X-Plain Preventing Traumatic Brain Injury Reference Summary

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X-Plain Preventing Traumatic Brain Injury Reference Summary Introduction A sudden violent movement or blow to the head can cause the brain to get hurt. This is known as traumatic brain injury or TBI.

TBI costs the United States more than $56 billion a year, and more than 5 million Americans alive today have had a TBI resulting in a permanent need for help with daily activities.

1 X-Plain Preventing Traumatic Brain Injury Reference Summary Introduction A sudden violent movement or blow to the head can cause the brain to get hurt. This is known as traumatic brain injury or TBI. TBIs are very common in the USA, with about 1.5 million people injuring their brain every year of which fifty thousand die. TBI costs the United States more than $56 billion a year, and more than 5 million Americans alive today have had a TBI resulting in a permanent need for help with daily activities. Survivors of TBI are often left with significant cognitive, behavioral, and communicative disabilities, and some patients develop long-term medical complications, such as epilepsy. A severe brain injury may occur even if the head is violently shaken without coming in contact with a hard object. This reference summary explains how brain injuries can cause serious complications and presents tips for avoiding traumatic brain injuries. Prevention tips are grouped under 3 different causes of TBI; vehicle accidents, sport, and falling. A special section on preventing TBI in children is also included. The Brain and TBI The brain is the control center of the body. It controls movement, actions, thoughts and sensations. The brain is inside the skull. The skull is very tough and protects the brain from mild blows to the head. 1

The brain has the consistency of gelatin. It floats inside the skull in a special fluid called cerebrospinal fluid also known as CSF spinal fluid or CSF.

2 The brain has the consistency of gelatin. It floats inside the skull in a special fluid called cerebrospinal fluid also known as CSF spinal fluid or CSF. This fluid acts as a shock absorber protecting the brain from blows to the skull. In accidents where the head is suddenly and violently shaken, the brain may push the cerebrospinal fluid and hit the skull. Even if the brain does not hit the skull, the sudden acceleration/deceleration of the brain can cause injury. This may cause bruising and swelling known as contusion. Cerebrum Brain Stem Cerebellum Acceleration and deceleration is when the brain suddenly moves fast then suddenly stops. For instance, during a car crash when the neck flexes forward then extends backward very fast, the brain, inside the skull, moves very fast forward, stops suddenly, then moves very fast backward, and then again stops very suddenly. In this example the brain accelerates, decelerates, accelerates again and decelerates again before it hits the head rest! When injured brain tissue swells up, it puts pressure on the rest of the brain. The hard and rigid skull does not expand. This makes brain swelling more dangerous. It causes more pressure on the brain itself, which results in more damage to the brain cells. Usually, brain swelling starts at the time of the injury and is worse three days later before it starts going back to its normal condition. If the swelling and pressure is severe and is not treated, it can lead to death. The brain is surrounded by a membrane called the dura. This membrane keeps the cerebrospinal fluid from leaking to the outside. If an object goes through the skull and enters the dura, this may lead to a bacterial infection known as meningitis. If not controlled, the infection can spread throughout the body and can be fatal. Brain cells need oxygen and nutrients to survive. These are delivered by blood vessels. The blood vessels of the brain could get hurt easily during a head injury. During a head injury, they can burst. This causes bleeding in or around the brain. This bleeding is also known as a hematoma. Dura 2

3 Bleeding, swelling, and pressure inside the brain can also cause less blood to flow to the brain. This can cause problems in how well oxygen, blood sugar, and certain minerals are delivered to the brain cells. If a balance is not kept, too much of certain substances can become toxic to the brain cells, causing them to die. Minerals are substances such as calcium and sodium. Brain tissue is made up of small cells called neurons. Neurons have long connections called axons. Axons can be seen only with microscopes. Axons work a lot like cables. They transfer information between brain cells. A sudden and violent trauma to the head can cause injury to the axons. This type of tearing is known as diffuse axonal injury or DAI. This microscopic injury of axons can lead to long-lasting mental problems, coma and possibly death. The brain has two parts, called the left and the right hemispheres. Each hemisphere has specialized areas for movement, thinking, sensation, and feeling. Which functions are affected depends on which area of the brain is damaged. For example, if a bullet injures the vision area of the brain, the person may not be able to register and understand what they are seeing even if the eyes are working perfectly. Brain showing left and right hemisphere The brain is a very complex organ and scientists do not fully understand how the brain thinks, feels emotions, and coordinates body functions. Because uncontrolled increase in the pressure of the brain can injure different areas inside the brain, it is not always possible for doctors to tell what will happen with a brain injury. The effects could be long-term mental, physical, emotional, and psychological effects. Causes of TBI A traumatic brain injury is caused by a force, blow, or penetrating injury to the head that is too strong. The leading causes of TBI in the United States are falls and motor vehicle accidents. Other causes of TBI include being accidentally hit by a hard object, assault, and sport injuries. Half of TBI incidents involve alcohol use. 3

