Traumatic Brain Injury 101Lisa Brenner, PhD, ABPPDepartments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation University of Colorado School of Medicine

TBI DefinitionTraumatic Brain Injury - A bolt or jolt to the head or a penetrating head injury that disrupts the function of the brainNot 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 symptomsThese symptoms can result in short- or long-term problems with functioningCDC 2005

McCallister 2005Mild 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.

McCallister 2005

TBI - Mechanisms

Thanks John Kirk, Ph.D.Mechanism of Injury Acceleration/DecelerationJohn Kirk, Ph.D.

www.dvbic.org/blastinjury.htmlBlast InjuryBlast 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

Susan O'Brien, MDBlast InjuryPrimary Barotrauma Secondary Objects being put into motion

Tertiary Individuals being put into motion

TBI -Severity

Thanks John Kirk, PhDPosttraumatic Amnesia

Thanks John Kirk, PhD

Department of Veterans Affairs 2004Injury Severity

MildModerateSevereAltered or LOC

Common TBI Symptoms NOT to be confused with the injury itself

TBI is a historical event

Common Mild TBI/Postconcussive SymptomsHeadache Poor concentrationMemory difficultyIrritabilityFatigue

DepressionAnxietyDizzinessLight sensitivitySound sensitivityImmediately post-injury 80% to 100% describe one or more symptomsMost individuals return to baseline functioning within a yearFerguson et al. 1999, Carroll et al. 2004; Levin et al. 1987

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

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

Slowed motor response (often due to processing delay vs. motor deficit)Paralysis, disturbed balance and coordination, ataxia, tremors, parkinsonism, bradykinesia, and weaknessDistorted pain, touch, temperature and positional informationMotor and Sensory Deficits

Rosenthal et al. 1983Common Neuropsychological ComplaintsDisordered consciousnessDisorientationMemory deficitsDecreased abstractionDecreased learning abilityLanguage/communication deficitsPoor judgmentPoor quality controlInability to make decisionsPoor initiativePoor depth perceptionDizziness

General intellectual deficitsDeficits in processing/sequencing informationIllogical thoughtsPerseverationConfabulationDifficulty with generalizationPoor attentionFatigueReduced motor speed/poor hand eye coordinationVisual neglect

Rosenthal et al. 1983

Common Behavioral ComplaintsRestlessnessAgitationCombativenessEmotional LabilityConfusionHallucinationsDisorientation

Paranoid IdeationHypomaniaConfabulationIrritabilityImpulsivityEgocentricityEmotional Lability

Common Behavioral Complaints continuedImpaired JudgmentImpatienceDepressionHypersexualityHyposexualityDependencySillinessAggressivenessApathyImmaturityDisinhibitionLoss of interestAnxiety

Impaired JudgmentImpatienceDepressionHypersexualityHyposexualityDependencySillinessAggressivenessApathyImmaturityDisinhibitionLoss of interestAnxietyCommon Behavioral Complaints continued

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