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Nebraska Brain Injury Advisory Council

About Brain Injury

Brain Injury Definitions
(Taken from Brain Injury Association of America website on 2/13/12.)

Traumatic Brain Injury (TBI)
TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force.


Acquired Brain Injury

An acquired brain injury is an injury to the brain, which is not hereditary, congenital, degenerative, or induced by birth trauma. An acquired brain injury is an injury to the brain that has occurred after birth.

There is sometimes confusion about what is considered an acquired brain injury. By definition, any traumatic brain injury (eg, from a motor vehicle accident, or assault) could be considered an acquired brain injury. In the field of brain injury, acquired brain injuries are typically considered any injury that is non-traumatic. Examples of acquired brain injury include stroke, near drowning, hypoxic or anoxic brain injury, tumor, neurotoxins, electric shock or lightening strike.

Mild Brain Injury
The term “mild brain injury” can be misleading. The term “mild” is used in reference to the severity of the initial physical trauma that caused the injury. It does not indicate the severity of the consequences of the injury.

For more information/details, visit Brain Injury Association of America: About Brain Injury

Other Resources Available:

Center for Disease Control and Prevention

Brainline.org

Brain Injury Severity Definitions

There are many definitions describing the levels of severity of brain injury, however they are often classified into mild, moderate and severe brain injuries.

While these definitions “medically” describe the severity of a brain injury, they may not describe the challenges that the person will experience. For example, a mild brain injury may have a significant impact on a person’s life by causing personality changes that in turn cause problems at home, at work, and in the community. Because of this, anyone who feels there is a possibility they may have a TBI should be seen by a doctor. If these problems are not addressed through rehabilitation or therapy, they may severely alter a person’s ability to function successful at work or in social situations.

Medical Symptoms (From the Essential Brain Injury Guide, Edition 4.0, Brain Injury Association of America):

    Mild:
  • No loss of consciousness, or loss of consciousness for less than 30 minutes.
  • Glascow Coma Scale of 13-15.
  • Post-traumatic amnesia of less than 24 hours.
  • Temporary or permanently altered mental or neurological state.
  • Post-concussion symptoms.

    Moderate:
  • Coma of more than 20-30 minutes, but less than 24 hours.
  • Glasgow Coma Scale of 9-12.
  • Possible skull fractures with bruising and bleeding.
  • Signs on EEG, CAT or MRI scans.
  • Some long term problems in one or more areas of life (i.e., home, work, community).

    Severe:
  • Coma longer than 24 hours, often lasting days or weeks.
  • Glasgow Coma Scale of 3-8.
  • Bruising, bleeding in brain.
  • Signs on EEG, CAT or MRI scans.
  • Long term functional impairments in one or more areas of life (i.e., home, work, community).

Brain Injury Symptoms

Every brain injury is unique and symptoms can vary widely. Damage to different parts of the brain will result in different symptoms. Brain Injury shares symptoms with other physical and mental health conditions, such as Post Traumatic Stress Disorder, which complicates diagnosis. Below are some of the symptoms. Having some of them, however, does not necessarily mean a person has a brain injury. Only a doctor can definitively identify and diagnose a brain injury.

This information is not intended to be a substitute for medical advice or examination. A person with a suspected brain injury should call 911, go to the emergency room or contact a physician immediately.

    Common Symptoms Immediately After Injury

  • Being dazed, confused, or "seeing stars"/dizziness
  • Not remembering the injury/memory problems
  • Losing consciousness (being knocked out)
  • Headache
  • Vomiting
  • Sleep disturbance
  • Irritability
  • Depression

    Common Symptoms Later On

  • Persistent headache or neck pain
  • Sensitivity to light and noise
  • Loss of balance
  • Changes in sleep patterns
  • Feeling tired all the time, lacking energy
  • Ringing in the ears
  • Loss of sense of smell and taste
  • Slowness in thinking, acting, speaking or reading
  • Short term memory loss
  • Getting lost or easily confused

    • Symptoms that may appear to be mental health conditions
    • Sudden mood changes for little or no reason
    • Difficulty managing relationships
    • Chronic anxiety, depression, apathy

      Having more trouble than usual with
    • Paying attention or concentrating
    • Organizing daily tasks
    • Making decisions

Brain Injury in Veterans

    The Facts: Primary Causes of Combat Related Traumatic Brain Injury are:
  • Blasts (IED's, RPG's, Land Mines)
  • Penetrating Injuries (Wounds to the head neck and face)
  • Acceleration / Deceleration (Vehicular)
  • Impact (Falls / Assaults)

 

The Facts: PTSD vs. TBI
Post-Traumatic Stress Disorder (PTSD) can occur as the result of exposure to events that involve actual or threatened death, intense fear, extreme stress or violence, or feeling helpless. You may have been exposed to these events daily. There are similarities and differences between PTSD and TBI. Common symptoms of PTSD include irritability, depression, sleep problems, feeling jumpy, difficulty concentrating, inability to recall details of the trauma, reliving the trauma, avoiding close contact with family or friends, flashbacks, and feeling detached or disconnected from emotions.

These symptoms could also be indicative of a TBI. It is not unusual for people to experience both diagnoses. The differences are often subtle. Common symptoms of a TBI include insomnia, anxiety, mood changes, feeling like you are losing it, problems remembering or concentrating, depression, irritability, and avoiding close contact with family or friends. Certain physical symptoms may differentiate a traumatic brain injury from PTSD. If you are experiencing any of these symptoms, it is important to talk to a professional who can help you understand what is happening.

