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Traumatic Brain Injury (TBI) - Fact Sheet

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What is Traumatic Brain Injury?

  Brain injuries occur in a variety of different ways, and are more common than most people think. According to the Brain Injury Association, over 50,000 people a year have a serious, traumatic injury to the brain requiring extensive rehabilitation services. Another 700,000 people a year experience mild brain injury, which over half of them require some degree of rehabilitation services. Traumatic brain injury is the leading cause of death among children and adolescents in the United States.

  Brain injuries may occur as a result of motor vehicle accidents, assaults, falls, industrial accidents, sporting accidents, or gunshot wounds. Sometimes injury is caused by internal factors, such as surgery, infection, or lack of oxygen to the brain. A stroke, where there is a blockage or a break in a blood vessel in the brain can produce damage to the brain, and depending on the location and size of the lesion, can result in some of the same problems as a traumatic brain injury.

  Because of the complexity of the brain, each person's response to a brain injury can be very different. A person's recovery process will depend on many factors, including the extent of the damage, their pre-injury personality and learning styles, their abilities before the injury, their age at the time of injury, and the amount of time that has passed since the injury.

  Perhaps one of the most significant factors in recovery is the support system of the injured person. A brain injury affects not only the person with the injury, but also their family, friends and employer. Since recovery is a long term process, those who have a high degree of support from family, friends, and employer, have a greater chance of continuing to make long term improvements in functioning, even after the formal rehabilitation process.


The Functions of the Brain

  The brain is made up of literally billions of nerve cells that control all human activity, including thinking, emotion, action, and movement. These microscopic nerve cells form bundles of nerve fibers that altogether form a gelatinous mass, which is cradled inside the skull. Brain tissue is very delicate, and even so much as poking it with your finger can cause disruption of neural pathways.

   There are several forms of protection for the brain, which cushion the brain against injury from the normal bumps and scrapes of everyday life. First there is the skull, which provides a bony framework and totally encases the brain. Next there are 3 layers of membranes, and finally there is a cushion of fluid called cerebrospinal fluid.

  The brain is comprised of three systems, any of which may sustain damage in a head injury. The brainstem, which sits at the base of the brain, and continues on down to become the spinal cord, is responsible for maintaining arousal and tone, which is required for higher functioning areas of the brain. It is also responsible for maintaining certain autonomic functions such as regulation of breathing, swallowing, heart rate, and body temperature.

  Moving on up, the rear part of the brain is responsible for processing information that comes in from the sensory organs, like eyes, ears, taste, smell, and feel. Finally, the front of the brain is responsible for coordinating all of this information, and making decisions to do things.


How Does Brain Injury Occur?

  Ironically, the front of the brain is frequently injured in a traumatic brain injury. This is because of the structure of the skull, which is sharp and bony in the frontal region, resulting in contusion and bleeding in this area.

  Another major cause of damage is shearing, or the stretching and tearing of the tiny nerve cells that comprise the brain. Shearing can occur throughout the brain, including the brainstem and the cortex, and can result in decreased arousal and attention, and slowed processing of information.


Detecting Brain Injury

  Neuroimaging, such as magnetic resonance imaging (MRI), computerized tomography (CT), and positron emission tomography (PET) is readily used in detecting brain injury by obtaining the best possible neuroanatomical information from images of the brain. It is also used to determine a correlation between the region of the brain that is damaged and the changes in behavior of the injured individual.

  However, there are many limitations in using neuroimaging as the only source of information for detecting brain injury. Therefore, neuropsychological and neurofunctional assessments are usually administered to the brain injured individual.

  Neuropsychological testing is usually conducted by neuropsychologists. These tests attempt to systematically measure strengths and deficits in a variety of cognitive and behavioral areas. Neurofunctional assessments are situational assessments in which an individual's ability to perform everyday life activites and tasks such as cooking, writing bills, and following written directions are evaluated.

  Only by using a combination of these methods (neuroimaging, neuropsychological testing, and neurofunctional assessments), can a healthcare professional obtain the most accurate and detailed information about the brain injured individual.


What Happens After a Brain Injury?

  After a brain injury, the individual may go through a period of acute inpatient rehabilitation, where they are medically stabilized. After their stay, the individual may go through a period of post-acute rehabilitation or outpatient rehabilitation. It is during this time that the individual really begins to notice changes in their cognitive, behavioral, and emotional aspects of their life. Cognitive deficits may be noticed in memory and problem solving. Behavioral problems may arise in which the individual is exhibiting less inhibition and more impulsivity. Depression and anxiety are emotional factors that may be noticeable in the individual.

  Post-acute rehabilitation is a period where the individual and their family/friends are educated about brain injuries and their outcomes. They can begin to understand why there may be certain types of deficits and how to deal with them. However, they are taught to use the brain injured individual's strengths in order to reduce the functional implications.


The Treatment Team

A variety of health care professionals may work with a person who has sustained a traumatic brain injury in a variety of settings. These clinicians may include:


Thanks to Tom Smith and the Drucker Brain Injury Center for providing this information.


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