brain injury- adult barriers

what is the definition of a TBI

an aqcuired injury to the brain from an external mechanical force or internal medical concern that results in temporary or permanent physical, cognitive, and/or psychosocial impairments

how are brain injuries a unique type of physical injury?

they are dependent on the location, cause or severity, this impacts all areas of ones life

what are the incidence rates for brain injury

most common in adults, specifically aged 15-24 they are three times more likely to die

what are some of the most common causes of brain injury?

• falls (most common in kids and older adults and is leading cause)

• motor vehicle accidents

• blunt trauma like stabbing, suicide and firearms

• failed suicide

what is the difference between an open versus closed head injury?

open head injury is a major life expectancy issue, as this is an open wound caused by penetration through the skull, way more at risk for infection. closed is not skull penetrated

what are stand out points of an open head injury?

missile injuries penetrating the skull like from a gunshot or knife wound, very serious as skull fractures are caused, and can be caused by a high (MVA) or low (stab) velocity trauma

what are examples of high velocity traumas to the head

TBIs caused by bullets, rocks, shell fragments, knives, nails and blunt instruments, herniation of brain tissue here is possible

what are examples of low velocity traumas to the head

caused by more so piercing the scalp skull or brain at a lower speed or rate

what are the standout points of a closed head injury

caused by MVA, falls, or blunt force trauma. effects are usually broader and more diffuse throughout the brain although the brain is not penetrated. This results in concussion or contusion

what is a contusion?

bruising to the brain cortex found most commonly in the frontal and temporal lobes. Small contusions can combine to form a large intracranial hematoma

how is concussion/mild TBI diagnosed?

having one or more of the following: GLCS level of 13-15, LOC, loss of memory for events immediately before or after accident, or altered mental state

what is a diffuse axonal injury (DAI)

not as common, results from coup-contrecoup injuries, not seen on traditional CT scans or MRIs, occurs in the cerebral hemispheres, corpus callosum and brainstem

what is a coup-contrecoup injury

High velocity incidents with strong force can hit the brain on one side, causing it to hit on another side. So could be hit on the speech side but knocked of the vestibular side, there would be vestibular and speech deficits

what is an oxygen deprivation TBI

occurs when blood flow is interrupted and depleted of oxygen, takes only a few minutes to occur and could be caused by heart attacks, drops in BP, drowning and birth issues

what infections could cause a brain injury and how?

encephalitis, meningitis both secondary to an open wound.

what is a subdural hematoma

bleeding between the dura mater and arachnoid interface causing massive headache. very common with people falling on the back of their head

what is an epidural hematoma

most often caused from skull fracture, developing as rapid bleed and requires surgical intervention

what is an intracerebral hemorrhage

associated with contusions and causes bleeding into the cerebral tissue which in turn builds up a lot of ICP. this has a very poor prognosis as if they are not seen quick enough they will die.

what is important to note if you are dealing with pts with an intracerebral hemorrhage

be slow and cautious when changing positions to make sure BP does not get too high, and check BP often

what is a subarachnoid hemorrhage

bleeding into the subarachnoid space that is associated with severe head injury and aneurysm ruptures. this also increase ICP quickly

how is a TBI an evolving process?

what you see at the acute phase of a brain injury is not the same as what it is like in the chronic stages, could be better but could be worse

what is a primary injury in TBI

brain damage from external injury that is immediate from external forces, this damage is irreversible occurring at the moment of impact typically results from contact and diffuse injuries

what causes diffuse injuries?

acceleration-deceleration injuries from concussion, contusion and DAIs (from falls, MVA and blunt force trauma) this causes broad and diffuse damage throughout the brain

what causes contact injuries?

contusions, lacerations, hematomas, penetration and hemorrhages. these create focal damage from a trauma involving specific areas of tissue damage

what are secondary injuries from TBIs

post-injury complications like organ failure, infections, fractures. most occur in the first 24 hours after trauma but can occur up to 10 days post-injury

what is the most common classification of TBI and what are its traits

mild TBI which is a concussion, this accounts for 75%-90% of all TBIs. this causes confusion, disorientation, or impaired consciousness lasting 30 mins or less, dysfunction of memory around the time of injury (amnesia)

what are symptoms of a mild TBI

• tinnitus

• visual changes

• irritability

• balance problems

• headache

• amnesia

what are traits of a moderate level TBI

LOC of 30 mins to 6 hours, amnesia for 24 hours after incident but could last as long as a week, may have a good recovery but an incomplete one

what is the GLCS score for a moderate TBI

range of 9-12

what are traits of a severe TBI classification?

LOC longer than 6 hours, amnesia lasting longer than a week but could last for life with residuals, improvements dependent on severity and location (coup-contrecoup are common in this classification), often left with permanent deficits.

what are symptoms of moderate and severe TBI

• LOC

• severe persistent headaches

• repeated vomiting

• seizures

• inability to awake

• personality changes

• dilation of one or both pupils

• slurred speech

what is locked in syndrome?

eyes can open and move around but no other voluntary movements exist, basic cognitive function is present on exam. this is caused by lesion in the pons

what is minimally conscious state

they have in and out consciousness and basic skills like blinking/squeezing hand for yes and no. this is reversible, and once they can communicate and follow commands they are no longer in this state

what is akinetic mutism

this is focused on speech with attention deficits. eye opening and spontaneous visual tracking present with inconsistent purposeful responses can exist

what is a vegetative state

no conscious awareness of self or environment, eyes open spontaneously, sluggish arousal that is poorly sustained, no language perception, communication or internal response to stimuli. does have a sleep-wake cycle

what is a coma

complete absence of arousal or responsiveness, eyes do not open spontaneously or in response to stim, no sleep wake cycle, no purposeful motor activity. this is likely due a a brain injury that is so serious they cannot come back from it.