Traumatic Brain InjuryDefinitions, Prevalence and Consequences

Rebecca Quinn, MSW701-777-5200rquinn@medicine.nodak.edu

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Traumatic brain injury is the most

misunderstood, misdiagnosed,

underfunded public health problem our nation faces.”Susan Connors, President

Brain Injury Association of America

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TBI Grants in North Dakota

• Federal TBI Planning Grant – 2003-2005 – Conducted a TBI needs and resource assessment – Developed a state TBI action plan

• Federal TBI Implementation Partnership Grant– 2007-2010– $118,000 a year, Local funds will provide $59,000 in match– Awarded to ND Department of Human Services – Contracted to The UND Center for Rural Health– Partners

• Dakota Medical Foundation• Anne Carlsen Center for Children• North Dakota Head Injury Association

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Myths of Brain Injury

• “They doesn’t look brain injured”

• “The brain-injury should be healed by now!”

• “We use only 10% of our brain”

• “Time heals”

• “It was just a bump on the head.”

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So what is a Brain Injury?

• Acquired Brain Injury (ABI)– Any injury to the brain that occurs after birth. – Does not include

• Hereditary or congenital conditions

• Birth traumas

• Degenerative disorders

• Traumatic Brain Injury (TBI) – Is a blow or jolt to the head or a penetrating

head injury that disrupts the function of the brain.

Acquired Brain Injury (ABI)Any injury to the brain occurring after birth.

Traumatic Brain Injury (TBI)

Injuries occurring From external force

Infectious Disease

Oxygen Deprivation

Stroke or Tumor

Chemical orSubstance Exposure

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Scope of the TBI

• An estimated 1.5 million people

will sustain a TBI each year in the United States.

• Of these: 50,000 die; 235,000 are hospitalized 1.1 million are treated and released

from an emergency department.

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That means every 21 seconds…

…someone in the US sustains a traumatic brain

injury!

That’s roughly 85 people every 30 minutes,

and 170 people each hour.

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Many More Unknown

Numbers do not include:

• Those treated at clinics or Drs offices.

• Individuals not receiving treatment– Due to lack of insurance– Thinking the injury is not a problem

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Changes Over the Years30 years ago –

Only 50% of those with a TBI survived.

Today –

78% survive a TBI.

Causes of TBI

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TBI is the leading cause of death and disability for children, adolescents,

and young adults in the United States.

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Who experiences TBI?

• Anyone can get a TBI!

• Yet some are more at risk than others.– Highest risk 0-4 years, 15-24, and 75 years

and older.– Males are 1.5 times more likely than

females to experience TBI.– Individuals who have already sustained one

or more concussions.

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RCH “Silent Epidemic” or “Invisible

Disability”

• Brain injuries are often unnoticed or misdiagnosed

• Often are no outward signs• May have no conclusive measures• Person looks the same• Individuals often told they would be fine.

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Resulting Disabilities

• Estimates say 15-20% of TBIs will have long term disabilities.

• An estimated 5.3 million Americans have a long-term or life long need for help with activities of daily living as a result of TBI.

Estimate of TBI-Disabled Persons in ND:

12,844*

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National statistics for TBI

and other disability groups

Comparison of Disability Prevalence Rates

400,000 with Spinal Cord Injuries

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Focal Impact Injury

• Coup-contra coup-brain slams forward and back inside skull.

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Diffuse Axonal Injuries

• Rotational forces on the brain cause the stretching, snapping and shearing of axons

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Blast Injury

• Leading cause of TBI in war zones.

• Primary injury results from the complex pressure wave generated by an explosion.

• Can cause wide spread Diffuse Axonal Injury.

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Neuro-chemical Changes

• Changes in brain chemistry and neurotransmitters

• Effects neurological functioning

• Body must work extra hard to restore chemical balance

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Severity Continuum

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Severe Brain Injury

• Coma for more than 24 hours.

• 80% have multiple long-term impairments.

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Moderate Brain Injury

• Unconscious for more than 20-30 minutes but less than 24 hours.

• Usually shows signs on EEG or CT scan or MRI.

• 33-50% have long-term difficulties in one or more areas.

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Mild Brain Injury (mTBI)

• Brief (<15 min) or NO loss of consciousness,

• May also have:

dazed look, confused, headache, nausea, dizziness, groggy or tired.

• CT scans, MRI, EEG or routine neurological evaluations may be normal.

• “concussion” “bell rung” “ding” “blow” “bump on the noggin”

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Mild can be a Misnomer

• 90% of mild TBIs will recover within 6-8 weeks.

• Degree of physical injury does not always determine the degree of difficulty related to long-term functioning.

• Post-Concussion Syndrome is the term for individuals who have concussion symptoms more than six months after a concussion.

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Recovery After Brain Injury

• Measured in weeks, months and years.

• Usually most rapid in the first six months.

• Recovery from brain injury is slow and often incomplete.

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Treatments

• Prevention is the only cure

• Medications– Presently no medications approved for TBI– Changes in brain chemistry

• Cognitive Rehabilitation– Takes time– Qualified providers?– Lack of insurance approval

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No Two Brain Injuries Are Alike.

As diverse as each human being is, this is how different brain injury can be for each person.

• Factors influencing outcomes:– Personal – Medical– Social

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Possible Changes after a Brain Injury

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Executive Functioning

Coach Executive Function

Spelling

Math

Memory Attention

Reading

Languag

e

Skills Team

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"Unidentified traumatic brain injury is an unrecognized major source of

social and vocational failure,"

Wayne A. Gordon, director of the Brain Injury Research Center at Mount Sinai School of Medicine in New

York

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National Resources

• Brain Injury Association of America703-236-6000, www.biausa.org

• National Association of State Head Injury Administrators, www.nashia.org

• TBI Technical Assistance Center, www.tbitac.org

• Center for Disease and Prevention, www.cdc.gov/injury

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Acknowledgments

This training and its associated training materials are supported in part by the TBI State Grant Program, Grant Number 1 H21MC07894-01-00, from the Department of Health and Human Services (DHHS) Health Resources

and Services Administration, Maternal and Child Health Bureau. The contents are the sole responsibility of the authors and do not necessarily represent the official

views of DHHS.

Additional support provided by:

North Dakota Brain Injury Association

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For more information contact:

Center for Rural HealthUniversity of North Dakota

School of Medicine and Health SciencesGrand Forks, ND 58202-9037

Tel: (701) 777-3848Fax: (701) 777-6779

http://medicine.nodak.edu/crh