Traumatic Brain Injuries

A leading cause of death and disability in the U.S.

MARCH is Brain Injury Awareness Month

Traumatic Brain Injury, or TBI, is a leading cause of death and disability in the U.S.

Approximately 166 Americans die everyday from TBI-related injuries. TBI is an injury caused by a blow, jolt, or penetrating object that disrupts normal functioning of the brain at any age. TBI can result in serious damage to the brain that can lead to long-term complications and death. CDC reports that more than 2.8 million U.S. people sustain a TBI each year; of those, more than 55,000 die and more than 280,000 are hospitalized.

Source: Centers for Disease Control and Prevention

Types of TBI & Symptoms

Differences in severity of damage to the brain after TBI is the primary factor in predicting the injury’s impact on the individual. TBI is typically categorized as mild, moderate, or severe.

Mild TBI or Concussion:

  • An individual with a Mild TBI or concussion may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of Mild TBI or concussion may include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.

Moderate or Severe TBI:

  • An individual with Moderate or Severe TBI may show the same symptoms but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.

Major Causes of TBI

  • Falls
  • Firearm-related wounds and suicide
  • Military actions (eg, Blast injury)
  • Assaults (eg, being struck by or against something)
  • Motor vehicle accidents
  • Sports and recreational injuries
  • Workplace injuries
  • Abusive head trauma (eg, Shaken baby Syndrome)
  • Child abuse
  • Domestic violence

People at high risk of TBI

A person of any age can experience a TBI, but data suggest that some groups are at greater risk for experiencing a TBI or having worse health outcomes after the injury.

Keeping children and teens healthy and safe is always a top priority. Whether you are a parent, youth sports coach, school coach, school professional, or health care provider, it is important to recognize, respond to, and minimize the risk of concussion or other serious brain injury. General prevention and safety measures include using gates at top and bottom of stairs to prevent serious falls; playing at playgrounds with soft material like mulch or sand to lessen impact; properly installing age- and size-appropriate car and booster seats; and making sure children and teens wear helmets that fit correctly when engaging in activities.

 

Source: Centers for Disease Control and Prevention

How does TBI impact the brain?

TBI is unpredictable in its consequences.

TBI affects who we are and the way we think, act, and feel. It can change everything about us in a matter of seconds.

For example, a TBI to the frontal lobes of an individual’s brain may affect their ability to control emotions, impulses, and behavior or may cause difficulty in recalling events or speaking. TBI to the temporal lobes may lead an individual to demonstrate difficulty with communication or memory. TBI to the parietal lobes may cause an individual to experience trouble with their five primary senses. TBI to the cerebellum may affect an individual’s balance, movement, and coordination. And TBI to the occipital lobes may cause an individual to have trouble seeing or perceiving the size and shape of objects.

More specifically, research shows that TBI incurred on the Left side of the brain may cause:

  • Difficulties understanding language (receptive language)
  • Difficulties in speaking or verbal output (expressive language)
  • Catastrophic reactions (depression, anxiety)
  • Difficulty speaking
  • Impaired logic
  • Sequencing difficulties
  • Decreased control over right-sided body movements

Whereas TBI incurred on the Right side of the brain may cause:

  • Visual-spatial impairment
  • Visual memory deficits
  • Left neglect (inattention to the left side of the body)
  • Decreased awareness of deficits
  • Altered creativity and music perception
  • Loss of “the big picture” type of thinking
  • Decreased control over left-sided body movements

Source: Brain Injury Association of America

What Is a Concussion?

A concussion is a mild type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.

4 Important Facts

  • A person with a concussion is a person first.
  • No two concussions are exactly the same.
  • The effects of concussions are complex and vary greatly from person to person.
  • The effects of concussions depend on factors such as cause, location, and severity.

Signs & Symptoms

An individual with a concussion…

  • may not be able to recall events prior to or after the concussion.
  • may have the appearance of being dazed or stunned after the concussion.
  • may forget an instruction, seem confused, or unsure after the concussion.
  • may experience clumsy movement after the concussion.
  • may answer questions slowly.
  • may lose consciousness (even briefly).
  • may show mood, behavior, or personality changes.

Physical signs & symptoms of a concussion include:

  • Loss of consciousness
  • Mild to severe headache
  • Nausea or vomiting
  • Dilation of pupils
  • Loss of coordination
  • Sleeping disorders
  • Convulsion
  • Dizziness or fatigue
  • Loss of balance
  • Sensory Symptoms
  • Blurred vision
  • Double vision
  • Ringing sound in ears
  • Loss of ability to smell
  • Sensitivity to light or sound

Mental signs & symptoms of a concussion include:

  • Memory problems
  • Alexia
  • Speaking disorder
  • Dysgraphia
  • Mood swings
  • Depression or Anxiety
  • Coma

Source: Centers for Disease Control and Prevention

Five Ways to Prevent TBI

1 – Buckle Up Every Ride

Wear a seat belt every time you drive – or ride – in a motor vehicle.

