Every 21 seconds someone in the U.S. suffers traumatic brain injury. According to the National Center for Disease Control and Prevention, about 5.3 million people in the United States live with a disability that was caused by a traumatic brain injury (TBI). Motor vehicle crashes, falls, violent crimes and child abuse are major causes of sudden TBI and the leading cause of death and disability in children and young adults.
TBI can be categorized as mild, moderate, or severe:
- A mild case is called a concussion, and the patient is usually awake following the injury. Approximately 80% of TBIs fall into this category.
- In a moderate case, the patient is sleepy following a brief loss of consciousness or disorientation. Approximately 10% of TBIs fall into this category.
- In severe cases, approximately 10% of TBIs, the patient is comatose, unable to respond.
Traumatic Brain Injury: Symptoms
According to the National Institute of Neurological Disorders and Stroke (NINDS), a person with a mild traumatic brain injury may either remain conscious or experience a brief loss of consciousness for a few seconds or minutes. Other symptoms include:
- Blurred vision or tired eyes
- Ringing in the ears
- Bad taste in the mouth
- Fatigue or lethargy
- Change in sleep patterns
- Behavioral or mood changes
- Trouble with memory, concentration, attention, or thinking
A person with a moderate or severe TBI may show these same symptoms, but may also present with:
- Headache that gets worse or does not go away
- Repeated vomiting or nausea
- Convulsions or seizures
- Inability to awaken from sleep
- Dilation of the pupil in one or both eyes
- Slurred speech
- Weakness or numbness in the extremities
- Loss of coordination
- Confusion, restlessness, or agitation
Traumatic Brain Injury: Diagnosis
Once a traumatic brain injury patient is stabilized, doctors can begin assessing the extent of damage. If the patient is conscious and capable of communicating, the doctor will attempt to acquire a detailed medical history. The doctor will then perform a complete neurological evaluation to determine if there is damage that requires neurosurgical attention.
A number of X-rays, computed tomography (CT) and/or magnetic resonance imaging (MRI) scans may be necessary to examine the skull for fractures and intracranial lesions. Intracranial lesions include traumatic intracranial hematomas or hemorrhage, cerebral contusions or lacerations, or penetrating cerebral injuries (e.g., injury sustained from a gunshot wound).
Depending upon how the brain is injured, a person’s speech, movement, cognition, and behavior may be affected. A comprehensive neurological examination will reveal abnormalities including decreased motor function, sensory function, or reflexes; speech problems (aphasia or dysphasia); and/or seizures.
A neuropsychological exam may also be performed to assess mental status (such as disorientation, agitation, or confusion.
Traumatic Brain Injury: Treatment
Prompt treatment is critical with traumatic brain injury, since a patient will continue to sustain damage well after the trauma occurs. The quicker the response time, the better the outcome.
Treatment must focus first on primary brain damage, damage that is said to be complete at the time of impact, and then secondary brain damage, damage that evolves over a period of hours to days after the trauma occurs.
The Brain Trauma Foundation (BTF) identifies the following guidelines for treating severe primary brain damage:
- Quick recognition that a TBI has occurred.
- Appropriate treatment in the ambulance.
- Rapid transport to a Level I Trauma Center.
- Brain pressure monitoring in the intensive care unit.
- Treatment to maintain enough blood and oxygen to the brain.
The treatment program for secondary damage will vary depending on the stage of recovery and the extent of the damage. During the early stages (e.g., during coma), treatment at an intensive care unit of a hospital focuses on provoking sensory response through stimulation. As the patient grows increasingly aware of his or her surroundings, the patient care team will develop an individualized course of treatment. This program will be tailored exclusively to the patient’s specific needs and may include a combination of some or all of the following therapies:
- Physical therapy.
- Occupational therapy (learning skills for the activities of daily living).
- Speech/language therapy.
- Physiatric therapy (rehabilitation medicine).
- Psychological therapy and social support.
The overall goal treatment is to improve the TBI survivor’s ability to function at home and in society and, in so doing, improve his or her quality of life.
Traumatic Brain Injury: Resources
Brain Trauma Foundation
7 World Trade Center
250 Greenwich St,
New York, NY 10007
Family Caregiver Alliance/National Center on Caregiving
180 Montgomery Street
San Francisco, CA 94104
Tel: 415-434-3388or 800-445-8106
National Rehabilitation Information Center (NARIC)
8201 Corporate Drive, Suite 600
Landover MD 20785
Tel: 800/346-2742 or 301/459-5900
National Institute on Disability and Rehabilitation Research (NIDRR)
U.S. Department of Education
Office of Special Education and Rehabilitative Services
400 Maryland Ave., S.W., Mailstop PCP-6038
Washington, DC 20202-7100