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Brain Injury

Acquired Brain Injury (ABI) and Traumatic Brain Injury (TBI)

Epidemiology and Prevalence

In the United States approximately three to four million adults and children sustain an acquired brain injury (ABI) every year (1). ABI is classified as any injury to the brain that is not congenital, hereditary, birth related, or degenerative. There is a wide range of causes for ABI, which include electric shock, lightning strike, drowning, infectious disease, oxygen deprivation, substance abuse, brain tumors, strokes, seizures, and direct and indirect assaults to the brain (physical assaults, falls, vehicle accidents, military trauma, etc.) Traumatic Brain Injury (TBI) is a subset of ABI that is caused by a direct or indirect trauma from an external force to the brain, such as blunt force, a bump or a blow, a rotational or jolty motion, or an object’s penetration of the head (2). About 30% of all deaths are caused by TBI, and TBI is one of the major causes of long-term disabilities (4). According to the Centers for Disease Control and Prevention during the period between 2006-2010 the most common causes of TBI were falls (40%), unintentional blunt traumas (15%), motor vehicle crashes (14%), and assaults (10%). (5). The leading cause of death varied based on age. Adults above 65 were at the highest risk of dying from TBI, and men were three times more likely to die from TBI when compared to women. On average, about 4 people suffer from a TBI within an hour in the U.S. and about 5 million Americans live with TBI-related disabilities (6, 7). Children’s sports-related concussions are on the rise; the rate of sports and recreation concussion emergency room visits rose 57% among children (age 19 or younger), based on a data from 2001 to 2009 (4).

About 5 million Americans today suffer from permanent disabilities in daily life functioning due to a TBI (6). Some deficits are temporary, lasting a few days, weeks, or months, while others are permanent and life long. The majority of TBIs are classified as mild, with a recovery time that is estimated between three months to a year (with a small percent of individuals reporting cognitive concerns for a longer period of time). The extent and nature of deficits resulting from a TBI depend upon the severity of injury, location in the brain, and the age and other health factors of the individual. A TBI often results in cognitive, emotional, behavioral and communicative disabilities and in some cases follow with medical complications such as epilepsy (6). Areas of cognitive concerns are impaired thinking or memory, lack of focus and concentration, movement and sensation difficulties, personality changes and depression. The most common cognitive impairment in moderate to severe TBI is memory loss of specific memories or the inability to form new memories and store them as long-term memory. Family members of TBI survivors are often effected and may need psychological and supportive services as they adjust their lives to care for their loved ones and learn to accept them as they are post injury. TBIs can have a significant impact on survivors, their parents, spouses, siblings, extended families, friends, health care providers, insurance companies, attorneys, educators, and government agencies.

Diagnosis and Symptomatology

The rating of TBI severity is generally categorized as mild, moderate, or severe, and is assessed using the Glasgow Coma Scale. The World Health Organization Collaborating Centre Task Force, The Centers for Disease Control, the ACRM, and the majority of other bodies require the assessment of: loss of consciousness, post traumatic amnesia, transient alterations in consciousness, and focal neurological deficits. Other symptoms of TBI include headache, lightheadedness, dizziness, confusion, blurry eye vision, bad taste, tinnitus (ringing in the ears), tiredness, sleeping problems, trouble with memory, attention, concentration, or thinking, and behavioral or mood changes (4-7).  More severe symptoms often include a persisting or worsening headache, nausea and vomiting, seizures, convulsions, slurred speech, coordination problems, difficulty waking up, dilated pupils, numbness in the extremities, restlessness, or agitation. While moderate to severe TBI results in more cognitive problems than mild TBI, repeated mild TBIs, particularly within a short period of time, can cause cognitive deficits resembled in ones detected in moderate to severe TBIs.

In about 40 percent of TBI cases, individuals develop a cluster of symptoms classified as a condition called post-concussive syndrome (PCS)(6). Symptoms may last for days to weeks and often include memory problems, headache, trouble concentrating, irritability, depression and anxiety, vertigo, dizziness, sleeping problems, restlessness, and apathy. Prior history of psychiatric symptoms increases the likelihood of developing PCS. Medications for pain and psychiatric conditions, along with occupational and psychological therapies are often implemented to alleviate symptoms (6).

Treatment

Immediate medical attention is required in TBI, and focuses on stabilizing and preventing further injury, providing oxygen, maintaining blood flow, and controlling blood pressure. Imaging tests such as MRI, CT, PET, DTI, and X-rays are used to assist in the diagnosis and prognosis post TBI. Moderately to severely injured individuals receive rehabilitation treatment program that is designed based on the individual need, in the areas of physical therapy, speech/language therapy, occupational therapy, psychological and psychiatric services, and social support (6, 7). A rehabilitation plan is important to implement post a TBI, as the brain and functioning continuously change after injury. At the acute stage, moderate to severe TBI are treated in a hospital intensive care unit. Upon stabilizing the individual, he or she is either transferred to a sub-acute unit or to an independent rehabilitation hospital. Long-term rehabilitation plans are individually catered. The need and nature of rehabilitative services are often determined by a neuropsychological exam by a trained neuropsychologist. Neuropsychological testing reveals information as to the level of performance on a wide range of cognitive domains, such as: memory, executive functions (the ability to plan and organize information, execute complex tasks, and mediate emotions and behavior), sensory-perceptual processing, processing speed, and changes in personality and behavior. It is recommended to reassess neuropsychological functioning as treatment progresses.

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References:

 

1.   Brain Injury Association of Massachusetts (BIA-MA) Brain Injury Facts and Statistics, Retrieved May 20th, 2015 from: http://www.biama.org/BLUEforBrainInjuryCampaignMaterials/Brain%20Injury%20Facts%20and%20Statistics.pdf.

2.   American Congress of Rehabilitation Medicine (ACRM): Menon, D. K., Schwab, K., Wright, D. W., Maas, A. I., and  (2010). The Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position Statement: Definition of Traumatic Brain Injury, Archives of Physical Medicine Rehabilitation, (91), 1637-1640.

3.   American Congress of Rehabilitation Medicine (ACRM). Definition of Mild Traumatic Brain Injury. Retrieved on May 20th from: http://www.acrm.org/wp-content/uploads/pdf/TBIDef_English_10-10.pdf

4.  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.

5.   Centers for Disease Control and Prevention. Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged ≤19 Years — United States, 2001–2009. MMWR 2011; 60(39), 1337–1342.

6.  The National Institute of Neurological Disorders and Stroke (NINDS) Traumatic Brain Injury Information Page. Retrieved on May 20th, 2015 from: http://www.ninds.nih.gov/disorders/tbi/tbi.htm

7.  The Center for Neuroscience and Regenerative Medicine (CNRM) on Traumatic Brain Injury. Retrieved on May 20th from: http://www.cnrmstudies.org/

 

 

 

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