Traumatic Brain Injury and Related Information
Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other features (e.g. occurring in a specific location or over a widespread area). Head injury usually refers to TBI, but is a broader category because it can involve damage to structures other than the brain, such as the scalp and skull.
Brain trauma can be caused by a direct impact or by acceleration alone. In addition to the damage caused at the moment of injury, brain trauma causes secondary injury, a variety of events that take place in the minutes and days following the injury. These processes, which include alterations in cerebral blood flow and the pressure within the skull, contribute substantially to the damage from the initial injury.
According to CDC, it is estimated that at least 1.4 million people in the United States are affected by traumatic brain injuries (TBI) every year.
Among them:
50,000 people die
235, 000 are hospitalized
1.1 million are treated for TBI and discharged from an emergency department.
Every year 475,000 cases of TBI occur in children aged from 0-14 years and 90 of TBI that occur every year are concussions or other forms of mild TBI.
Head injuries are twice as common in men as in women.
Males also account for two thirds of childhood and adolescent TBI. The great majority of head injuries are caused by road-traffic accidents, falls, sports and assaults, but the proportion of injuries due to each cause varies according to age group.
Falls and domestic accidents are much more common in the elderly, whereas assaults, sports injury & industrial injuries are more common in younger men. TBI hospitalizations are highest among African Americans and American Indians.
According to National Head Injury Foundation, causes of minor head injury are:
a. Motor vehicle accident - 28
c. Sports - 18
e. Struck by/against events - 19 of the cases of TBI. Motor vehicle accidents account for 64 of these cases, the driver was under the influence of alcohol.
There are many different causes that could result in traumatic brain injury.
It is very important to know about the cause of TBI. This is because the same cause would have resulted in other injuries as well and it is also important in the medico legal point of view.
The major causes of head injuries are:
Road traffic accidents
Domestic accidents
Sports injury
Assault, warfare & civil violence
Recreational accidents
Industrial accidents
Alcoholism
Epilepsy
Road-traffic accidents
Road-traffic accident is the most common cause of severe head injury. It may cause multiple injuries in the same person. If the person is trapped inside the vehicle and if the medical attention is delayed, his brain injury may get worsened. This is due to respiratory impairment and excessive blood loss which reduce the oxygen supply to brain.
Motor cycle riders & pedal cyclists are more likely to suffer from severe head trauma than those who drive cars and bigger vehicles. Cycling accidents occur more frequently on main roads particularly at road junctions. Provision of cycle lanes, wearing helmet while riding can reduce the incidence of head injury.
Alcohol and head injury
Alcohol is an important factor in traumatic brain injury. It is responsible for head injuries that result due to falls, assaults and road traffic accidents. But irrespective of the cause of injury alcohol intoxication is associated with a higher incidence of head injury. Moreover assessing the severity of head injury is difficult in person who is inebriated. The conscious level cannot be ascertained properly. Moreover, the injured person may get aspirated during vomiting which occurs as a result of head injury.
Sports injury
Sports injuries account for 20-30% of head injury in children & adolescents. Horse riding is the single most dangerous sport in the context of head injury. Blunt head injuries are more common in contact sports such as football, hockey & rugby caused by clashes of heads and kicks. In golf it occurs due to swinging of the club. Head injury is the most common cause of death in climbing accidents.
Other causes
Domestic accidents and falls are more common in older patients. Industrial injuries are seen frequently amongst younger age group.
Fire arm use is also an important cause of TBI. Gun shots and blasts are also the leading cause of death due to TBI in military personnel.
Traumatic brain injuries (TBI) can have a serious impact on many aspects of the human body's ability to function normally, including a person's ability to maintain balance.
A TBI is defined as brain damage caused by a severe trauma to the head and can cause a large number of problems. Balance impairments (also sometimes called balance dysfunctions or balance disorders) are common for some following a TBI.
One unexpected aspect of this problem is that compared to other medical conditions that can cause balance impairments (such as strokes or seizures), there has been relatively little study into the effects of brain injury on balance. Fortunately however, this is changing.
Symptoms of Balance Disorders
Balance disorders occur, at least temporarily, in nearly all people who have suffered a TBI. This instability can exist even when neurological tests do not detect any problems.
Symptoms common to balance impairments can include:
* Feeling dizzy, lightheaded, woozy or a sensation of spinning (vertigo)
* Burred vision
* Falling or unsteady gait (feeling of falling)
Diagnosing Balance Disorders
Maintaining balance is a complex multifunctional process that involves interplay between three systems:
Vestibular system (the inner ear balance organs)
Visual system (eyes)
Somatosenory system (joint and muscle receptors or sensors)
Normally, the brain receives and processes information about the environment and these systems work together to control balance. The primary test that is used to assess balance impairment is the Sensory Organization Test (SOT), which is conducted by evaluating each of the the three balance systems. Balance Impairment and Severity of Traumatic Brain Injury
The severity of TBI is determined using several measures such as:
Glasgow Coma Test
Length of unconsciousness (time in a coma)
Length of post-traumatic amnesia (PTA)
For TBI patients beginning rehabilitation, there is a significant relationship between TBI severity and degree of sitting and standing balance impairment. Patients with more severe TBI ratings also have more impaired balance ratings.
Recovery from Balance Disorders Caused by Traumatic Brain Injury:
A study at Wayne State University found that the degree of balance impairment for brain-damaged patients (specifically sitting balance impairment), measured at time of admission to rehabilitation can predict the Functional Independence Measure (FIM) at discharge. FIM illustrates how well patients recovering from a TBI can live independently after they are discharged. The relationship between balance impairment, brain injury severity, the prognosis for recovery from a TBI is underscored by this study.
For cases of mild traumatic brain injury in which there was no loss of consciousness and no clinically detectable problems, balance impairments (as measured by performance on the Sensory Organization Test), usually last from 3 to 10 days. However, subtle balance impairments that are harder to detect, such as abnormally high reliance on vision for maintaining balance, can persist for months or years.
Treatment for TBI balance disorders may include balance retraining exercises, general exercise, and certain drugs. Recovery takes time and recovery times vary. Some brain-injured people require assistance for years.
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