Traumatic Brain Injury

S+S of Mild TBI

15% of people with mild TBI have symptoms last 1 year Headache Impaired vision Difficulty thinking clearly Dizziness Nausea and vomiting (early) Difficulty remembering information Irritability Sleeping more or less than usual Sensitive to noise Balance problems Seizures Depression Memory loss

Epidemiology

2013: 2.8 million TBI related emergency department visits, hospitalizations and deaths occurred TBI contributed to the deaths of nearly 50,000 people In 2012, an estimated 329,290 children (age 19 or younger) were treated in U.S. emergency departments for sports and recreation-related injuries that included a diagnosis of concussion or TBI

Causes of TBI

3 Top causes of TBI (2013): Falls (47%) (54%) children 0 to 14 years were caused by falls (79%) adults aged 65 and older were caused by falls Blunt trauma (15%) Being struck by or against an object (22%) children less than 15 years of age were caused by being struck by or against an object. Motor vehicle crashes (14%) Other causes: assault, firearms Firearm TBI are usually fatal: 9/10 will die People with TBI are susceptible to spinal cord injuries

Potential Effects of Severe TBI

A non-fatal severe TBI may result in an extended period of unconsciousness (coma) or amnesia after the injury. For individuals hospitalized after a TBI, almost half (43%) have a related disability one year after the injury. A TBI may lead to a wide range of short- or long-term issues affecting: Cognitive Function (attention and memory) Motor function (extremity weakness, impaired coordination and balance) Sensation (hearing, vision, impaired perception and touch) Emotion (depression, anxiety, aggression, impulse control, personality changes)

Diagnosis

CAT/CT Scan, MRI, PET Scan Cognitive evaluation Ranchos Los Amigos scale- measure awareness, cognition, and behavior

Diffuse axonal injury

AKA: Deceleration of Acceleration Injury Differential movement of the skull and brain when the head in struck Results in direct brain injury from axonal shearing and brain swelling Axonal shearing - Brain is slammed back/forth in the skull, axons are stretched and compressed to where they are from Ex: Child abuse such as Shaken Baby Syndrome

Traumatic Brain Injury (TBI)

Acquired brain injury Sudden trauma causes damage to the brain Symptoms range from mild to severe The severity of a TBI may range from "mild" (a brief change in mental status or consciousness) to "severe" (an extended period of unconsciousness or memory loss after the injury). Most TBIs that occur each year are mild, commonly called concussions.

Risk Factors

Any person is at risk for TBI Children, teenagers, elderly are high risk Males have 1.5x higher risk than females Males 3x more likely to die from injuries Elderly more likely to die from a TBI

Measures of Severity

Duration of loss of consciousness: (LOC) Classified as mild (mental status change or LOC < 30 min), moderate (mental status change or LOC 30 min to 6 hr), or severe (mental status change or LOC >6 hr) Posttraumatic amnesia (PTA): The time elapsed from injury to the moment when patients can demonstrate continuous memory of what is happening around them Glasgow Coma Scale - add the value for score Estimates the outcomes of the brain injury on a 3- to 15-point scale, assesses level of consciousness and neurologic functioning Motor Response Verbal Response Eye opening

Open Head Injury

Focal damage Penetration of skull Ex: Bullet wound

Closed Head Injury

Focal damage and diffuse damage to axons Broad injury No penetration of skull Ex: Slip, Fall, Car accident

Tools to Measure Outcome after TBI

Functional Independence Measure: An 18-item scale used to assess the patient's level of independence in mobility, self-care, and cognition Glasgow Outcome Scale Disability Rating Scale: Measures general functional changes over the course of recovery after TBI

Treatment

Initial treatment - stabilize the patient Rehabilitative care - restore the patient Acute treatment of TBI if needed Surgical treatment if needed - maintain blood flow and oxygen to brain Medications Antidepressants Muscle relaxants Anticonvulsants Antipsychotics Antihypertensives Stimulants

Effects of Injury

MILD- most prevalent, often missed at time of injury Loss of consciousness, confusion, disorientation shorter than 30 minutes MRI and CAT scans often normal Some cognitive problems MODERATE Loss of consciousness for 20 minutes to 6 hours and Glasgow Coma Scale of 9 to 12 SEVERE Loss of consciousness for more than 30 minutes Memory loss after the injury lasting more than 24 hours Limited arm and leg function Abnormal speech or language Loss of thinking Emotional distress

Dental Considerations

Mouth guards if tolerable for those at higher risk for TBI Medications Toothbrush adaptations Saliva substitutes Dysphagia management Tube fed - low caries risk, fast calculus build-up, aspiration risk Possible wheel chair transfers Modifications to dental office Restorative treatment

Mechanism of Injury

Open head injury Closed head injury Deceleration injury (aka Diffuse Axonal) Other mechanisms: chemical, hypoxia, tumors, infections, strokes. Not usually a TRUE TBI because of the cause

Oral Manifestations

Oral trauma from the TBI Non-vital teeth Lacerations Intrusion of teeth Chipped teeth Lesions on lip, mucosa Mobility Attachment loss Missing teeth Retained root tips Inadequate oral hygiene from poor dexterity, ataxia, spasticity, cognitive impairments Xerostomia GERD Bruxism

S+S of Moderate to Severe TBI

Poor concentration Distractibility Memory loss Poor speed of processing Confusion Difficulty with language processing Difficulties with speech Difficulty interpreting touch, temperature, movement, limb position Lack of control of bowels and bladder Loss of smell and taste Seizures Loss of stamina Appetite changes Poor emotional control Partial or total loss of vision Involuntary eye movement Intolerance of light Decreased or loss of hearing Tinnitus- ringing in ears Chronic pain

TBI-related deaths (2013)

Rates were highest for persons 75 years of age and older. The leading cause of TBI-related death varied by age. Falls were the leading cause of death for persons 65 years of age or older. Intentional self-harm was the leading cause of death for persons 25-64 years of age. Motor vehicle crashes were the leading cause of death for persons 5-24 years of age. Assaults were the leading cause of death for children ages 0-4 years. Shaken Baby Syndrome (SBS), a form of abusive head trauma (AHT) and inflicted traumatic brain injury (ITBI), is a leading cause of child maltreatment deaths in the United States. Inconsolable crying often triggers the abuse.

Prevention of a TBI

Seat belts Car seats (rear facing up to age 2, front facing up to at least age of 5, booster seat up to age of 9) Helmets Remove tripping hazards for those at risk Grab bars in shower/next to toilet Handrails on stairs Non-slip mats Improved lighting Window guards Safety gates Reduce risky behaviors Playground made of shock absorbing material: hardwood mulch or sand

TBI Classification

TBI's are classified as mild, moderate or severe.