Traumatic Brain Injuries (TBIs) and Non-Traumatic Brain Injuries (nTBIs)
Traumatic Brain Injuries (TBIs)
What is a Traumatic Brain Injury (TBI)?
A TBI is caused by a bump, blow, or jolt to the head that disrupts the normal function of the brain. Not all blows or jolts to the head result in TBIs. The severity of a TBI may range from “mild” (a brief change in mental status or consciousness) to “severe” (an extended period of unconsciousness or memory loss after the injury). Most TBIs are mild and commonly called concussions, according to the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. (Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.) (https://www.cdc.gov/traumaticbraininjury/get_the_facts.html)
Overview of a Traumatic Brain Injury
Traumatic brain injury (TBI) is one of the leading causes of disability in the United States, estimated to affect 13.5 million individuals. (Schiller JS, Lucas JW, Ward BW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Vital Health Stat 10 2012; :1.)
Many survivors live with significant disabilities, resulting in major socioeconomic burden as well as health issues. In 2010, the economic impact of TBI in the United States was estimated to be $76.5 billion in direct and indirect costs. (Finkelstein E, Corso P, Miller T. The Incidence and Economic Burden of Injuries in the United States, Oxford University Press, New York 2006; Coronado V, McGuire L, Faul M, et al. Epidemiology and public health issues. In: Brain Injury Medicine: Principles and Practice, 2nd ed, Zasler ND, Katz DI, Zafonte RD, et al. (Eds), Demos Medical Publishing, New York 2012.)
In 2013, there were approximately 2.5 million emergency department (ED) visits, 282,000 hospitalizations, and 56,000 deaths related to TBI in the United States. (Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013. MMWR Surveill Summ 2017; 66:1.)
TBI contributes to 30 percent of all injury-related deaths in the United States. (Id.) These numbers are thought to significantly underestimate the burden of TBI, since they do not include patients who did not seek medical attention, received ambulatory care, were seen at Veterans Affairs centers, or were in the military.
TBI is a major problem for the United States military; the Department of Defense reports that between 2000 and 2017, 375,230 military personnel suffered TBI. (Defense and Veterans Brain Injury Center. DoD Numbers for Traumatic Brain Injury. Department of Defense, 2017.)
Non-Traumatic Brain Injuries (nTBIs)
What is a non-traumatic brain injury (nTBI)?
Non-traumatic events that can lead to nTBIs include:
- Lack of oxygen (anoxic/hypoxic injury)
- Cardiac arrest
- Medication errors
Children & young people with nTBIs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955214/
Older adults with nTBIs:
Functional recovery after nTBI:
Causes of Brain Injury
Motor vehicle accidents
- Impact of head with structural components of vehicle or other objects in the vehicle.
- De-acceleration Injuries, where there is no impact to the head itself, but injuries occur within the brain as tissue is damaged by the sudden deceleration of the brain impacting with the skull.
- These injuries commonly occur to the front (frontal) and side (temporal) of the brain, which are used for learning, memory, planning, organization, concentration, and emotional control.
- Most-frequent causes:
- Car accident
- Truck accident
- Motorcycle accident
- Plane accident
- Coup Contre Coup, when there is a blow to the head and the brain strikes the inside of the skull on the side of the blow and on the opposite side.
Injuries from falling
- A fall from a ladder, a roof, stairs, or a high surface can result in a traumatic brain injury (TBI).
- In 2014, falls were the leading cause of TBIs. Falls accounted for almost half (48%) of all TBI-related emergency department visits. Falls disproportionately affect children and older adults: Almost half (49%) of TBI-related ED visits among children 0 to 17 years old were caused by falls. (https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm)
- Four in five (81%) TBI-related emergency department visits in older adults aged 65 years and older were caused by falls.
- Falls were the leading cause of death for people 65 years of age or older.
- Falls were the leading cause of ED visits among young children aged 0 to 4 years old and adults age 65 years and older.
- Falls were the leading cause of hospitalizations among children 0 to 17 years old and adults 55 years of age and older.
- An open head wound caused by an impact to the skull by an object such as a bullet, knife, baseball bat, etc.
