What is Traumatic Brain Injury or TBI?
A traumatic brain injury (TBI) is a blow or jolt to the head or 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. A TBI can result in short or long-term problems with independent function.
What are the most common causes of TBI?
- Motor vehicle/traffic crashes
- Sports injuries
- Assaults (domestic violence, gunshot, shaken baby syndrome)
- Blast injuries (a leading cause of TBI for active duty military personnel in war zones or training environments)
Who is at highest risk for TBI?
- Males are about 1.5 times as likely as females to sustain a TBI
- Military duties increase the risk of sustaining a TBI
What are the signs and symptoms of mild TBI or concussion?
- Excessive fatigue (tiredness)
- Concentration problems
- Forgetting things (memory problems)
- Sleep problems
- Balance problems
- Ringing in the ears
- Vision changes (such as blurred or double vision)
How is TBI classified into mild, moderate or severe?
TBI classification is based on the length of time a person is unconscious, the presence of memory loss or posttraumatic amnesia (PTA), and the results of neuroimaging tests:
||Mild TBI / Concussion
||Normal or Abnormal
||Normal or Abnormal
|Loss of Consciousness
||0 – 30 minutes
||More than 30 minutes and less than 24 hours
||More than 24 hours
|Alteration of Consciousness / Mental State
||Up to 24 hours
||More than 24 hours
||More than 24 hours
|Posttraumatic Amnesia (PTA) or Memory Loss
||0 – 1 day
||More than 1 day and less than 7 days
||More than 7 days
What is the Glasgow Coma Scale?
The Glasgow Coma Scale is used by healthcare providers to help determine the level of consciousness of a person with TBI. The test is easy to administer, reliable, and serves as a good indicator or prognosis for recovery following severe TBI. Responses are scored using three measures (eye opening, best verbal response, and best motor response) and are scored separately, and then combined. The Department of Defense recommendations do not use the GCS to diagnose TBI.
|Eye Opening (E)
|Best Motor Response (M)
|Obeys verbal commands
|Responds to localized pain
|Best Verbal Response (V)
Score: Eye score (E) + Motor score (M) + Verbal score (V) = 3 to 15
The GCS score is used to classify TBI severity as follows:
- Severe: GCS score 3 to 8
- Moderate: GCS score 9 to 12
- Mild: GCS score 13 to 15
What are the signs and symptoms of moderate and severe TBI?
Signs and symptoms of moderate and severe TBI are dependent upon the type of injury and area of the brain that was injured. Some general symptoms can include:
- Coma (unconsciousness)
- Severe headaches
- Inability or difficulty speaking, understanding and concentrating
- Confusion, restlessness or agitation
- Loss of or changes in coordination
- Memory loss/amnesia
- Vision changes or loss of vision
- Paralysis and/or muscle spasticity
- Chronic pain
- Sleep disturbances
- Inability or changes in ability to use senses of taste, touch, sight, sound, and smell
- Loss of bowel and/or bladder control
What is a penetrating head injury?
A penetrating head injury is a brain injury in which an object pierces the skull and enters the brain tissue.
What is a blast injury?
A blast injury is trauma or damage occurring as the result of a violent explosion or the wave of pressure from an explosion.
How long will my symptoms last?
Symptoms of mild TBI or concussion typically improve within hours to days and almost always resolve completely over a relatively short period of time (one to three months). Patients with moderate to severe TBI may have long-term medical, physical, and cognitive problems that require specialized attention. However, keep in mind that the symptoms and effects will vary greatly from one patient to another depending on the severity of the TBI and location of the injury.
What therapies will aid my rehabilitation?
There are a variety of therapies available and your medical team will make recommendations depending on your personal needs. A few therapies that may be prescribed are:
- Physical therapy
- Speech therapy
- Cognitive therapy
- Neuropsychological assessment/therapy
- Occupational therapy
- Recreational therapy
What is a case manager and why do we need one?
A case manager is typically a nurse or a social worker who will help guide you and your family through the TBI journey. The case manager will coordinate the services and therapies needed for your optimal recovery by working with you and your healthcare team. They will also assist you with finding available local resources for medical, social and financial issues.
What disabilities can result from a TBI?
When the effects of TBI are prolonged, severe, and interfere with normal functioning, they may be considered disabilities, but it’s important to remember that problems caused by TBI may not be disabling for everyone. Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury in the brain, and the age and general health of the patient. Some common disabilities include problems with mobility and motor skills, cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).
What is PTSD?
Post-traumatic stress disorder (PTSD) is a condition that may occur to people who have lived through or witnessed events perceived by the person to be life-threatening. Examples of traumatic events include:
- Military/combat exposure
- Physical/sexual assault or abuse
- Terrorist attacks
- Natural disasters (fires, floods, hurricanes, earthquakes)
- Serious accidents (car wreck, explosions, collisions)
What are the symptoms of PTSD?
- Re-living the traumatic event/experience
- Avoiding situations/environments that remind you of the event
- Feeling numb or detached
- Hyperarousal (constantly alert, on edge, jittery, on the look out)
- Sleep problems
- Personality changes
People with PTSD may also have chronic pain, depression, problems with personal, professional and social relationships and/or substance abuse.
Does PTSD occur in patients with TBI?
Yes, PTSD and concussion can occur together and can be caused by the same traumatic event. Some patients with a concussion may also have PTSD, but not everyone does. Both medical conditions involve physical changes and psychological symptoms. The symptoms of PTSD and concussion are similar and may make it hard for your healthcare provider to determine which condition you have.
How is PTSD treated?
Treatments for PTSD may include taking medications to control or minimize symptoms. Cognitive-Behavioral Therapy (CBT) is a form of counseling which has been shown to be very effective for treating PTSD. Your provider will be customize your treatment to meet your personal symptoms and needs.
What is the Defense and Veterans Brain Injury Center (DVBIC)?
DVBIC is a group of multi-site TBI programs in Department of Defense (DoD) and Department of Veterans Affairs (VA) hospitals. These DVBIC sites work collaboratively to provide and improve TBI care for active duty military and veterans. DVBIC’s overall work involves screening and briefing troops heading into theater, performing pre-deployment provider training at military treatment facilities, gathering data mandated by Congress and DoD, and overseeing research programs. DVBIC treats service members and veterans with mild, moderate, or severe TBI, and helps them from the moment of injury to their return to duty or reintegration into the community. DVBIC also develops, provides and distributes educational materials for both military and civilian providers, families, service members, and veterans. DVBIC's goal is to ensure expert care coordination and individualized, evidence-based treatment to each patient in order to maximize function and decrease or eliminate TBI-related disability. DVBIC works to provide services and supports to help an individual with TBI return to duty, work and community.