1. TBI Traumatic Brain Injury
Purdue University Northwest
Counseling Center Gyte 005
Phone number:

2. Who is affected by Traumatic Brain Injury TBI ?
1.5-2 million adults and children suffer TBI annually
Approximately 1.1. million have mild injuries and do not require hospitalization
250,000 will be hospitalized with moderate to severe head injuries
50,000 die from their injuries

5. What is TBI?
Traumatic brain injury (TBI) can occur when something outside the body hits the head with significant force. Whether it is a head hitting the windshield during a car accident, an impact from a fall, head injuries received during sports or other recreational activities , or trauma from a nearby blast or explosion, TBI can cause changes in a person’s ability to think, control emotions, walk, or speak, and can also affect sense of sight or hearing.

6. What are the causes of TBI
a head hitting the windshield during a car accident
an impact from a fall
head injuries received during sports or other recreational activities
trauma from a nearby blast or explosion
or assault with or without weapons

7. Leading Causes of TBI The leading causes of TBI: -Falls (35.2%):
-Motor vehicle – traffic (17.3%);
-Struck by/against events (16.5%);
-Assaults (10%).1

8. Leading Causes of TBI Falls
-Falls continued to be the leading cause of TBI (35.2%) in the United States.
-Falls cause half (50%) of the TBIs among children aged 0 to 14 years and 61% of all TBIs among adults aged 65 years and older.
Motor Vehicle-Traffic Crashes
-Motor Vehicle Accidents MVA is the leading cause of TBI-related Death (CDC, 2014)
-Rates of death from TBI from MVA are highest for adults aged 20 to 24 years (CDC, 2014)

9. Leading causes of TBI cont.
Struck By/Against Events
-Struck by/against events, which include colliding with a moving or stationary object, were the second leading cause of TBI among children aged 0 to 14 years, with 25%.
Assault
-Assaults produced 10% of TBIs in the general population; they accounted for only 2.9% in children aged 0 to 14 years and 1% in adults aged 65 years old and older.

10. How is TBI Classified ?
TBI can be further classified according to findings from various imaging tests (CT scan MRI and PET scans)
Both individual findings from such tests as well the collective results influence both Prognosis and Treatment for victims of TBI
See Primary and Secondary Injury

11. Primary Injury in TBI
Occurs at the time of the injury
Relates to the “mechanism of injury” and includes
Direct impact
Rapid acceleration and deceleration (see next slide Coup countercoup)
Penetrating injury
Blast waves
All these mechanisms result in trauma to the brain from mechanical forces including:
Bruising swelling
Bleeding
Actual shearing of the white matter of the brain (predicts poor outcome)

13. Secondary Brain Injury in TBI
Includes damage that occurs over hours to days and occurs at the cellular level in the brain such as:
Free radical injury to cell membranes
Electrolyte imbalances
Inflammatory responses
Cellular death
Ischemia from vascular injury
It is these secondary injuries that current medical research is attempting to limit or prevent. No current treatments have demonstrated clear benefit

14. Did You Know?
TBI FACTS:
TBIs can occur on the battlefield, on the football field, on the playground, in a car accident, and even at home.
There are four categories of TBI including mild, moderate, severe and penetrating.
A mild TBI (mTBI), which is also known as a concussion, is the most common form of TBI (see Next Slide).

16. TBI Symptoms
Injuries can range from mild concussions to severe permanent brain damage.
The consequences of a brain injury can affect all aspects of a person’s life, including physical and mental abilities as well as emotions and personality.
TBI can result in changes in a person’s physical functioning, thinking abilities or cognitive function, and behavioral effects and they are often interrelated. These effects sometimes cause other difficulties such as sleeping problems, depression, and anxiety.

17. TBI Symptoms Continued
Depending on the type and location of the injury, a person’s immediate symptoms may include:
Sleep disturbances
Dizziness / loss of balance
Irritability / emotional disturbances
Feelings of depression
Seizures
Vomiting
Loss of consciousness
Confusion and disorientation
Memory loss / amnesia
Headaches
Visual problems
Poor attention / concentration

18. Symptoms: General Difficulty speaking Blurry eyesight Trouble hearing
Loss of energy
Change in sense of taste or smell
Dizziness or trouble with balance
Behavioral effects may include:
Becoming angry easily
Getting frustrated easily
Acting without thinking
Cognitive effects may include:
Difficulty concentrating
Trouble with attention
Forgetfulness
Difficulty making decisions
Repeating things
Behavioral effects may include:
Becoming angry easily
Getting frustrated easily
Acting without thinking

19. Symptoms Thinking/Remembering Difficulty thinking clearly
Feeling slowed down
Difficulty concentrating
Difficulty remembering new information
Physical
Headache Fuzzy or blurry vision
Nausea or vomiting (early on) Dizziness
Sensitivity to noise or light Balance problems
Feeling tired, having no energy
Emotional/Mood
Irritability
Sadness
More emotional
Nervousness or anxiety
Sleep
Sleeping more than usual
Sleep less than usual
Trouble falling asleep

20. How is a diagnosis made?
When a person is brought to the emergency room with a head injury, doctors will learn as much as possible about his or her symptoms and how the injury occurred. The person’s condition is assessed quickly to determine the extent of injury.
Diagnostic Imaging Tests:
-Magnetic Resonance Imaging (MRI)
-Magnetic Resonance Spectroscopy (MRS)
-Computed Tomography (CT)
-PET scans

21. Diagnosis Team
A professional may work with his or her family/caregivers as part of a team that may also include:
doctors
nurses
Neuropsychologists and clinical psychologists
occupational therapists
physical therapists
social workers
employers
teachers

22. Treatment for Chronic TBI
Disabilities from TBI may last a lifetime, and different interventions may be appropriate even many years later. This is particularly true for survivors of moderate to severe TBI. It is essential for survivors, their families, and caregivers to be involved in designing and implementing the rehabilitation plan.
Patients may have residual symptoms that require skilled management by qualified neurologists, physiatrists, and neuropsychologists
There are two categories of chronic treatment:
Community-based rehabilitation and return to work or school, and
Treatment of long-term consequences of the injury.

