What is a Traumatic Brain injury (TBI)
A Traumatic Brain Injury or TBI is blow, jolt or penetration of the head which disrupts normal brain function.
There are open (skull breakage) and closed (no skull breakage) head injuries which are TBIs. These help categorize potential patient issues and rehabilitation needs, however, each brain and each injury is slightly different and this is not an exact science.
Primary Medical Team, Testing and Scans
To further categorize and assist the primary medical care team in TBI, Scans and Testing may be needed. The primary medical care team is typically made up of: physiatrists, neurologists, psychotherapists, speech and language pathologists,occupational therapists,advocates,and other care providers.
Typically, neurological exams, usually, Neuro-psychological Testing, is needed in order to identify strength and weakness in the various functional areas of the brain of the TBI patient. Neuro-psychological Testing, is an actually functional test with quantitative results demonstrating correlation to a TBI and brain functionality.
Scans are another tool to help the primary medical team. Scans can identify areas of damage, swelling, or bleeding and more importantly help to stabilize and treat the TBI patient. Typical scans are Magnetic Resonance Scanning (MRI), PET, and sometime CAT scan. These are tools to identify patient brain structure, morphology, and potential areas of trauma,and function loss.
These tests vary depending on the whether the TBI is open- or closed-head injury, based on how a patient is presenting and on degree of known trauma.
Treatment Plans for TBIs
The various neurological tests and scans administered to TBI patients are evaluated and quantified, and this provides a basis for rating the TBI as mild, moderate, severe. Once a medical team has this valuable data from these various testing sources (all may not be needed), a cogent plan of rehabilitation and recovery can be put together for a TBI patient.
Note that the human brain is very complicated. Though the rehabilitation and recovery plan is a start, more is needed. Goals from the rehabilitation plan need to be monitored and readjusted. This occurs once the TBI patient has started active rehabilitation. Testing and scans are good initial indicators of severity of injury and deficiency, however, when actual rehabilitation begins the various health care providers typical find areas that are much better than indicated by testing and some areas which have deficiencies which did not show up in previous testing.
TBIs are tricky and there is still a lot to learn about assessment, plan of treatment and rehabilitation. But more education and awarenes will hopefully bring more research and discovery of improved treatment methods.
TBIs are also very costly and show very disturbing trends which need to be known. We need to help the silent epidemic of TBI become less of a family, health care and financial burden.
Centers for Disease Control and Prevention (CDC) have websites and data which show the disturbing trends of the silent epidemic called TBI (April,2008). Please note that these numbers may be low as the population has increased since these data were collected.
CDC states 1.4 million Traumatic Brain Injuries (TBIs) in the USA each year.
- 50,000 die
- 235,000 hospitalized
- 1.1 million treated and released and need follow up care
Among children ages newborn to 14 years old
- 2,685 deaths
- 37,000 hospitalizations
- 435,000 emergency room visits
The reason these numbers so important and so disturbing are because TBIs contribute to many deaths and disability annually. CDC estimates at least 5.3 million Americans (approx. 2% of population) currently have long-term or lifelong Activities of Daily Living (ADL) need due to TBI.
Direct medical costs and indirect cost are estimated to be $60 billion US per year by CDC (2001).
What are the major causes of TBIs?
CDC data indicate (April 2008):
- Fall 28%
- Motor vehicle-traffic crashes 20%
- Struck by some or against something 19%
- Assaults 11%
This information is especially alarming as our growing elderly population and children are at the highest risk. If you look at the data- the falls and struck by or on something category is approximately 50% or more. This number is likely much higher as many people do not seek care when they fall or are hit on/in the head.
The elderly population, many times may not seek care due to financial constraints, embarrassment, or they may not be aware that they are injured after a fall or hit to the head.
If you have an elderly loved one or friend who says they fell or were struck on the head with something, please try to get them medical attention. Even a minor fall of strike to the head could cause a TBI. Additionally, many may not realize they are injured or may not remember the injury. In this case, observe if there is erratic behavior and if that is the case, they should seek medical attention. Of course, not all injuries and symptoms mean a patient has suffered a TBI. The issue is that TBI is a silent epidemic and we need to become more educated on what a TBI is, what are the symptoms, and how can patients be helped. This is especially important to help our aging elderly community and our children.
Children Up to Age 14
To me personally, the more disturbing trend is with children. Children in the United States often play contact sports, such as hockey, lacrosse and football and even non-contact sports like baseball, softball, volleyball etc. Many times a young athlete is not aware of the implications of playing sports with a concussion, post-concussion, both of which are TBIs. The parents or coaching staff should be qualified enough to ensure proper equipment, conditioning, and injury identification and, especially TBI recovery period.
What is this time period. A child should not return to physical activity until it is determined that all symptoms of the concussion, post-concussion or TBI have dissipated. Until this happens, they need rehabilitate and heal. Many do not. Please listen to your health care team and do not return your child to athletics until they are medically cleared.