Traumatic and Acquired Brain Injury #4066

MILD Loss of Consciousness

- 0-30 minutes *A loss of consciousness does not always occur

A TBI is a type of acquired brain injury that disrupts the normal function of the brain and is caused by:

- A blow to the head - A penetrating head injury

Mild brain injuries are deceptive:

- A person may look "normal" and feel "fine" - Mild brain injuries are often unrecognized and undiagnosed - A "mild" brain injury can have just as severe consequences as a "severe" brain injury - Multiple "mild" brain injuries can exponentially increase the consequences and even lead to death

Frontal lobe functions

- Attention - decision making - social behavior - concentration - personality - memory - awareness of abilities and limitations - emotions - planning - problem solving - impulse control

Who is at risk for brain injury?

- Children ages 0-4 and Adolescents ages 16-19 - Older adults age 75+ - Domestic Violence Survivors - Athletes - Adult and Juvenile offenders - Homeless - Veterans

Exposure to Toxins

- Cleaning products - pesticides (DDT/DDE, Chlorpyrifos) - PCB's - arsenic - ethanol - toluene

Drug Induced

- Cocaine - Methamphetamines - Inhalants - MDMA

The easiest way to think about how a brain injury can affect a person is to split up the effects into three categories:

- Cognitive Changes - Emotional/Behavioral Changes - Physical Changes

Traumatic Brain Injuries:

- Concussion - violence - blast injury - struck by or against something - falls - motor vehicle crash - abusive head trauma - shaken baby syndrome - sports injuries

Determining the severity of a brain injury usually depends on four factors:

- Confusion/ Disorientation - Loss of Consciousness - Memory Loss - MRI/CT/Imaging

Cognitive Changes:

- Difficulty with memory - Personality change - Lack of concentration - Delayed thinking/processing - Reckless decision-making - Difficulty communicating and understanding

As a first responder, you have an impact on these very aspects of health when you respond to:

- Domestic Violence - Elderly falls - Public Intoxication - Strokes - Heart Attacks - Juvenile Misconduct - Drug activity - Assault - Suspicious person/activity - Child abuse and negligence - Trauma - DWIs - Motor vehicle accidents - Mental health concerns - Welfare concerns - Suicide attempts/completions

TBI Vision issues

- Double vision - Nystagmus - Reduced visual acuity or visual field - Trouble with depth perception

How does Brain Injury happen?

- Falls: Falls from heights like buildings, trees, ladders, bicycles, etc., as well as small falls like slips, tumbles down steps, and loss of balance. - Struck by/against something: falling debris, motor vehicles, violence, etc. - Motor vehicle crash: Cars, motorcycles, ATVs, etc. - Violence: Domestic violence, gang violence, assault, shaken baby syndrome, etc. - Explosion/Blast Injury: Military service members (combat and non-combat positions), civilians, journalists, etc. - Concussion: Sports-related injuries, motor vehicle crashes etc.

TBI Impaired Hearing

- Hearing loss - Difficulty differentiating sets of sounds from background noise - Auditory agnosia-not recognizing the meaning of sounds

Emotional/Behavioral Changes

- Irritability - Aggression - Anxiety/Depression - Mood swings - Inappropriate social behavior - Impulsivity

What are the different types of brain injuries?

- Neurological Damage - Abusive Head Trauma - Stroke - Brain Damage - Shaken Baby Syndrome - Head Injury - Concussion

Anoxia/Hypoxia:

- No oxygen or too little oxygen is making it to the brain - Near drowning, asphyxiation, strangulation, aspiration, etc.

Each person will experience TBI changes differently:

- Not every person will experience changes - A person may experience a few changes or many - Changes can be mild or severe - Many individuals don't know they have sustained a brain injury, and don't realize these changes have a cause - Overstimulation, being upset or irritated, and/or anxiety can increase the level at which these changes are displayed.

An acquired brain injury is an injury to the brain which:

- Occurs after birth - Is not related to a congenital or a degenerative disease - Can cause temporary or permanent impairments that result in physical, emotional, and intellectual difficulties.

What will TBI Emotional/Behavioral changes look like?

- Physical and verbal outbursts - Depression/anxiety - Inappropriate sexual behavior - Makes impulsive decisions - Difficulty reasoning and concentrating - Inappropriate laughing or crying - Inappropriate social behavior

Physical Changes:

- Poor balance - Impaired fine motor skills - Impaired hearing - Vision issues - Persistent talking - The inability to speak - Slurred speech - Muscle tremors - Chronic headaches - Incontinence - Seizures

Assorted causes of Non-traumatic Brain Injury

- Stroke - Infection: Meningitis, Encephalitis, etc. - Anoxia/Hypoxia: No oxygen or too little oxygen is making it to the brain Near drowning, asphyxiation, strangulation, aspiration, etc. - Brain Tumors - Aneurysm - Exposure to Toxins: C leaning products, pesticides (DDT/DDE, Chlorpyrifos), PCB's, arsenic, ethanol, toluene, etc. - Drug Induced: Cocaine, Methamphetamines, Inhalants, MDMA, etc.