2 – Never Drive While Under the Influence of Alcohol or Drugs

3 – Wear a Helmet, or Appropriate Headgear

  • When you or your children ride a bike, motorcycle, snowmobile, scooter, or use an all-terrain vehicle.
  • Play a contact sport, such as football, ice hockey, or boxing.
  • Use in-line skates or ride a skateboard.
  • Bat and run bases in baseball or softball.
  • Ride a horse.
  • Ski or snowboard.

4 – Prevent Falls in Older Adults

  • Talk to your doctor to evaluate your risk for falling and talk with them about specific things you can do to reduce your risk for a fall.
  • Ask your doctor or pharmacist to review your medicines to see if any might make you dizzy or sleepy (this should include prescription medicines, over-the counter medicines, herbal supplements, and vitamins).
  • Have your eyes checked at least once a year and be sure to update your eyeglasses (if needed).
  • Do strength and balance exercises to make your legs stronger and improve your balance.
  • Make your home safer.

5 – Make Living & Play Areas Safer for Children

  • Install window guards to keep young children from falling out of open windows.
  • Use safety gates at the top and bottom of stairs when young children are around.
  • Make sure your child’s playground has soft material under it, such as hardwood mulch or sand.

Source: Centers for Disease Control and Prevention

Brain Injury Awareness Month Video featuring Return to Learn Program Champions.

Shareable Graphics:

Return to Learn (RTL)

Return to Learn (RTL) is a fast, comprehensive assessment program for any high school student with a concussion.

The program coordinates care between physicians, parents, and school administrators to offer best practice academic accommodations to help students return to their full classroom capacity more quickly. It was developed by Harborview Injury Prevention and Research Center (HIPRC) researchers and is backed by the Center for Disease Control (CDC).

RTL is based on research, clinical expertise, focus groups with school staff, and surveys of students impacted by concussion. The program features a concussion protocol that focuses on getting students back in the classroom through best practices in academic accommodations. The program was created by synthesizing the best practice recommendations from many sources and the research of the HIPRC. In Washington State, if someone has active symptoms after having a concussion they cannot play in any organized sports per state law. Washington was first to adapt this legislation through the Zachery Lystedt Law.

“Return to Learn refers to the idea that students with a concussion should have attention paid to the pace and nature of how they return to academics,” explains HIPRC director Dr. Vavilala.

RTL provides a step-by-step toolkit:

  • Following an actionable, flexible RTL protocol
  • Training and educating school staff
  • Providing coordinated, interdisciplinary care for injured students
  • Formalizing communication between the family, school, and medical providers

RTL includes a packet with a weekly checklist to help staff evaluate symptoms, as well as corresponding academic adjustments and accommodations to match. It also provides information on when students should seek additional treatment, and how to foster coordination between teachers and other applicable school staff to ensure the student’s needs are being met.

For more information on RTL, visit: Return to Learn – Harborview Injury Prevention and Research Center (hiprc.org)

PEGASUS Project: Argentina

PEGASUS, a global partnership led by Harborview Injury Prevention and Research Center (HIPRC), is aiming to improve outcomes after severe pediatric TBI with support from a grant by the National Institutes of Health (NIH).

The partnership with Centro de Informática e Investigación Clínica in Rosario, Argentina, Children’s National Hospital in Washington D.C., and HIPRC in Seattle is studying best practice guideline adherence and outcomes in severe pediatric TBI treatment in Argentina, Chile, and Paraguay.

Pediatric TBI is the leading killer of children worldwide, and learning how to provide the best care possible in a variety of settings is critical to reducing the harms from these injuries.

For more information, visit: TBI Argentina – Harborview Injury Prevention and Research Center (hiprc.org)

Pediatric TBI Resources

Source: Eunice Kennedy Shriver National Institutes of Child Health and Human Development

Infographic: Traumatic Brain Injury (TBI): Pediatric Causes and Prevention Strategies

Webinar: Pediatric Return to Learn after Concussion

Learn from experts working in research and community programs around pediatric concussion and the school-based Return to Learn program. This webinar discusses the documented need and collaborative development of a school-based program to support high school students returning to school after a concussion diagnosis.

For more information on RTL, visit: Return to Learn – Harborview Injury Prevention and Research Center (hiprc.org)

Each year, approximately 37,200 children sustain a severe TBI. Severe pediatric TBI is associated with significant mortality and morbidity. Of the children who survive TBI, more than 50% experience unfavorable outcomes up to 6 months after the injury. All types of TBI can seriously affect a child’s daily life.

Putting prevention strategies in place will help reduce the risk of TBI in children of all ages:

SEATBELTS
Use a child safety seat or a seat belt when the child is in a motor vehicle.

HELMETS
Make sure the child wears a helmet when riding a bicycle, skateboarding, and playing sports like hockey and football.

WINDOW GUARDS & SAFETY GATES
Properly install window guards and stair safety gates at home.

AVOID SHAKING YOUR BABY
Learn how to prevent Shaken Baby Syndrome which may result in lifelong medical care.

 

TBI Prevention Strategies
Courtesy: Centers for Disease Control and Prevention; Unsplash contributors

To learn more about TBI, visit: https://www.nichd.nih.gov/health/topics/tbi.

Source: Eunice Kennedy Shriver National Institutes of Child Health and Human Development