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
Persons 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
Concentration
Memory
Speed of Processing
Confusion

Perseveration
Impulsiveness
Language Processing
Executive functions

Areas of function affected

Cognitive
Sensory/Perceptual

Sensory/perceptual functions

Vision
Hearing
Smell
Vestibular

Taste
Touch
Balance

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%
Dont 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 adults
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