Traumatic Brain Injury

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• Overview of Traumatic Brain Injury

Introduction

TBI injury is more properly defined as an alteration in brain function manifest as confusion, altered level of consciousness, seizure, coma, or focal sensory or motor neurologic deficit resulting from blunt or penetrating force to the head. In mild TBI, subtle behavioral and neuropsychological changes may be the only symptom(s)1, it is a common problem in society leading to morbidity and mortality2 and it is a major cause of epilepsy.1

The term head injury potentially covers not only those injuries resulting in a change in brain function (an altered level of conscious, confusion, coma, convulsions, or other signs of neurological deficit) but also injuries to the bones and soft tissues of the face and head but not involving the brain.3

according to the World Health Organization, will surpass many diseases as the major cause of death and disability by the year 20203

The burden of TBI is manifest throughout the world, and is especially prominent in Low and Middle Income Countries which face a higher preponderance of risk factors for causes of TBI and have inadequately prepared health systems to address the associated health outcomes3

(TBI) is a fairly common problem in Saudi Arabia and has a significant impact on victims, caregivers and the health care system.2

Each year in the USA, approximately 1.4 million persons sustain a TBI (traumatic brain injury). (Incidence of Long-term Disability Following Traumatic Brain Injury Hospitalization, United States, 2003, 2008) and every 21 seconds, one person in the United Stated sustains a TBI.3

A case study from Yemen revealed a prevalence of TBI of 219 cases per 100,000 (160 in adults and 480 in children per 100,000 population).3

With an estimated 10 million people affected annually by TBI .3

In the European Union, TBI accounts for one million hospital admissions per year.3 Males are about twice as likely as females to experience a TBI.4

Picture 1: Damages of TBI - Reference number 4

Definition

An injury to the brain arising from an external physical force5

Thomas Duncan and Javier Romero define the TBI " An injury to the brain resulting in disorders of motor, sensory and/or cognitive function "6

Accident Compensation Corporation (N.Z.), New Zealand Guidelines Group define the TBI "an acute brain injury resulting from mechanical energy to the head from external physical forces. Operational criteria for clinical identification include one or more of the following:

·      Confusion or disorientation

·      Loss of consciousness

·      Post-traumatic amnesia

·       Other neurological abnormalities, such as focal neurological signs, seizure and/or intracranial lesion" 7

Mechanism of the TBI

The leading causes of TBI are falls, motor vehicle crashes, struck by or against events, and assaults, respectively , and blasts are a leading cause of TBI among active duty military personnel in war zones.4

Other studies suggest that injuries involving loss of consciousness may account only for between 8% and 19.2% of sports-related TBIs.4

Picture 2: Causes of TBI - Reference number 4

TBI occurs in higher frequencies in the very young, adolescent and young adult, and elderly. Males are at higher risk of TBI, particularly during adolescence and young adulthood. Minorities have a higher incidence of TBI, although this is confounded by socioeconomic factors.1

