Traumatic Brain Injury

Traumatic Brain Injury, or TBI, is a trauma to your brain that occurs as a result of a blow to the head, resulting in loss of consciousness, amnesia after experiencing the brain trauma, confusion or a sense of disorientation, or some type of neurological issue.  A brain trauma can affect one's memory, ability to learn, ability to pay attention, and executive functions such as logic and decision-making.

That is not to say that all bumps automatically result in traumatic brain injury but if one does, the impact may range from mild to severe.  Some symptoms of mild TBI include headache, confusion, dizziness, blurry vision, ringing in your ears, loss of memory, mood changes, and difficulty sleeping.  Most people recover from mild TBI.  Symptoms of moderate to severe TBI include a severe headache that doesn’t stop, repeated vomiting, seizures, slurred speech, extreme sleepiness, extreme irritability, and more.*

Sadly, many of our solders coming back from war areas have been impacted by TBI due to explosions. However, TBI can just as easily happen from a car accident, a fall, or a sports injury.  Traumatic brain injury is particularly common among athletes, especially those who participate in contact sports such as football or soccer. In cases where players experience multiple concussions over time, doctors and researchers are just beginning to understand the long-term implications including signs of brain damage and symptoms similar to early Parkinson’s disease.

A clinical tool called the Glasgow Coma Scale (GCS) 5 is used to assess TBI.  It has a scale to determine severity.  Individuals scoring 3-8 are classified with severe TBI, scores of 9-12 are classified as moderate TBI, and scores of 13-15 are classified with mild TBI.

TBI is an important area of concern, because it effects approximately 2% of the population.  It contributed to almost one-third of all injury-related deaths in the United States in 2010.** Effects of severe traumatic brain injury include a serious and sometimes lasting negative impact to cognitive function, motor skills, and personality traits. The most common type is a “concussion,” which can occur from a bump to the head or also from a movement that violently jostles the brain inside the skull. While concussions are not typically life threatening, the effects can be serious and irreversible.

Depending upon severity, treatment can include some or all of the following professionals: a physiatrist (rehabilitation physician), physical therapist, occupational therapist, psychologist, neuropsychologist, neurologist, psychiatrist, speech pathologist, vocational rehabilitation counselor, social worker, and recreational therapist.

Find additional resources on traumatic brain injury within our site.

* Veterans Administration

** Center for Disease Control


The above summary by WebPsychology.

Understanding Traumatic Brain Injury

Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. In 2010 2.5 million TBIs occurred either as an isolated injury or along with other injuries.1

A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury.

CDC’s research and programs work to prevent TBI and help people better recognize, respond, and recover if a TBI occurs.

Concussion and mild TBI

What is a concussion?

A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.

Health care professionals may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, their effects can be serious.

What are the signs and symptoms of concussion?

Most people with a concussion recover quickly and fully. But for some people, symptoms can last for days, weeks, or longer. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one and may find that it takes longer to recover if they have another concussion.

Symptoms of concussion usually fall into four categories:

BI symptoms thinking icon.gifThinking/
Remembering

BI symptoms physical icon.gifPhysical

BI symptoms emotional icon.gifEmotional/
Mood

BI symptoms sleep icon.gifSleep

Difficulty thinking clearly

Headache

Fuzzy or blurry vision

Irritability

Sleeping more than usual

Feeling slowed down

Nausea or vomiting
(early on)

Dizziness

Sadness

Sleep less than usual

Difficulty concentrating

Sensitivity to noise or light

Balance problems

More emotional

Trouble falling asleep

Difficulty remembering new information

Feeling tired, having no energy

Nervousness or anxiety

 

Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems may be missed by the person with the concussion, family members, or doctors. People may look fine even though they are acting or feeling differently.

When to seek immediate medical attention

Danger signs in adults
In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. Contact your health care professional or emergency department right away if you have any of the following danger signs after a bump, blow, or jolt to the head or body:

  • Headache that gets worse and does not go away.
  • Weakness, numbness or decreased coordination.
  • Repeated vomiting or nausea.
  • Slurred speech.

The people checking on you should take you to an emergency department right away if you:

  • Look very drowsy or cannot be awakened.
  • Have one pupil (the black part in the middle of the eye) larger than the other.
  • Have convulsions or seizures.
  • Cannot recognize people or places.
  • Are getting more and more confused, restless, or agitated.
  • Have unusual behavior.
  • Lose consciousness (a brief loss of consciousness should be taken seriously and the person should be carefully monitored).

Danger signs in children
Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:

  • Have any of the danger signs for adults listed above.
  • Will not stop crying and cannot be consoled.
  • Will not nurse or eat.

Concussion

What should I do if a concussion occurs?

