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Traumatic Brain Injury 101

Traumatic Brain Injury 101. Lisa Brenner, PhD, ABPP Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation University of Colorado School of Medicine. TBI – Definition.

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Traumatic Brain Injury 101

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  1. Traumatic Brain Injury 101 Lisa Brenner, PhD, ABPP Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation University of Colorado School of Medicine

  2. TBI – Definition • Traumatic Brain Injury - A bolt or jolt to the head or a penetrating head injury that disrupts the function of the brain • Not all blows or jolts to the head result in a TBI. The severity of such an injury may range from “mild” (a brief change in mental status or consciousness) to “severe” (an extended period of unconsciousness or amnesia) after the injury. • Post-injury individuals may experience symptoms • These symptoms can result in short- or long-term problems with functioning CDC 2005

  3. Mild TBI Definition American Congress of Rehabilitation Medicine “Traumatically induced disruption of brain function that results in loss of consciousness of less than 30 minutes’ duration or in an alteration of consciousness manifested by an incomplete memory of the event orbeing dazed and confused.” McCallister 2005

  4. TBI - Mechanisms

  5. Mechanism of Injury – Acceleration/Deceleration • John Kirk, Ph.D. Thanks John Kirk, Ph.D.

  6. Blast Injury • Blast injuries are injuries that result from the complex pressure wave generated by an explosion. • The explosion causes an instantaneous rise in pressure over atmospheric pressure that creates a blast overpressurization wave • Air-filled organs such as the ear, lung, and gastrointenstinal tract and organs surrounded by fluid-filled cavities such as the brain and spinal are especially susceptible to primary blast injury www.dvbic.org/blastinjury.html

  7. Blast Injury • Primary – Barotrauma • Secondary – Objects being put into motion • Tertiary – Individuals being put into motion Susan O'Brien, MD

  8. TBI -Severity

  9. Trauma Encoding events Retrograde Amnesia Posttraumatic Amnesia LOC TIME Posttraumatic Amnesia Thanks John Kirk, PhD

  10. Injury Severity Department of Veterans Affairs 2004

  11. Common TBI Symptoms –NOT to be confused with the injury itselfTBI is a historical event

  12. Headache Poor concentration Memory difficulty Irritability Fatigue Depression Anxiety Dizziness Light sensitivity Sound sensitivity Common Mild TBI/Postconcussive Symptoms Immediately post-injury 80% to 100% describe one or more symptoms Most individuals return to baseline functioning within a year • Ferguson et al. 1999, Carroll et al. 2004; Levin et al. 1987

  13. Terrio, H., Brenner, L.A., Ivins, B., Cho, J.M., Helmick, K.,Schwab, K., Scally, K., Bretthauser, R., Warden, D. Traumatic Brain Injury Screening: Preliminary Findings Regarding Prevalence and Sequelae in a US Army Brigade Combat Team. Journal of Head Trauma Rehabilitation. 2009

  14. Terrio, H., Brenner, L.A., Ivins, B., Cho, J.M., Helmick, K.,Schwab, K., Scally, K., Bretthauser, R., Warden, D. Traumatic Brain Injury Screening: Preliminary Findings Regarding Prevalence and Sequelae in a US Army Brigade Combat Team. Journal of Head Trauma Rehabilitation. 2009

  15. Motor and Sensory Deficits • Slowed motor response (often due to processing delay vs. motor deficit) • Paralysis, disturbed balance and coordination, ataxia, tremors, parkinsonism, bradykinesia, and weakness • Distorted pain, touch, temperature and positional information

  16. Disordered consciousness Disorientation Memory deficits Decreased abstraction Decreased learning ability Language/communication deficits Poor judgment Poor quality control Inability to make decisions Poor initiative Poor depth perception Dizziness General intellectual deficits Deficits in processing/sequencing information Illogical thoughts Perseveration Confabulation Difficulty with generalization Poor attention Fatigue Reduced motor speed/poor hand eye coordination Visual neglect Common Neuropsychological Complaints Rosenthal et al. 1983

  17. Restlessness Agitation Combativeness Emotional Lability Confusion Hallucinations Disorientation Paranoid Ideation Hypomania Confabulation Irritability Impulsivity Egocentricity Emotional Lability Common Behavioral Complaints

  18. Impaired Judgment Impatience Depression Hypersexuality Hyposexuality Dependency Silliness Aggressiveness Apathy Immaturity Disinhibition Loss of interest Anxiety Common Behavioral Complaints continued

  19. Impaired Judgment Impatience Depression Hypersexuality Hyposexuality Dependency Silliness Aggressiveness Apathy Immaturity Disinhibition Loss of interest Anxiety Common Behavioral Complaints continued

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