Non-Traumatic brain Injury:

- Stroke - drug induced - anoxic brain injury - exposure to toxins - meningitis - encephalitis - brain tumors - near drowning - infection - aneurism

What will TBI cognitive changes look like?

- Struggles following conversations - Difficulty finding a word to say - Needs things repeated several times - Is unable to recognize words they once knew - Difficulty following instructions - Is easily distracted - Has trouble following directions - Doesn't pay attention to conversation - Can't remember answers to simple questions - Makes reckless decisions

Common Comorbidities include:

- Substance use/abuse - Sleep problems - Depression and suicidality - Epilepsy - Neurodegenerative diseases (EX. ALS, Alzheimer's, dementia, etc.) - Fatigue

What are the different terms of brain injuries?

- Traumatic Brain Injury/TBI - Knocked Out

What will TBI physical changes look like?

- Uncooperative - Disrespectful - Indifferent - Defiant - Rude - Vulgar - Reckless - Detached - Irrational - Dismissive - Evasive - Unapproachable - Unresponsive - Dazed - In shock - "Airheaded" - "Out of it" - Aloof - Senile - "Socially awkward" - As if they are under the influence of alcohol and/or drugs

Examples of public figures who sustained brain injuries:

-Tracy Morgan: TBI from car crash -Gabby Giffords: TBI from gunshot wound -Lamar Odom: Drug-induced strokes -Natasha Richardson: TBI from ski accident -George Clooney: TBI from accident while filming -Bob Woodruff: TBI from blast injury -Ronald Dahl: TBI from plane crash -Bret Michaels: Stroke -Stevie Wonder: TBI from car crash -Dwight D. Eisenhower: Stroke -Kurt Vonnegut: TBI from fall

Veteran's advocates estimate that _____% - _____% of Iraq veterans and service members have some level of brain injury.

10-20

Over 2.2 million people sustain a traumatic brain injury in the United States each year. Over ___________ of those injuries are in Texas.

144,000

Studies estimate the prevalence of TBI in domestic violence survivors is over ______%

35

There is an estimated prevalence of TBI in Adult and Juvenile offenders imprisoned populations is _______%.

60.3

Older adults age ______ have highest rates of TBI-related hospitalizations and deaths among all age groups.

75+

________% of traumatic brain injuries seen are mild TBIs. Many individuals who sustain these injuries will recover and may not suffer many long term changes. However, it should be noted that ________ injuries are a major public health concern.

75; mild

Brain injuries can fit under the broad term of ___________ __________ _________.

Acquired Brain Injury

Cerebellum

Balance and Coordination

Brain Stem

Breathing, heart rate, and temperature

Brain injury affects every aspect of health. According to the World Health Organization, "___________ is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

Health

Temporal Lobe

Hearing, learning, and emotions

The effects of brain injuries were recorded by early writers and doctors such as Hippocrates, _________, and Aristophanes.

Homer

_______-____________ brain Injury: Stroke, drug induced, anoxic brain injury, exposure to toxins, meningitis, and encephalitis, brain tumors, near drowning, infection, and aneurism.

Non-Traumatic

______-__________ brain injuries are just as serious and life altering as TBIs.

Non-traumatic

_____________ is an ongoing process throughout life.

Recovery

Frontal Lobe

Thought, memory, and behavior

_____________ Brain Injuries: Concussion, violence, blast injury, struck by or against something, falls, motor vehicle crash, abusive head trauma, shaken baby syndrome, sports injuries.

Traumatic

______________ brain injury is the leading cause of death and disability in children and adults.

Traumatic

How common is a brain injury?

Traumatic brain injury is the leading cause of death and disability in children and adults. Over 2.2 million people sustain a traumatic brain injury in the United States each year. Over 144,000 of those injuries are in Texas.