People with a concussion need to be seen by a health care professional.  If you think you or someone you know has a concussion, contact your health care professional. Your health care professional can refer you to a neurologist, neuropsychologist, neurosurgeon, or specialist in rehabilitation (such as a speech pathologist). Getting help soon after the injury by trained specialists may speed recovery.

Concussion in sports and recreation

If a concussion occurs during sports- and recreation-related activities, implement the 4-step action plan.

Athletes with a concussion should never return to sports or recreation activities the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.

What to expect when you see a health care professional

While most are seen in an emergency department or medical office, some people must stay in the hospital overnight. Your health care professional may do a scan of your brain (such as a CT scan) or other tests. Other tests, known as “neuropsychological” or “neurocognitive” tests, assess your learning and memory skills, your ability to pay attention or concentrate, and how quickly you can think and solve problems. These tests can help your health care professional identify the effects of a concussion. Even if the concussion doesn’t show up on these tests, you may still have a concussion.

Your health care professional will send you home with important instructions to follow. Be sure to follow all of your health care professional’s instructions carefully.

If you are taking medications—prescription, over-the-counter medicines, or “natural remedies”—or if you drink alcohol or take illicit drugs, tell your health care professional. Also, tell your health care professional if you are taking blood thinners (anticoagulant drugs), such as Coumadin and aspirin, because they can increase the chance of complications.

What can I do to help feel better after a concussion?

Although most people recover fully after a concussion, how quickly they improve depends on many factors. These factors include how severe their concussion was, their age, how healthy they were before the concussion, and how they take care of themselves after the injury.

Some people who have had a concussion find that at first it is hard to do their daily activities, their job, to get along with everyone at home, or to relax.

Rest is very important after a concussion because it helps the brain to heal. Ignoring your symptoms and trying to “tough it out” often makes symptoms worse. Be patient because healing takes time. Only when your symptoms have reduced significantly, in consultation with your health care professional, should you slowly and gradually return to your daily activities, such as work or school. If your symptoms come back or you get new symptoms as you become more active, this is a sign that you are pushing yourself too hard. Stop these activities and take more time to rest and recover. As the days go by, you can expect to gradually feel better.

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Getting better: tips for adults

  • Get plenty of sleep at night, and rest during the day.
  • Avoid activities that are physically demanding (e.g., heavy housecleaning, weightlifting/working-out) or require a lot of concentration (e.g., balancing your checkbook). They can make your symptoms worse and slow your recovery.
  • Avoid activities, such as contact or recreational sports, that could lead to another concussion. (It is best to avoid roller coasters or other high speed rides that can make your symptoms worse or even cause a concussion.)
  • When your health care professional says you are well enough, return to your normal activities gradually, not all at once.
  • Because your ability to react may be slower after a concussion, ask your health care professional when you can safely drive a car, ride a bike, or operate heavy equipment.
  • Talk with your health care professional about when you can return to work. Ask about how you can help your employer understand what has happened to you.
  • Consider talking with your employer about returning to work gradually and about changing your work activities or schedule until you recover (e.g., work half-days).
  • Take only those drugs that your health care professional has approved.
  • Do not drink alcoholic beverages until your health care professional says you are well enough. Alcohol and other drugs may slow your recovery and put you at risk of further injury.
  • Write down the things that may be harder than usual for you to remember.
  • If you’re easily distracted, try to do one thing at a time. For example, don’t try to watch TV while fixing dinner.
  • Consult with family members or close friends when making important decisions.
  • Do not neglect your basic needs, such as eating well and getting enough rest.
  • Avoid sustained computer use, including computer/video games early in the recovery process.
  • Some people report that flying in airplanes makes their symptoms worse shortly after a concussion.

Getting better: tips for children

Parents and caregivers of children who have had a concussion can help them recover by taking an active role in their recovery:

  • Having the child get plenty of rest. Keep a regular sleep schedule, including no late nights and no sleepovers.
  • Making sure the child avoids high-risk/ high-speed activities such as riding a bicycle, playing sports, or climbing playground equipment, roller coasters or rides that could result in another bump, blow, or jolt to the head or body. Children should not return to these types of activities until their health care professional says they are well enough.
  • Giving the child only those drugs that are approved by the pediatrician or family physician.
  • Talking with their health care professional about when the child should return to school and other activities and how the parent or caregiver can help the child deal with the challenges that the child may face. For example, your child may need to spend fewer hours at school, rest often, or require more time to take tests.
  • Sharing information about concussion with parents, siblings, teachers, counselors, babysitters, coaches, and others who interact with the child helps them understand what has happened and how to meet the child’s needs.