signs and symptoms of TBI

§ Mild traumatic brain injury

·      Physical symptoms

o  Loss of consciousness for a few seconds to a few minutes

o  No loss of consciousness, but a state of being dazed, confused or disoriented

o  Headache

o  Nausea or vomiting

o  Fatigue or drowsiness

o  Difficulty sleeping

o  Sleeping more than usual

o  Dizziness or loss of balance

·      Sensory symptoms

o  Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell

o  Sensitivity to light or sound

·      Cognitive or mental symptoms

o  Memory or concentration problems

o  Mood changes or mood swings

o  Feeling depressed or anxious

§  Moderate to severe traumatic brain injuries

·       Physical symptoms

o   Loss of consciousness from several minutes to hours

o   Persistent headache or headache that worsens

o   Repeated vomiting or nausea

o   Convulsions or seizures

o   Dilation of one or both pupils of the eyes

o   Clear fluids draining from the nose or ears

o   Inability to awaken from sleep

o   Weakness or numbness in fingers and toes

o   Loss of coordination

·       Cognitive or mental symptoms

o  Profound confusion

o   Agitation, combativeness or other unusual behavior

o   Slurred speech

o   Coma and other disorders of consciousness

§  Children's symptoms

·       Change in eating or nursing habits

·       Persistent crying and inability to be consoled

·       Unusual or easy irritability

·       Change in ability to pay attention

·       Change in sleep habits

·       Sad or depressed mood

·       Loss of interest in favorite toys or activities

Examined and diagnosed TBI

§  Assessment of need for medical attention

·       Glasgow Coma Scale

·       Loss of consciousness

·       Post-traumatic amnesia

·       Neurological signs

·       Skull fracture

·       Seizure

·       Mechanism of injury

·       Age

·       Drug or alcohol intoxication

·       Headache

·       Vomiting

·       Irritabiliy and altered behavior

·       History of cranial neurosurgical interventions

§ Assessments of the physical functioning of people with TBI should include assessment for the following:

·      Motor deficits:

o   Muscle weakness and paralysis

o   Abnormal muscle tone (spasticity)

o   Deficits in joint range of motion

o   Ataxia/coordination

·      Sensory deficits:

o   Visual/hearing loss

Medical and physiotherapeutic interventions to treatment TBI

For patients who suffer significant neurologic and functional deficits due to traumatic brain injury (TBI), inpatient rehabilitation centers provide comprehensive post-injury care that has been shown to improve functional outcomes and successful reintegration into the community (Librada Callender, 2017)

The physical therapist uses exercise and task-specific training to help the patient improve:

1.      The ability to maintain alertness and follow commands

2.      Muscle and joint flexibility that may be reduced after inactivity

3.      The ability to move around in bed, to sit without support, and to stand up

4.      The ability to balance safely when sitting, standing, or walking

5.      The ability to move by strengthening and the practicing of functional activities

6.      Balance and coordination

7.     Strength and energy, reducing any feelings of fatigue that occur from inactivity or the injury to the brain itself

8.     A return to sports and fitness activities

References

1: John Bruns and W. Allen Hauser (2003) 'The Epidemiology of Traumatic Brain Injury: A Review', International League Against Epilepsy, (), pp. [Online]. Available at: (Accessed:).

2: Mohammed Bangash and Ahmad T. Alshareef (2014) 'Pattern of Traumatic Brain Injury at King Abdulaziz University Hospital', , (), pp. [Online]. Available at: (Accessed:).

3: Adnan A. Hyder, Colleen A. Wunderlich, Prasanthi Puvanachandra, G. Gururaj and Olive C. Kobusingye (2007) 'The impact of traumatic brain injuries: A global perspective', NeuroRehabilitation, (), pp. [Online]. Available at: (Accessed:).

4: Jean A. Langlois,Wesley Rutland-Brown, and Marlena M. Wald (2006) 'The Epidemiology and Impact of Traumatic Brain Injury A Brief Overview', Head Trauma Rehabil, (), pp. [Online]. Available at: (Accessed: ).

5: Courtney J. Wright*, Heidi Zeeman, and Valda Biezaitis (2016) 'Holistic Practice in Traumatic Brain Injury Rehabilitation: Perspectives of Health Practitioners', PLoS ONE, (), pp. [Online]. Available at: (Accessed: ).

6: Thomas Duncan,Javier Romero (2012) TRAUMA BOOK 2012, : Ventura county medical center trauma department.

7: (2006) Traumatic Brain Injury : Diagnosis , Acute Management and Rehabilitation, : New Zealand Guideline Groub.

8: Mayo Clinic Staff () mayoclinic, Available at: http://www.mayoclinic.org/ (Accessed: May 15, 2014).

9: Move Forward Guide () American Physical Therapy Association, Available at: http://www.mayoclinic.org/ (Accessed: June 19, 2012).

10: Garcia P, Homeidan A, Kinne E, Rosado M, Curiel R (2015) 'Cognitive Rehabilitation Therapy Following Acute Spinal Cord and Mild Traumatic Brain Injuries in an Inpatient Rehabilitation Hospital Setting', , (), pp. [Online]. Available at: (Accessed: ).