Anytime, anywhere, anyone. Brain injuries don’t discriminate. Every year, 1.7 million people suffer brain injuries. Yet, it is a mostly silent epidemic. Often, the injury and ongoing symptoms remain unrecognized.
The severity of brain injury is described in three categories: mild, moderate, and severe. The assessment of severity is made at the time of injury, using physical exam and the Glasgow Coma Score (GCS). The GCS measures the response in three areas; eye-opening, verbal response, and motor response. The total score possible is 15. In a mild TBI, the GCS is 13-15; moderate 9-12; and severe 8 and below. The severity of the injury does not necessarily indicate the level of symptoms and ongoing disability a person can experience. Even in a mild TBI, it is possible for someone to have ongoing difficulties in function. However, usually the person recovers full function.
Symptoms of TBI
Mild: headache, fatigue, sleep disturbance, irritability, sensitivity to light and/or sound, balance problems, decreased attention span and/or concentration, decreased speed of thinking, memory problems, depression and/or anxiety, and emotional mood swings. Loss of consciousness is not necessary. People with mild TBI generally recover fully.
Moderate: The symptoms of mild TBI are present in moderate injury. A moderate TBI occurs when there is a loss of consciousness that lasts over 30 minutes. Confusion lasts from days to weeks. Physical, cognitive, and/or behavioral impairments last for months or are permanent. People with moderate TBI generally can make a good recovery with treatment and successfully learn to compensate for their deficits. Some may make full recovery.
Severe: In severe TBI, there can be a loss of consciousness for days, weeks, or months. Severe TBI is broken into subgroups, depending on the symptoms.
Head injuries can either be open (fracture or displacement of the skull) or closed (no fracture or displacement). There are six types of skull fractures associated with head injuries. Each type of fracture can cause additional medical issues. With closed head injuries, the swelling in the brain can press against the skull or into the sinuses. This also causes an increase in intracranial pressure, the pressure within the skull. Swelling and pressure within the brain can be life threatening.
Causes of TBI
According to the Centers of Disease Control and Injury Prevention Center, the leading causes of TBI are: falls (35.2%), motor vehicle accidents (17.3%), struck by or against (16.5%), assault (10%), and unknown/ other (21%). The hallmark injury of the wars in Iraq and Afghanistan is Traumatic Brain Injury. The most frequent cause is explosions, either IEDs or mortar fire.
Outcomes of TBI
Brain injury can result in a number of different outcomes. Every year, 52,000 people die, 275,000 are hospitalized, and 1,365,000 are treated and released from Emergency Rooms. I was treated and released. However, I later went on to develop more serious symptoms. If it weren’t for the intervention of my friends and co-workers, my recovery would have been greatly complicated. At one point, I had let water boil on the stove until it was mostly evaporated. Any brain injury needs to be taken seriously. The injured person needs a watchful support network to help improve recovery and safety.
The long-term outcome of TBI varies by individual. It ranges from complete recovery, to severe disability, to death. Often, individuals will be fully functional but may have some continuing symptoms. Even in mild TBI, ongoing symptoms may be present. The most improvement of the injury occurs within the first 18 months post injury. It is vital to protect the individual from additional head injuries during this time.
Repeated head injuries
Repeated mild TBI can result in significant long-term neurological and functional deficits. The majority of the research conducted in this area has been in athletes in football, boxing, and soccer. Numerous studies of boxers and football players have uncovered a form of dementia caused by repeated mild head trauma. In addition, lower responses in neuropsychological function and slower healing from progressive head injuries have been noted. Difficulties in the visual cortex and balance have also been noted. Healing from progressive head injuries may leave permanent change in function.
Impact of head injuries
Head injury not only affects the injured individual but also the families, friends, and communities. Depending on the level of disability, the individual may require continued speciality care. The victim may never recover independent function. Families, friends, and the individual must grieve the losses and discover a new way to live. Even in mild TBI, the individual may have permanent mood, mental, or emotional changes. The individual must adjust to the “new normal” of life post-injury.
Brain injury is unpredictable. Each brain injury is different and the impact on the person varies. Our brains impact who we are, how we act, how we feel, how we think. Injury can change everything. In one second, my life changed. The long-term outcome is still unknown. The unknown is the most difficult part.
Take time to learn more about Traumatic Brain Injury during March. The information may change your life or the life of someone you love.
The information in this blog was taken primarily from the Brain Injury Association of America website, available here: http://www.biasua.org The BIAA website contains a wealth of information and links.
The information about repetitive brain injury was taken from MedScape: Repetitive Brain Injury Syndrome by David Cifu. Available here: http://emedicine.medscape.com/article/92189-overview
Other useful resources:
Centers of Disease Control and Prevention: http://www.cdc.gov/TraumaticBrainInjury/
Defense and Veterans Brain Injury Association: http://www.dvbic.org/