23. Mental Health related effects of TBI
TBI symptoms can affect people in different ways and sometimes symptoms change as people recover.
Some people may recognize TBI symptoms immediately, and others may write them off or minimize what they’re experiencing.
The effects of mild TBI usually get better on their own and may be unnoticeable within three months.
Some moderate to severe TBI symptoms last for a longer period of time or may be permanent. However, there are effective treatments and support for helping Veterans manage their symptoms and find a path to recovery.

24. Mental Health related effects of TBI
Feeling tired all the time
Feeling sad and anxious
Getting frustrated or overwhelmed easily
Sleeping much more or less than usual
Feeling irritated or angered all the time
Doing things without stopping to think
Having trouble concentrating, remembering, or focusing on tasks
Drinking more alcohol
Taking more of a prescription or over-the-counter medication than as directed
Using illegal drugs
Smoking or using tobacco more often
Not feeling like yourself

25. Physical problems from TBI
Decreased strength and coordination in the body, arms, and legs
Hearing loss
Tinnitus (ringing or buzzing in the ears)
Headaches
Seizures
Dizziness
Nausea
Vomiting
Blurred Vision
Decreased smell or taste

26. Communication problems from TBI
People with a brain injury often have cognitive (thinking) and communication problems that significantly impair their ability to live independently. These problems vary depending on how widespread brain damage is and the location of the injury.
The person may have trouble with social communication, including:
taking turns in conversation
maintaining a topic of conversation
using an appropriate tone of voice
interpreting the subtleties of conversation (e.g., the difference between sarcasm and a serious statement)
responding to facial expressions and body language
keeping up with others in a fast-paced conversation

27. Cognitive problems from TBI
Trouble concentrating when there are distractions (e.g., carrying on a conversation in a noisy restaurant or working on a few tasks at once).
Slower processing or "taking in" of new information.
Longer messages may have to be "chunked," or broken down into smaller pieces.
The person may have to repeat/rehearse messages to make sure he or she has processed the crucial information.
Communication partners may have to slow down their rate of speech.

28. Cognitive Problems cont.
Problems with recent memory.
New learning can be difficult.
Long-term memory for events and things that occurred before the injury, however, is generally unaffected (e.g., the person will remember names of friends and family).
Executive functioning problems.
The person may have trouble starting tasks and setting goals to complete them.
Planning and organizing a task is an effort, and it is difficult to self-evaluate work.
Individuals often seem disorganized and need the assistance of families and friends.
They also may have difficulty solving problems, and they may react impulsively (without thinking first) to situations.

29. Managing the effects of TBI
There are also steps you can take to help manage your TBI symptoms:
Get enough sleep
Write things down or use electronic reminders if you have trouble remembering
Establish a regular, daily routine
Check with someoneyou trust when making decisions
Avoid alcohol—it could slow down the healing process and make symptoms worse
Avoid caffeine, cold medications that treat nasal congestion, or other products that contain pseudoephedrine—they may increase the symptoms
Recognize triggers—keep a record to help identify situations that are more likely to worsen your symptoms
Take up a hobby or a recreational activity
Talk to others—to keep you from feeling isolated and to give friends and loved ones a chance to help you
Remember that symptoms are a normal part of the recovery, and they will get better

30. More Information Complete guide to TBI Brainline Media Webpage
Living with TBI
Brainline Webpage link
Blast injuries may be causing TBI in our military
Brainline webpage link
20 lifesaving apps for those with TBI
Some are unaware they have suffered a TBI
-Youtube link to video

31. References
1. Centers for Disease Control and Prevention. Traumatic Brain Injury in the United States: A Report to Congress. Atlanta (GA): Department of Health and Human Services (US), CDC, National Center for Injury Prevention and Control; 1999.
2. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
3.Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010
4.Champion HR, Holcomb JB, Young LA. Injuries from explosions. Journal of Trauma 2009;66(5):1468–1476.
Hemphill C. J. , Phan N., Aminoff A. J. In Aminoff M. J., Wilterdink J. L. Editor Tramatic Brain Injury: Epidemiology, classification and pathophysiology. Uptodate 2014.
5. Marge K. Introduction to violence and disability. In: Marge K, editor. A call to action: Ending crimes of violence against children and adults with disabilities, a report to the nation. Syracuse: State University of New York, Upstate Medical University; p

32. rEFERENCES
6. Petersilia JR. Crime victims with developmental disabilities: a review essay. Criminal Justice & Behavior 2001;28(6):655–94.
7. Sobsey D, Doe T. Patterns of sexual abuse and assault. Sexuality & Disability 1991;9(3):243–59.