traumatic brain injury 101 lisa brenner, phd, abpp departments of psychiatry, neurology, and...
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Traumatic Brain Injury 101
Lisa Brenner, PhD, ABPPDepartments of Psychiatry,
Neurology, and Physical Medicine and Rehabilitation University of Colorado School of Medicine
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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
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McCallister 2005
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 or being dazed and confused.”
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TBI - Mechanisms
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Thanks John Kirk, Ph.D.
Mechanism of Injury – Acceleration/Deceleration
John Kirk, Ph.D.
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www.dvbic.org/blastinjury.html
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
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Susan O'Brien, MD
Blast Injury
• Primary – Barotrauma • Secondary – Objects
being put into motion
• Tertiary – Individuals being put into motion
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TBI -Severity
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Thanks John Kirk, PhD
Posttraumatic AmnesiaTrauma
Retrograde
AmnesiaLOC Posttraumatic
Amnesia
Encoding events
TIME
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Department of Veterans Affairs 2004
Injury Severity
Mild Moderate Severe
Altered or LOC<30 minutes with normal CT and/or MRI
LOC<6 hours with abnormal CT and/or MRI
LOC>6 hours with abnormal CT and/or MRI
GCS 13-15 GCS 9-12 GCS<9
PTA<24 hours PTA<7 days PTA>7days
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Common TBI Symptoms –NOT to be confused with the injury
itself
TBI is a historical event
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Common Mild TBI/Postconcussive Symptoms
• Headache • Poor concentration• Memory difficulty• Irritability• Fatigue
• Depression• Anxiety• Dizziness• Light sensitivity• Sound sensitivity
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
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Headache Dizziness BalanceProblems
Irritability MemoryProblems
Ft. Carson: Post-Deployment Data (n = 907)
Acute (right after mTBI)
Post-Deployment
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
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Headache Dizziness BalanceProblems
Irritability MemoryProblems
Currently Symptomatic: Onset of Symptoms (n = 844)
Post-deployment Onset (New Sx)
Persistent Sx since TBI
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
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• 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
Motor and Sensory Deficits
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Rosenthal et al. 1983
Common Neuropsychological Complaints
• 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
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Common Behavioral Complaints
• Restlessness• Agitation• Combativeness• Emotional Lability• Confusion• Hallucinations• Disorientation
• Paranoid Ideation• Hypomania• Confabulation• Irritability• Impulsivity• Egocentricity• Emotional Lability
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Common Behavioral Complaints continued
• Impaired Judgment• Impatience• Depression• Hypersexuality• Hyposexuality• Dependency• Silliness
• Aggressiveness• Apathy• Immaturity• Disinhibition• Loss of interest• Anxiety
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• Impaired Judgment• Impatience• Depression• Hypersexuality• Hyposexuality• Dependency• Silliness
• Aggressiveness• Apathy• Immaturity• Disinhibition• Loss of interest• Anxiety
Common Behavioral Complaints continued