compressed by the swelling of surrounding tissues, restricting blood flow and its essential nutrientsHematoma (SDH)Bleeding over the surface of the brain exerts pressure and may need to be surgically drained
14 Prognosis Duration of coma Severity of coma immediate post-injury Duration of post-traumatic amnesiaLocation and size of injurySeverity of injuries to other body systemsMore severe the injury, the longer the recovery periodRecovery from diffuse damage takes longer than from localized damageNeed for surgery does not necessarily indicate a worse prognosis.
15 Prognosis cont’dInitial improvement may be due to reduction in swelling (edema)Damaged neurons begin functioning againPlasticity - undamaged areas of the brain may assume the functions of nearby damaged areas