Help prevent long-term problems

If you already had a medical condition at the time of your concussion (such as chronic headaches), it may take longer for you to recover from the concussion. Anxiety and depression may also make it harder to adjust to the symptoms of a concussion. While you are healing, you should be very careful to avoid doing anything that could cause a bump, blow, or jolt to the head or body. On rare occasions, receiving another concussion before the brain has healed can result in brain swelling, permanent brain damage, and even death, particularly among children and teens.

After you have recovered from your concussion, you should protect yourself from having another one. People who have had repeated concussions may have serious long-term problems, including chronic difficulty with concentration, memory, headache, and occasionally, physical skills, such as keeping one’s balance.

What are the potential effects of TBI?

The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness, to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury.

TBI can cause a wide range of functional short- or long-term changes affecting thinking, sensation, language, or emotions.

  • Thinking (i.e., memory and reasoning);
  • Sensation (i.e., touch, taste, and smell);
  • Language (i.e., communication, expression, and understanding); and
  • Emotion (i.e., depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).1

TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.1

About 75% of TBIs that occur each year are concussions or other forms of mild TBI.2

Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.3

General tips to help aid in recovery

  • Get lots of rest. Don't rush back to daily activities such as work or school.
  • Avoid doing anything that could cause another blow or jolt to the head.
  • Ask your health care professional when it's safe to drive a car, ride a bike, or use heavy equipment, because your ability to react may be slower after a brain injury.
  • Take only the drugs your health care professional has approved, and don't drink alcohol until your health care professional says it's OK.
  • Write things down if you have a hard time remembering.
  • You may need help to re-learn skills that were lost. Your health care professional can help arrange for these services.4

References

  1. National Institute of Neurological Disorders and Stroke. Traumatic brain injury: hope through research. Bethesda (MD): National Institutes of Health; 2002 Feb. NIH Publication No.: 02-158.
  2. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.
  3. Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries—United States.MMWR 1997;46(10):224–227.
  4. Centers for Disease Control and Prevention (CDC). Facts about concussion and brain injury: Where to Get Help. 2010.

Source: Centers for Disease Control and Prevention (CDC)

Substance abuse and traumatic brain injury

A traumatic brain injury (TBI) is a shock or blow to your head that changes the way your brain works. A TBI can change the way you think, feel, and act. Substance abuse is using a substance, like alcohol or a drug, in an uncontrolled way that hurts you or those around you. Many people with a TBI also have problems with substance abuse.

Substance abuse can lead to a TBI. Studies show that at least 30 percent of people hospitalized for a TBI have a history of substance abuse. This relationship can work in the opposite way, as well. Having a TBI can lead to substance abuse, even if you haven’t had a problem with substance abuse in the past. Studies show that 10 to 20 percent of people develop a substance abuse problem after a TBI. Alcohol is the most common type of substance abuse problem seen in people with a TBI.

Why substance abuse leads to TBI 

Just like a TBI, substance abuse changes the way you think, act, and feel. Being intoxicated affects your vision, coordination, and judgment. This can lead to risky behavior and poor decisions that cause TBI accidents and injuries. 

Why TBI leads to substance abuse

Symptoms of a TBI include slowed thinking, mood swings, depression, anxiety, and headaches. Living with these symptoms can be very frustrating, and some people try to ease their problems with alcohol or drugs. This is very dangerous because a TBI may make your brain more susceptible to the effects of alcohol and drugs.

The dangers of misusing alcohol or drugs after a TBI

If you have been diagnosed with a TBI, you need to know how dangerous it is to try to relieve your symptoms with alcohol or drugs. Mixing a TBI with misuse of alcohol or drugs raises your risk for:

  • Slower recovery
  • Worsening of TBI symptoms
  • Making bad decisions
  • Having another TBI
  • Seizures
  • Family and job problems
  • Suicide

What to do 

Knowing the dangers of substance abuse after TBI is the first step. Many people who have had a substance abuse problem in the past actually stop using drugs and alcohol after a TBI because they understand the dangers. Here are important steps to take:

  • Be honest with your TBI team. Let them know if you are having problems with alcohol or drugs.
  • Stick with your treatment program. People in supervised treatment are less likely to have substance abuse problems.
  • Don’t spend too much time alone. Get your friends and family involved in your recovery.
  • Join a support group. Ask your TBI team if you need help finding one.
  • Don’t get discouraged. Knowing that the symptoms of TBI usually go away in time will help you have a successful recovery.

Although it may be tempting to ease the symptoms and frustration of recovering from a TBI by drinking alcohol or taking drugs, this only makes things worse. Be patient with your brain. It takes time to heal and remember that most people do recover.

A good resource for more information on drug and alcohol abuse is located at the Department of Veterans Affairs.

Source:  Department of Veterans Affairs