Who Should Be Screened For TBI?

    Veterans should be screened for TBI if they experienced any of the following during their service:
  • Close proximity to a blast or explosion (IED, RPG, Land Mine, Grenade, etc.)
  • Fragment wound or bullet wound above the shoulders
  • Vehicular accident or crash (including aircraft, tank, personnel carrier, etc.)
  • Fall
  • Assault / Blow to the head

Brain Inury in Youth

 

 

 

 

 

Youth includes: (1) Babies, (2) Sports Players, and (3) Children and Teens In Out of Home Placements.

1.

Shaken Babies
(Taken from the National Center on Shaken Baby Syndrom, dontshake.org on 2/24/12.)

Shaken Baby Syndrome/Abusive Head Trauma is a term used to describe the constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child.

What Happens:
  • The brain rotates within the skull cavity, injuring or destroying brain tissue.
  • When shaken, blood vessels feeding the brain can be torn, leading to bleeding around the brain.
  • Blood pools within the skull, sometimes creating more pressure within the skull and possibly causing additional brain damage.
  • Retinal (back of the eye) bleeding is very common

Immediate Consequences:
  • Breathing may stop or be compromised
  • Extreme irritability
  • Seizures
  • Limp arms and legs or rigidity/posturing
  • Decreased level of consciousness
  • Vomiting, poor feeding
  • Inability to suck or swallow
  • Heart may stop
  • Death

Long-Term Consequences:
  • Behavior disorders and/or cognitive impairment
  • Learning, physical and/or speech disabilities
  • Visual disabilities or blindness
  • Hearing impairment
  • Cerebral Palsy
  • Seizures
  • Death

Why:
Babies' heads make up about 25% of their total body weight, and their neck muscles are too weak to support such a disproportionately large head. Plus, their brains and blood vessels around the brain are immature and more easily injured by shaking.

When:
Often, perpetrators shake an infant or child out of frustration or anger, such as when the baby won't stop crying or other triggering events like toilet training difficulties and feeding problems.

2.

Sports Concussions
Concussions can occur in any sport or recreation activity. So, all coaches, parents, and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs.

Action Plan: What Should a Coach Do When a Concussion is Suspected?

Remove the athlete from play. Look for the signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head. Athletes who experience signs or symptoms of concussion should not be allowed to return to play. When in doubt, keep the athlete out of play.

Ensure that the athlete is evaluated right away by an appropriate health care professional. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions.

Inform the athlete’s parents or guardians about the possible concussion. Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.

Allow the athlete to return to play only with permission from a health care professional with experience in evaluating for concussion. A repeat concussion that occurs before the brain recovers from the first can slow recovery or increase the likelihood of having long-term problems. Prevent common long-term problems and the rare second impact syndrome by delaying the athlete’s return to the activity until
the player receives appropriate medical evaluation and approval for return to play.

3.
Information about Children and Teens In Out of Home Placements is being developed. Stay tuned.

 

Brain Injury in Seniors

Brain Injury is a Special Health Concern for Older Adults.

People ages 75 and older have the highest rates of brain injury-related hospitalizations and death. They also recover more slowly and die more often from these injuries than do younger people.

Falls are the leading cause of brain injury in older adults.

An Older Adult With a Moderate or Severe Brain Injury May Show the Symptoms Accessed Through the Links on the Left, but May Also Experience:

  • Loss of balance, feeling light headed or dizzy
  • Increased confusion, restlessness, or agitation
  • Increased sensitivity to sounds, lights, distractions
  • Blurred vision or eyes that tire easily
  • Dilation of one or both pupils
  • A headache that gets worse or does not go away
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • Inability to wake up from sleep
  • Slurred speech
  • Weakness or numbness in the arms or legs
  • Loss of coordination

 

Preventing Falls: The Most Common Cause of Brain Injury Among Older Adults.

1.
Encourage Exercise
Exercise is one of the best ways to reduce older adults’ chances of falling. Exercises that improve balance and coordination, like Tai Chi, are most helpful. You should check with the older adult’s doctor about which exercises are safest and best for them.
2.
Make the Home or Surroundings Safer
  • Remove things from stairs and floors that might cause tripping.
  • Remove small throw rugs or use double- sided tape to keep the rugs from slipping.
  • Place items used often within easy reach, so that a step stool is not needed.
  • Install grab bars next to the toilet and in the tub or shower.
  • Place non-stick mats in the bathtub and on shower floors.
  • Add brighter lighting and reduce glare by using lampshades and frosted bulbs.
  • Be sure there are handrails and lights on all staircases.
  • Be sure the older adult wears shoes that give good support and have thin, non-slip soles. They should avoid wearing slippers and socks and going shoeless.
3.
Review All Medicines and Address Vision

Ask the doctor or local pharmacist to look at all the prescription medicines the older adult takes as well as non-prescription drugs like cold medicines and various supplements. As people age, the way some medicines work in the body can change. This could cause a person to feel drowsy or lightheaded, which could lead to a fall.

Make sure an eye doctor checks to be sure eye glasses are correct and that there are no conditions that limit vision, like glaucoma or cataracts. Poor vision can increase the chance of falling.

Nebraska Brain Injury Advisory council © 2012