What is Traumatic Brain Injury (TBI)?

A traumatic brain injury (TBI) is caused by trauma to the head that interferes with the normal function of the brain. TBI may cause only a short-term change in mental status or consciousness or TBI may result in an extended period of unconsciousness. The physical, behavioral, or mental changes that may result from head trauma depend on the areas of the brain that are injured.

Most injuries cause focal brain damage, which is damage confined to a small area of the brain. In addition to focal damage, closed head injuries frequently cause diffuse brain injuries, which is damage to several areas of the brain. Because the major speech and language areas often suffer damage, communication difficulties may occur after TBI. Other problems may include difficulties with walking, balance, and coordination, as well as decline in memory and cognitive skills.

How many people suffer with TBI?

Each year, TBI contributes to a large number of deaths and cases of permanent disability.

Of the 1.4 million people who sustain a TBI each year in the United States:

• 50,000 die;
• 235,000 are hospitalized; and
• 1.1 million are treated and released from an emergency department.

Among children up to 14 years old, TBI results in an estimated:

• 2,600 deaths;
• 37,000 hospitalizations; and
• 435,000 emergency department visits annually.

What causes TBI?

Frequent causes of TBI are:

• Falls;
• Motor vehicle-traffic crashes;
• Struck by/against events; and
• Assaults

What are the signs and symptoms of TBI?

In moderate to severe cases of TBI, the swelling may cause pressure on a lower part of the brain called the brainstem, which controls consciousness or wakefulness. The individuals who suffer this type of TBI may suffer from a coma.

In conscious individuals, cognitive impairments often include having problems concentrating for varying periods of time, having trouble organizing thoughts, and becoming easily confused or forgetful. Many will experience difficulty solving problems, making decisions, and planning.

 Common symptoms of TBI include:

• Headaches or neck pain that do not go away;
• Difficulty remembering, concentrating, or making decisions;
• Slowness in thinking, speaking, acting, or reading;
• Getting lost or easily confused;
• Feeling tired all of the time, having no energy or motivation;
• Mood changes;
• Changes in sleep patterns;
• Light-headedness, dizziness, or loss of balance;
• Urge to vomit;
• Increased sensitivity to lights, sounds, or distractions;
• Blurred vision or eyes that tire easily;
• Loss of sense of smell or taste; and
• Ringing in the ears.

Brain Injury in Children

It was once thought that children were more resistant to brain trauma than adults because their developing brains could “rewire” over time. However, more recent studies suggest that children may, in fact, be more susceptible than adults to permanent brain damage. Children's skulls are thought to be only 1/8^th as strong as those of adults. Thus, children are much more vulnerable to injury through fracture or other injury to the skull.Unfortunately, head injuries are very common in children. Modes of injury include car accidents, bicycle accidents, falls, and sports injuries.

Some aspects of brain injury are unique to children. For example, it is more difficult to measure the loss of brain function in a child. In adults there are prior academic records and job histories to provide guidance and a performance history. For many children, there are no such references. Therefore, determining what level of function the child has lost is often difficult.

Also, in children, some neurologic deficits after head trauma may not appear for a long time. For example, injury to reading and writing centers in a child’s brain may not become apparent until the child demonstrates signs of delayed reading and writing skills.

The most commonly observed deficits observed in children with mild to severe TBI are:

1.) Dysnomia-inability to name objects presented visually

2.) Impaired auditory comprehension- Difficulty processing stimuli presented verbally.

3.) Sentence repetition- Unable to repeat sentences presented orally.

4.) Receptive language- Difficulty pointing to common objects named by the examiner.

5.) Memory deficits- Unable to recall recent events from short term memory.

6.) Expressive language- Difficulty describing things and events.

7.) Written language-Difficulty copying sentences presented orally and graphically.

8.) Mutism