- Usually causes a focal injury, meaning that the greatest impact is to one area of the brain.
- Penetrating injuries to the brain often require surgery.
- An injury resulting from a direct blow to the head, face, or neck.
- These injuries may range from mild to severe.
- Mild injuries may resolve themselves in a short period of time with minimal treatment.
Non–Trauma-Induced Brain Injury
This type of injury can be caused by:
Low oxygen levels
Low blood pressure
Temporary cardiac arrest
Symptoms of Brain Injury
Beware: These symptoms may be hidden (masked) by severe physical injuries such as broken bones, severe lacerations, etc. (https://www.health.ny.gov/publications/0660/).
Post-Traumatic Confusion State
- After a severe brain injury, the patient could be unaware of a variety of important symptoms, such as their personal feelings, their current location or daily schedule, or even their name.
- In some scenarios, these symptoms resolve after a few weeks. In other scenarios, victims experience symptoms for months, years, or even permanently, such as decreased attention span, differential levels of activity throughout the day, or severe personality changes.
- This state is referred to as delirium (mental confusion followed by emotional and behavioral disruptions).
Brain injuries actually damage the brain. As a result, they often affect parts of the brain that control a person’s personality. Victims frequently exhibit one or more of the following:
- Unexpected outbursts around loved ones, friends, and co-workers.
- Being irritable around loved ones, friends, or co-workers for non-apparent reasons.
- Inability to think, work, or take care of their family.
- Mood swings
- Frequent changes from “happy” to incredibly sad, and/or mad.
- Selfishness/Loss of empathy
- Often become “selfish” or seem to lack concern for others, including close family members, co-workers, and even pets.
- Aggressive reactions to minor situations caused by misinterpreting actions of those around them or other triggers.
- Lack of self-control
- Frequently lack the ability or even the awareness that they need to control/limit their behavior or attitude.
- Cursing at extremely inappropriate times and places.
- Sexual activity
- Purchasing activity
- A tendency toward excessive or irrational suspiciousness and distrust
- A tendency toward excessive or irrational suspiciousness and distrust
- An overwhelming feeling of fear
- Overwhelming feelings of sadness
- Post-Traumatic Stress Disorder (PTSD)
- An emotional disorder triggered by memories, the brain injury event or surrounding circumstances
- Flat affect
- Severe reduction in emotional expressiveness (https://onlinelibrary.wiley.com/doi/epdf/10.1002/msj.20097)
Difficulty with communication
- Memory problems
- Affect both long-term and short-term memory.
- Attention problems
- Changes in attention that may be caused by pain, fatigue, depression, PTSD.
- Can cause long-term issues such as Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD).
- Lack of interest in life & activities (Apathy)
- Subtle and sometimes drastic reductions in interest in parts of the patient’s life that previously brought them enjoyment.
- Often appears as a decrease of energy and/or lack of interest in completing activities they previously enjoyed.
- Slowed thinking
- Reduced ability to maintain previous information processing speed. Victims frequently experience the inability to process even simple information.
- Speech impairment
- Even after a mild to moderate brain injury, the inability to communicate thoughts, expressions, and emotions as clearly and easily as before the accident.
- May not speak clearly; may also have issues with speaking at the same speed/rhythm as before the injury.
- Word-finding problems
- Difficulty speaking or understanding language.
- Difficulty speaking or understanding language.
Altered sense of taste, smell, and vision
- Patients who have a brain injury may lose their sense of smell. They may also have a sensation of bad or disagreeable smells.
- The sense of taste may also be diminished or altered.
- These symptoms may be a clue to other problems associated with the brain injury.
- Physical injuries may mask signs and symptoms of brain injuries. The physical injuries may be so severe that they require immediate treatment to stabilize the victim’s injuries or even save their life, and the brain injury may go unnoticed because of the amount of attention required by the other injuries.
- Signs that a brain injury may have occurred include:
- Confusion of past and present situations
- Unintelligible speech
- Perseveration (repetition of a phrase or activity over and over again)
- Overwhelming need to sleep
- Light or sound sensitivity
Severity of Injury
Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is used by first responders (paramedics, EMS, etc.) to assess the level of brain injury/consciousness of a person after an accident or head injury.