4 People older than 75 have the highest rate of hospitalization and death resulting from brain injury. This is mostly due to falling and tripping. Babies can get a severe brain injury if they are violently shaken as a result of child abuse or playing rough. Shaken baby syndrome is a traumatic brain injury. Symptoms A TBI can be mild, moderate, or severe depending on the extent of the brain injury. Severe brain injuries can happen when a person is in a state of unconsciousness that lasts days, weeks, or months. Coma is a category of severe TBI where the patient is in a state of unconsciousness that he or she cannot be awakened from. Consciousness or being conscious means being awake and aware of what is going on around you. Being unconscious means not being awake and not being aware of what is going on around you. In moderate TBI, a person loses consciousness from a few minutes to a few hours. The person may be confused from days to weeks. Changes in the person s ability to move or to think last months or can be permanent. In mild TBI, the person may or may not lose consciousness. If consciousness is lost, it lasts from a few seconds to minutes. The person is dazed and confused. This brain injury is called a concussion. A concussion may happen, for example, after a fall at home, or during a tackle at a football game. It is normal for someone who had a concussion not to remember the events right before, during, and right after the accident. If you had a blow to the head, you should always get checked by your doctor to be on the safe side. You should seek emergency medical care if your symptoms or those of your loved ones include: Convulsions, which are involuntary muscle contractions and rigidity, usually along with a loss of consciousness Weakness or numbness in the hands or legs Slurred speech Repeated vomiting 4

Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, sleep disturbances,

5 Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, sleep disturbances, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking. These symptoms usually go away within a few weeks in a mild TBI. After becoming conscious again, a person with a moderate or severe TBI may show the same symptoms as those with mild TBI but with more severity. For instance, the person may have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, not be able to wake up from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, increased confusion, restlessness, and agitation. Complications Complications of traumatic brain injuries depend on the severity of the injury. Severe traumas to the brain, such as a gunshot bullet penetrating the brain, often lead to death. Most people who have mild TBI, on the other hand, usually recover fully. TBIs that cause a lot of pressure in the brain put the patient at risk of developing serious complications such as bleeding, blood clots, and cell death resulting from decreased blood flow to the brain. If not treated, these complications could lead to more damage to the brain and even death. Some complications respond well to treatment. However, the brain may take a long time to fix the damage or may never be able to fully recover. Some of these long-term effects include: Cognitive disabilities: Most people who have had a significant TBI will experience some problems in their cognitive skills. This may include problems with reasoning, problem solving, memory, speed of thinking, focusing, multitasking, and communicating. Personality changes: People who have had a significant TBI may become more impulsive, more irritable, agitated, and depressed. They may also develop posttraumatic stress disorder. These damaged social skills and unstable emotions 5

6 may become one of the greatest challenges for families and friends of the recovering patient. Sensory problems: A person recovering from TBI may sense ringing in the ears, which may last months or years. This is known as tinnitus. Vision may be changed causing blind spots, double vision or difficulty recognizing objects. The person may have less muscle coordination, which makes him or her look clumsy. In some cases, the person may experience a bitter taste or a bad smell. Headaches: Some people who have had a traumatic brain injury develop chronic headaches. Tension-type headache is the most common form but migraine-like headaches are also common. Seizures: Some people who have had a traumatic brain injury may have one or more seizures. A seizure is caused by abnormal electrical activity in the brain, and usually comes with convulsions or sudden movements of the body. Post-traumatic stress disorder: After a brain injury resulting from war, terrorism, or a serious accident, the injured person may develop post traumatic stress disorder. The person may have flashbacks or feel like the event is happening again. Post traumatic stress disorder may come with nightmares, sleep disturbances, and feelings of anger, guilt, loneliness, or fear. After a brain injury resulting from war, terrorism, or a serious accident, the injured person may develop post traumatic stress disorder. The person may have flashbacks or feel like the event is happening again. Post traumatic stress disorder may come with nightmares, sleep disturbances, and feelings of anger, guilt, loneliness, or fear. You can reduce and even prevent traumatic brain injuries by taking simple steps like wearing a seatbelt, wearing a helmet for sports that require one, clearing clutter from your home and avoiding violent situations. The next few sections include tips for helping prevent traumatic brain injuries. Preventing Motor Vehicle - Traffic Related TBI TBIs caused by motor vehicle-traffic accidents can be mild to deadly. You can help reduce your risk and even prevent brain injuries caused by motor-vehicle related accidents by following a few tips. 6

Here are some tips for reducing your risk and helping prevent TBI associated with vehicles and traffic accidents: 1. Never drive under the influence of alcohol or drugs.

Wear a seat belt at all times while traveling in a car. It does not matter if you are sitting in front or back of the car, you should always wear your seatbelt. 4.

