10.1 Traumatic brain injuries

Traumatic brain injuries

Traumatic brain injuries

• most common injury in people under the age of 40

• Sport activities account for 20% of TBI

• Higher incidence of head trauma in males between 15 and 30 years old

TBIs affect brain functioning through:

• Direct damage

• Disrupting the blood supply

• Inducing bleeding

• Swelling

• Infection

• Scarring of the brain

TBI mild

• (Concussion)

• A person with a mild TBI, which is also called a concussion, is awake after a force to the head, but may experience a loss of consciousness for a few seconds, or minutes, or not at all.

TBI moderate

• A person with a moderate TBI is often lethargic with their eyes open only to stimulation.

TBI severe

• (Coma)

• A person with a severe TBI is typically, in a coma state for more than six hours.

Behavioural assessment of head injury

• Glasgow Coma Scale

• Posttraumatic Amnesia (PTA)

Glasgow Coma Scale

• Objective indicator of the degree of unconsciousness & of recovery from it

Posttraumatic Amnesia (PTA)

• Measure of severity of injury

• Correlates with future memory disturbance

• No consistent method used for measurement of amnesia

Open head injury

• TBIs with skull penetration

• Neurological signs/symptoms highly specific

• May undergo rapid and spontaneous recovery if injury small and highly specific

• Recovery can be remarkable

Closed head injury

• People who sustain closed-head injuries are at risk for future head injury

• Effects are cumulative

General complaints after injury → Closed head injury

• Inability to concentrate or do things as well

• Highly skilled people most affected

• Effects on personality and social behavior if injury in frontal or temporal lobes

Primary brain injuries → immediate on impact

• coup & contrecoup contusions

• fiber sharing or stretching

• macroscopic & microscopic lesions

• laceration or depression from skull penetration or fracture

Secondary injuries

• intracranial hemorrhage & edema

• ischemic or bleed-induced damage

• increaszed intracranial pressure or distortion

• effects of multiple injuries & hypoxia

Injurious effects, delayed

• Degeneration of gray matter & white matter

• Hydrocephalus

Complications after a TBI

• Physical complications

• Cognitive problems

• Emotional changes

• Behavioral changes:

Physical complications

• motor problems

• seizures

• hydrocephalus

• nfections

• blood vessel damage

• vertigo

• headaches

 Cognitive problems

• memory

• learning

• reasoning

• attention

• problem-solving

• planning

• multitasking

• decision-making

• organization

• aphasia

Emotional changes:

• mood swings

• anxiety

• depression

• irritability

• lack of empathy

• anger

Behavioral changes

• difficulty with self- control

• risky behaviour

• difficulty in social situations

• lack of awareness of abilities

• verbal or physical outbursts

The bleeding and pressure can create hematomas

• Edema

• Loss of consciousness; commonly accompanies closed-head injury

• Coma

Behavioral effects after a TBI

• Impairment of specific functions mediated by the cortex at site of damage

• More generalized impairments from widespread trauma throughout brain

Recovering from and preventing head injury

• Recovery may continue 2–3 years, with bulk of recovery occurring in 6–9 months.

• Good recovery of cognitive skills, although memory is slower & lower.

• Poor recovery of social functions & personality (quality of life).

• Head injury is preventable by recognizing that concussions have severe immediate & also long-term & cumulative effects.