What is Traumatic Brain Injury or TBI?
A traumatic brain injury (TBI) is a blow or jolt to the head or penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI. The severity of such an injury may range from “mild,” ---a brief change in mental status or consciousness---to “severe,” an extended period of unconsciousness or amnesia after the injury. A TBI can result in short or long-term problems with independent function.
What are the most common causes of TBI? The leading causes of TBI are:
- Bullets, fragments, blasts
- Motor vehicle-traffic crashes
- Assaults Blasts are a leading cause of TBI for active duty military personnel in war zones.
Who is at highest risk for TBI?
What are the signs and symptoms of mild TBI or concussion?
- Males are about 1.5 times as likely as females to sustain a TBI
- Military duties increase the risk of sustaining a TBI
- Excessive fatigue (tiredness)
- Concentration problems
- Forgetting things (memory problems)
- Sleep problems
- Balance problems
- Ringing in the ears
- Vision changes
How is TBI classified into mild, moderate or severe?
TBI classification is based on the length of time a person is unconscious, the presence of memory loss or post-traumatic amnesia (PTA) and the Glasgow Coma score:
||Loss of conciousness
||Memory loss or PTA
||Glasgow Coma Score
||None – less than 30 min
||Lasting less than 24 hr
||13 - 15
||More than 30 min but less than 24 hr
||Lasting 24 hr up to 7 days
||9 - 12
||More than 24 hr
||Lasting 7 days of more
||8 or less
What is the Glasgow Coma Scale? The Glasgow Coma Scale is used to help determine the severity of TBI. Responses are scored using three measures (eye opening, best verbal response, and best motor response) and are scored separately, and then combined.
|Eye Opening (E)
|Best Motor Response (M)
|To verbal command: obeys
|To painful stimulus: localizes pain
|Best Verbal Response (V)
|Oriented and converses
|Disoriented and converses
Score: Eye score (E) + Motor score (M) + Verbal score (V) = 3 to 15
What are the signs and symptoms of moderate and severe TBI?
Signs and symptoms of moderate and severe TBI are dependent upon the type of injury and area of the brain that was injured. Some general symptoms include:
- severe headaches
- inability or difficulty speaking, understanding and concentrating
- confusion, restlessness or agitation
- loss of or changes in coordination
- memory loss/amnesia
- vision changes or loss of vision
- paralysis and/or muscle spasticity
- chronic pain
- sleep disturbances
- inability or changes in ability to use senses of taste, touch, sight, sound, smell and taste
- loss of bowel and/or bladder control
What is a penetrating head injury?
A penetrating head injury is a brain injury in which an object pierces the skull and enters the brain tissue.
What is a blast injury?
A blast injury is trauma or damage occurring as the result of a violent explosion or the wave of pressure from an explosion.
How long will my symptoms last?
Symptoms of mild TBI or concussion often resolve within hours to days and almost always improve over 1-3 months. Patients with moderate to severe TBI often have long-term medical problems that require specialized attention. However, keep in mind that the symptoms and effects will vary greatly from one patient to another, depending on the severity of the TBI and location of the injury.
What therapies will aid my rehabilitation?
There are a variety of therapies available and your medical team will make recommendations depending on your personal needs. A few therapies that may be prescribed are:
- Physical Therapy
- Speech Therapy
- Cognitive Therapy
- Psychological Assessment/Therapy
- Occupational Therapy
- Therapeutic Recreation
What is a Case Manager and why do we need one?
A case manager is a nurse or a social worker who will help guide you and your family through the TBI journey. The case manager will coordinate the services and therapies needed for your optimal recovery by working with you and your healthcare team. The case manager will design a plan of care based on your providers recommendations and customized to meet your needs. They will also assist you with finding available local resources for medical, social and financial issues.
What disabilities can result from a TBI?
Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the patient. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).
What is PTSD?
Post Traumatic Stress Disorder (PTSD) is a condition that may occur to people who have lived through or witnessed events perceived by the person to be life-threatening. Examples of traumatic events include:
- Military/combat exposure
- Physical/sexual assault or abuse
- Terrorist attacks
- Natural disasters (fires, floods, hurricaines, earthquakes)
- Serious accidents (car wreck, explosions, collisions)
What are the symptoms of PTSD?
- Re-living the traumatic event/experience
- Avoiding situations/environments that remind you of the event
- Feeling numb or detached
- Hyperarousal (constantly alert, on edge, jittery, on the look out)
- Sleep problems
- Personality changes
People with PTSD may also have chronic pain, depression, problems with personal, professional and social relationships and/or substance abuse.
How is PTSD treated?
Treatments for PTSD may include taking medications to control or minimize symptoms. Cognitive-Behavioral Therapy (CBT) is a form of counseling which has been shown to be very effective for treating PTSD. CBT may include exposure therapy and/or cognitive therapy. Your provider will be customize your treatment to meet your personal symptoms and needs.
What is the Defense and Veterans Brain Injury Center (DVBIC)?
DVBIC is a group of multi-site TBI programs in Department of Defense (DOD) and Department of Veterans Affairs (VA) hospitals and civilian TBI rehabilitation programs. These DVBIC sites work collaboratively to provide and improve TBI care for active duty military, veterans and their eligible beneficiaries. DVBIC’s goal is to ensure expert care coordination and individualized, evidence-based treatment to each patient in order to maximize function and decrease or eliminate TBI-related disability. DVBIC works to provide services and supports to help an individual with TBI return to duty, work and community.