7 Here are some tips for reducing your risk and helping prevent TBI associated with vehicles and traffic accidents: 1. Never drive under the influence of alcohol or drugs. Fifty percent of traumatic brain injuries are connected with the use of alcohol. 2. Do not ride with a driver who is under the influence of alcohol or drugs. 3. Wear a seat belt at all times while traveling in a car. It does not matter if you are sitting in front or back of the car, you should always wear your seatbelt. 4. Secure small children in child safety seats or booster seats. Depending on their size, seat belts alone may be good to help keep older children safe. 5. Wear a helmet when riding a bicycle or motorcycle. 6. Drive defensively. Defensive driving means reducing the risk of driving by watching out for and preparing for dangerous situations caused by road conditions or the mistakes of other drivers. Preventing Sport Related TBI TBIs caused by sports related accidents can be mild to deadly. You can help reduce your risk and even prevent brain injuries caused by sports related accidents by following a few tips. Here are some tips for reducing your risk and helping prevent TBI associated with sports related accidents. 1. Wear a helmet when riding a bicycle, a motorcycle, a skateboard, a snowmobile or an all-terrain vehicle. 2. Wear head protection when you bat, ride a horse, ski, skate, or play a contact sport. 3. Take time off to heal if you had an accident. Do not try to play again too quickly. Preventing Fall Related TBI Falls are the biggest cause of traumatic brain injuries. TBIs caused by falls can be mild to deadly. You can help reduce your risk and even prevent brain injuries caused by falls by preventing falls. 7

Here are some tips to prevent falling. 1. Use a cane or a walker if you need help walking. Ask your doctor to recommend one. 2. Avoid falls by installing safety features at home.

8 Here are some tips to prevent falling. 1. Use a cane or a walker if you need help walking. Ask your doctor to recommend one. 2. Avoid falls by installing safety features at home. This includes handrails on stairways, grab bars in the bathroom, night lights, and nonslip mats in the bathtub. 3. Cut down on clutter around the house. Extra decorations in high traffic areas can also increase your risk of falling. Make sure walkways and high traffic areas are clear of boxes, newspapers, electrical and phone cords, and furniture. 4. Make sure to secure loose rugs, carpeting, and floorboards. 5. Store items like clothes and dishes within your reach. 6. Make sure your floors are not slippery by cleaning up any spills right away and using non-skid floor wax. 7. Have regular vision tests and use your corrective lenses. Better vision can help lower the risk of falling. 8. Make sure to get exercise regularly. Exercise can improve your strength, coordination, and flexibility. Always talk with your doctor before starting any kind of exercise program. 9. Consider changing your footwear as part of your fall-prevention plan. High heels, floppy slippers and shoes with slick soles can make you slip, stumble, and fall. So can walking in your socks. 10. Keep your home brightly lit with 100-watt bulbs or higher to avoid tripping on objects that are hard to see. 11. Ask your doctors to take a look at the medications you are on. Your doctor may be able to spot side effects that might increase your risk for falling. Preventing TBI in Children TBIs in children can be mild to deadly. You can help reduce the risk of and even prevent brain injuries in children by following a few tips and rules. Here are some tips for reducing the risk of TBI in children: 1. Do not shake babies and children ever. Even if you are playing and think it is safe, you should always be careful and never shake a baby or child. 2. Teach children how to be careful around playgrounds. 3. Make sure the ground of your child s playground is made of materials that absorb shock like sand or woodchips. 8

4. Store firearms, unloaded, in a locked cabinet or safe. Store bullets in a separate location. 5. Teach children and teenagers how to avoid violence and conflict at school and social situations.

9 4. Store firearms, unloaded, in a locked cabinet or safe. Store bullets in a separate location. 5. Teach children and teenagers how to avoid violence and conflict at school and social situations. Conclusion A sudden violent movement or blow to the head can cause the brain to get hurt. This is known as a traumatic brain injury or TBI. TBIs are very common in the USA, with about 1.5 million reports of people injuring their brain every year of which fifty thousand die. Brain injury can be mild, moderate or severe. A mild traumatic brain injury may cause confusion and headache and most people recover from it. A severe head injury can cause disability or death. A severe brain injury may happen even if the head is violently shaken without coming in contact with a hard object. When patients recover from moderate to severe TBI they may be left with long-term effects such as: Cognitive disabilities Personality changes Sensory problems Headaches Seizures If you had a blow to the head, you should always get checked by your doctor to be on the safe side. You should seek emergency medical care if your symptoms or those of your loved ones include: Convulsions Weakness or numbness in the hands or legs Slurred speech Repeated vomiting You can help prevent brain injuries by wearing a seatbelt when driving, wearing a helmet for sports that require one, and preventing falls. 9

Preventing Traumatic Brain Injury in Older Adults. U.S. Department of Health and Human Services Centers for Disease Control and Prevention

Preventing Traumatic Brain Injury in Older Adults U.S. Department of Health and Human Services Centers for Disease Control and Prevention Most of us worry about staying safe, healthy, and independent as