The GCS measures three brain functions:
Low GCS scores are often caused by skull fractures, brain bleeds, or drastic damage to the brain itself, often resulting in the need for immediate surgery.
High GCS Scores (even 15, which is considered “mild”) do not mean that there was no brain injury. GCS is only an initial assessment tool and carries no guarantee for lack of future symptoms. GCS is a subjective determination that is not definitive of a brain injury.
Mild (GCS 13–15)
A traumatic brain injury (TBI) may occur without the loss of consciousness. The patient may be confused or disoriented. Imaging studies often appear normal. In many cases, the injured person’s family notices abnormal behavior first. Despite the lack of a loss of consciousness, significant problems with daily function and personality may become apparent over time.
Moderate (GCS 9–12)
A more-severe traumatic brain injury (TBI) is often characterized by the loss of consciousness for minutes to hours. Confusion is often present and may or may not improve after the injury. More-significant symptoms include cognitive, behavioral, and physical problems. These symptoms may be permanent and require extensive treatment by a wide range of healthcare providers.
Severe (GCS 8 or less)
More-severe traumatic brain injuries involve profound damage to the brain. These patients often suffer skull fractures and are not usually able to live independently after such an injury. They often need a team approach with the long-term involvement of multiple healthcare providers.
What Should Patients/Family Do if Worried about a Patient’s Brain Injury?
No two injuries are the same. Each person who sustains an injury to the brain must have a carefully tailored plan to assist them in their recovery.
If the brain injury was caused by the intentional act or negligence of someone else, the victim and his/her family will need, at minimum:
Medical doctors (MDs)
- ER doctor (trauma physician)
- Hospitalist (doctor who provides secondary care in a hospital setting)
- Primary care doctor
- Physical medicine & rehabilitation doctor (PM&R)
- Plastic surgeon
- Physician’s Assistants with special certifications in brain injury/polytrauma
- Physical Therapy: movement experts who optimize quality of life through prescribed exercise, hands-on care, and patient education.
- Speech and Language Therapy: to improve communications skills.
- Cognitive Therapy: therapy to restore intellectual and higher level skills.
- Occupational Therapy: rehabilitation in performing daily tasks.(https://www.biausa.org/brain-injury/about-brain-injury/treatment/brain-injury-rehabilitation)
- Damage to the brain frequently requires treatment by medications. These may include antidepressants, antispasmodics, medications to improve sleep, or medications to improve concentration.
- Brain-injured individuals frequently refuse medication or lack the understanding of its importance to their recovery. Family, friends, etc., must step forward and ensure the patient complies with the medical treatment plan fully and completely. Failure to do so will frequently result in a spiraling decline in the person’s condition, which often compounds the problem and alienates friends, loved ones, or coworkers.
- Reasons for issues with medications:
- Side effects are more unpredictable in patients with a traumatic brain injury and may be severe, leading patients to stop taking their medications.
- There may be many different medications.
- Medication interactions may be a problem.
- The patient may be non-compliant about taking their medications.
Medications may be very expensive.
- Some medications may require frequent laboratory monitoring.
- Patients may not be able to administer their medications safely.
Future of Brain Injury Evaluation
New ways to evaluate the types and levels of brain injury are being developed, including:
Laboratory testing for brain injury.
New imaging methods for diagnosis, such as a functional MRI (a testing method that measures brain activity by detecting changes associated with blood flow).
MRI analysis of brain anatomy using NeuroQuant (software that can measure brain shrinkage).
Eye-Trac Advance studies (a measurement that can track how well a patient can coordinate their eye movement).
SPECT and PET scanning.
The legal services provided by our Traumatic Brain Injury attorneys address the following:
- Medical malpractice
- Automobile accidents
- Trucking and tractor-trailer accidents
- Industrial accidents
- Assault and battery
- Birth injuries
- Aviation accidents
- Pharmaceutical and medical device litigation
Please choose from the attorneys listed at left to inquire about these matters. Learn more about the attorneys by clicking on their names.Have questions? Contact us.