What Is A TBI?

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Traumatic brain injury occurs when an external mechanical force causes brain dysfunction. Traumatic brain injury (TBI) is a complex injury with a broad spectrum of symptoms and disabilities. The impact on a person and his or her family can be devastating.

Traumatic brain injury, often referred to as TBI, is most often an acute event similar to other injuries. That is where the similarity between traumatic brain injury and other injuries ends. One moment the person is normal and the next moment life has abruptly changed.

A brain injury is different from a broken limb or punctured lung. An injury in these areas limit the use of a specific part of your body, but your personality and mental abilities remain unchanged. Most often, these body structures heal and regain their previous function. Brain injuries do not heal like other injuries. No two brain injuries are alike and the consequence of two similar injuries may be very different. Symptoms may appear right away or may not be present for days or weeks after the injury. Some symptoms last days or weeks, while others can last years, or a lifetime.

TBI is a common injury that is often missed initially when a medical team is focused on saving the individual’s life. Although the medical technology has advanced significantly, the effects of TBI are significant.  Some of the symptoms of traumatic brain injury can look like emotional or behavioral problems, even though they are actually due to TBI.  Some people may recognize TBI symptoms immediately, while for others, these symptoms don’t show up right away or can be ignored or minimized at first.  Ignoring symptoms of a TBI could make the symptoms worse and recovery more challenging and prolonged.

The mechanisms of the highest causes of brain injury: Open head Injury, Closed Head Injury, Deceleration Injuries, Chemical/Toxic, Hypoxia, Tumors, Infections and Stroke.

Most Common Causes are:

  • Falls
  • Motor vehicle accidents
  • Violence, such as gunshot wounds, child abuse, or beatings
  • Injuries from sports or during combat (such as explosions)

Mild Traumatic Brain Injury (Glasgow Coma Scale score 13-15)

Mild traumatic brain injury occurs when:

  • Loss of consciousness is very brief, usually a few seconds or minutes
  • Loss of consciousness does not have to occur—the person may be dazed, confused or disoriented. A mild traumatic brain injury is diagnosed only when there is a change in the mental status at the time of injury. The change in mental status indicates that the person’s brain functioning has been altered, this is called a concussion by many providers (a concussion is a brain injury).
  • Testing or scans of the brain may appear normal

Moderate Traumatic Brain Injury (Glasgow Coma Scale core 9-12)

Most brain injuries result from moderate and minor head injuries. Such injuries usually result from a non-penetrating blow to the head, and/or a violent shaking of the head. As luck would have it many individuals sustain such head injuries without any apparent consequences. However, for many others, such injuries result in lifelong disabling impairments.

A moderate traumatic brain injury occurs when:

  • A loss of consciousness lasts from a few minutes to a few hours
  • Confusion lasts from days to weeks
  • Physical, cognitive, and/or behavioral impairments last for months or are permanent.
  • Testing or scans of the brain may appear normal

Persons with moderate traumatic brain injury generally can make a good recovery with treatment or successfully learn to compensate for their deficits.

Severe Brain Injury 

Severe head injuries usually result from crushing blows or penetrating wounds to the head. Such injuries crush, rip and shear delicate brain tissue. This is the most life threatening, and the most intractable type of brain injury.

Typically, heroic measures are required in treatment of such injuries. Frequently, severe head trauma results in an open head injury, one in which the skull has been crushed or seriously fractured. Treatment of open head injuries usually requires prolonged hospitalization and extensive rehabilitation. Typically, rehabilitation is incomplete and for most part there is no return to pre-injury status. Closed head injuries can also result in severe brain injury.

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TBI can cause a wide range of functional short- or long-term changes affecting thinking, sensation, language, or emotions.

TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.

Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.

Signs and Symptoms of a Brain Injury

  • Headache
  • Nausea and/or Vomiting
  • Dizziness, loss of balance
  • Clear fluid draining from nose or ears
  • Visual disturbances, visual changes, blurred vision, slanted vision, double vision, Visual processing issues
  • Fatigue, drowsiness, difficulty sleeping, sleeping more than usual, insomnia, inability to awaken someone from sleep
  • Endocrine or hormone changes. Common problems can include reduced sex drive (loss of libido or interest), difficulties with sexual functioning (such as erectile problems) and behaving sexually at inappropriate times or in inappropriate ways.
  • Amenorrhea or menses irregularity (for women)
  • Sensory problems, ringing in the ears, a bad taste in the mouth or changes in the ability to smell, difficulty writing or understanding speech, change in tastes
  • Sensitivity to different types of lights and or sounds
  • Memory loss, concentration problems, slurred speech, delayed response to questions
  • Mood changes, mood swings, anxiety, depression, anxious, personality changes, agitation, combativeness or other unusual behavior
  • Convulsions or seizures
  • Dilation of one or both pupils of the eyes
  • Weakness or numbness in fingers and toes

Brain Injury in Infants and Children

The Centers for Disease Control and Prevention (CDC) report that traumatic brain injury (TBI) is the number one cause of disability and death among children and adolescents in the United States. Kids with brain injuries might not be able to communicate headaches, sensory problems, confusion and similar symptoms.

Modes of injury include motor vehicle accidents, bicycle accidents, falls, sporting injuries, and child abuse.

The symptoms of a brain injury in children are similar to the symptoms experienced by adults, the functional impact can be very different though. The major difference between children and adults with brain injury is that with adults there are prior academic records, I.Q. scores, and job histories to rely on. The brain of a child is continuing to develop. The cognitive impairments of children may not be immediately obvious after the injury but may become apparent as the child gets older and faces increased cognitive and social expectations for new learning and more complex, socially appropriate behavior. These delayed effects can create lifetime challenges for living and learning for children, and everyone they are associated with. Some children may endure lifelong physical challenges.

Some things to keep in mind, are that the greatest challenges many children with brain injury face are changes in their abilities to think, learn, and develop socially appropriate behaviors. Common deficits after brain injury include difficulty in processing information, impaired judgment and reasoning. When an adult is injured, these deficits can become apparent in the months following the injury. For a child, it may be years before the deficits from the injury become apparent.

Prior information was  a child with a brain injury would recover better than an adult because there was more “plasticity” in a younger brain, but recent research has shown that this is not the case. A brain injury actually has a more devastating impact on a child than an injury of the same severity on a mature adult.

In a child with traumatic brain injury, you may observe:

(any of the signs or symptoms listed for the adults above –  more signs and symptoms may change or develop as they grow older and their brain develops more)

  • Change in eating or nursing habits
  • Unusual or easy irritability, difficulty controlling emotions
  • Persistent crying and inability to be consoled
  • Change in ability to pay attention
  • Change in sleep habits or patterns
  • Seizures
  • Sad or depressed mood, lowered self esteem, violent acting out, Lack of Motivation
  • Drowsiness
  • Loss of interest in favorite toys or activities
  • Endocrine Changes
  • Cognitive changes