Occipital Lobe

Visual Processing

All traumatic brain injuries and non-traumatic brain injuries are types of _____________ brain injuries.

acquired

Over 1.6 million sports and recreation-related concussions occur to __________ in the U.S. each year.

athletes

An acquired brain injury is an injury to the brain which occurs after __________.

birth

A TBI may be a ___________- or an open-head injury.

closed

A __________-head injury is when the skull stays intact.

closed

The brain is the control center for our physical, emotional, and ____________ activities. When someone is living with a brain injury, some of those activities are ___________.

cognitive; altered

The effects a brain injury can have on a person often leads to the development of ________________.

comorbidities

Two or more simultaneously present chronic diseases or conditions are known as _________________. (Brain Injury + a chronic disease or condition)

comorbidities

An acquired brain injury is an injury to the brain which is not related to a _____________ or a degenerative disease.

congenital

People sustain brain injuries while riding in a car, sitting at a _________, playing their favorite sport, etc.

desk

So when someone sustains a brain injury in their __________ lobe, the functions of the frontal lobe are affected.

frontal

In a comparison of multiple studies, the prevalence of TBI in _____________ populations is between 30% and 40%.

homeless

An acquired brain injury is an injury to the brain which can cause temporary or permanent _____________ that result in physical, emotional, and intellectual difficulties.

impairments

The number of people who go undiagnosed, misdiagnosed, and untreated is _______________.

incalculable

While we call them "___________" it is more accurate to think of a brain injury as a chronic condition.

injuries

Multiple "________" brain injuries can exponentially increase the consequences and even lead to death.

mild

The severity of a brain injury can range from ________, to moderate, to _____________.

mild; severe

The number of people who are diagnosed with a brain injury each year is __________ than the number of people diagnosed with Alzheimer's, breast cancer, HIV/AIDS, prostate cancer, lung cancer, and ALS....combined. That doesn't include the number of individuals who experience other types of brain injuries, such as stroke (800,000 each year in U.S.), anoxic brain injury, hypoxic brain injury, encephalitis, drug induced brain injury, etc.

more

Though the labels seem to imply that one brain injury is __________ than another-that is not always the case.

worse

True or False: Recovery is the same for everyone.

False. Recovery is different for everyone

MRI/CT/Imaging

For all levels of severity, imaging results may come back normal or abnormal. Certain chemical and physical reactions are not picked up by these tests, so this should not be the only determining factor when diagnosing a brain injury.

Charles Dickens, Novelist:

Died from a stroke at age 58.

Often a brain injury affects multiple parts of the brain. __________ __________ injuries can damage cells throughout the brain.

Diffuse axonal

Parietal Lobe

Language and touch

MILD Confusion/Disorientation

Less than 24 hours

MILD Memory Loss

Less than 24 hours

Infection:

Meningitis, Encephalitis, etc.

_________ brain injuries are deceptive and a person may look "normal" and feel "fine".

Mild

_________ brain injuries are often unrecognized and undiagnosed

Mild

SEVERE Confusion/Disorientation

More than 24 hours

SEVERE Loss of Consciousness

More than 24 hours

MODERATE Memory Loss

More than 24 hours but less than 7 days

MODERATE Confusion/Disorientation

More than 30 minutes but less than 24 hours

MODERATE Loss of Consciousness

More than 30 minutes but less than 24 hours

SEVERE Memory Loss

More than 7 days

Children ages 0-4 and Adolescents ages 16-19

Most likely to have TBI-related ED visit or hospitalization

_____________ often go on to live the rest of their lives coping with the effects of their injuries.

Survivors

Abraham Lincoln, 16th U.S. President:

Sustained a TBI when a mule kicked him in the back of the head. He then went on to suffer from depression throughout his life.

Phineas Gage, railroad worker, first recorded neurological patient:

Sustained a TBI when an iron rod penetrated his skull.

Harriet Tubman, abolitionist and humanitarian:

Sustained a TBI when she was hit by a heavy metal weight. Suffered from epilepsy, headaches, and sleeping spells as a result.

A ______-___________ brain injury is a type of acquired brain injury that disrupts the normal function of the brain and is caused by an internal event, rather than an external force.

non-traumatic

Others may have to learn what their "new ___________" is (ex. limitations, adaptations, etc.)

normal

Some individuals may feel that they have returned to "____________".

normal

An _________-head injury is when an object penetrates the skull and enters the brain.

open

No one _________ to have a brain injury. Brain injuries often come as complete shocks to individuals and their families.

plans

To grasp the magnitude of this __________ health problem (TBI), it might help to think about people we know of who sustained brain injuries.

public

While some populations have a higher risk of sustaining a brain injury, the _____________ is.....brain injuries can happen to anyone, anywhere, and at any time.

reality

Advancements in medicine, therapy, and research have made it possible for a person to make a great _____________, but each individual is different.

recovery

Unlike the healing of a broken bone, a relatively quick process that will end and allow individuals to return to the life they knew before...the ____________ process for brain injuries is ongoing and changing.

recovery

Don't let your eyes deceive you. Even if a person looks "normal" or feels "fine," there may be changes you can't ________. All brain injuries need to be taken seriously.

see

A "mild" brain injury can have just as severe consequences as a "__________" brain injury

severe