CSD
2230
TBI
- Traumatic Brain Injury is injury to the brain
sustained by physical trauma or external force. As a result of
injury various skills and general behavior is affected.
- Primary Injuries - happens at the moment of
injury. It may be caused by a contusion (bruising) of the brain
itself, especially in those places where the brain hits the
skull. Primary brain damagemay also come from shearing
(tearing) of the brain cells from the same injury. Some brain
cells and fibers that are injured are able to repair
themselves, but sometimes the nerve damage is severe and
permanent.
- Skull fracture
- Contusions,
or bruises
- Hematomas (accumulation), or blood
clots
- Lacerations
- Diffuse Axonal Injury
- Secondary Injuries - caused by bleeding
into the brain, lack of blood and oxygen to the brain, or brain
swelling. When this happens, pressure builds. This intracranial
pressure (ICP) may damage or destroy nerves. In the minutes and
hours after a brain injury, a variety of other damage may
occur.
- Hematoma (epidural, subdural and/or
intracerebral)
- Brain swelling/edema
- Increased intracranial pressure
- Cerebral vasospasm
(constriction)
- Intracranial infection
- Epilepsy
- Types of Brain Injury
- Penetrating Brain Injuries (Open head
injuries due to open wound in head)
- Skull fracture: Breaking of the bony
skull; bone fragments exert pressure on the brain.
- Meninges are lacerated or
torn
- Brain tissue is
penetrated
- Nonpenetrating Brain Injuries (Closed
Head Injuries
- No open wound to head
- Brain structures within skull may be
damaged
- Contusions, or bruises, will occur
under the location of a particular impact. They are
common in the area of frontal temporal lobes, where the
force of the impact can drive the brain against the
inside bony ridges of the skull.
- Hematomas,
or blood clots, result when small blood vessels are
broken by the injury. They can occur between the skull
and the brain (epidural or subdural
hematoma), or inside the
substance of the brain itself (intracerebral hematoma).
They may compress or shift the brain, damaging sensitive
structures in the brain stem.
- Acceleration/deceleration Injuries occur
when
- moving object strikes unrestrained
head and propels head
- physical forces set the head into
motion, which strikes a stationary object
- Coup
(coo) Injury - at point of
impact trauma, brain is injured
- Contrecoup - Injury occurs at the
opposite side of brain
- Angular Acceleration of Head
- Diffuse axonal injury
- Head begins to move, brain is
still and will sustain twisting and shearing damage
(midbrain, basal ganglia, brainsem,
cerebellum)
- Head has stopped moving, the
brain may be moving internally and causes twisting
and shearing damage to structures
- Shifting and rotation of the
brain (closed head injury) inside the skull may
result in shearing injury to the brain's long
connecting nerve fibers or axons. Recent studies
have shown that some of the damage to axons
progresses over the first 12 to 24 hours after the
injury. Due to these recent findings, diffuse
axonal injury is now thought of as a combination of
primary and secondary damage.
- Nonacceleration Injuries
- occur when a restrained hed is hit by
a moving object
- head of a mechnic lying under
car
- Incidence
- Approximately 500, 000 individuals sustain
TBI annually
- Of the above group, 200,000 die from
sustained injures
- 50,000 to 100, 000 have significant
impairments
- 70%are males
- Overview of Cognitive and Communicative
Deficits
- Coma - condition in which individual
displays minimal purposeful responses to external
environment
- Cognitive Disturbances - major problem is
resulting cognitive disturbances
- Orientation - individual's awareness of
person (autobiographical information), place, time and
circumstances
- Attention - several dimensions (Sohlberg
& Mateer, 1989)
- Focused Attention - abilitiy to
respond discretely to specific visual, auditory or
tactile stumuli (visually tracking an object)
- Sustained Attention - ability to
maintain a consistent behaviroal response over a period
of time (sorting shapes)
- Selective Attention - ability to
maintain a behavioral set in presence of distracting
stimuli ( reading paper with tv in
background)
- Alternating Attention - ability to
shift focus of attention and move between tasks with
different behavioral requirements (serve tables and man
cash register)
- Divided Attention - ability to
respond simultaneously to multiple task demands (drive
and phone conversation)
- Problem-Solving and Reasoning
- Problem Solving
- Strategy Selection
- Application of Strategy for
Resolution
- Evaluation of Outcome
- Reasoning - drawing of inferences and
conclusions from knowing assumed facts
- Executive Function - Persons with
deficits in executive function may be able to perform single
step operations but unable to plan, sequence, adn monitor
multi-step activities (example: answer phone in office, but
not be an office manager). It is a composite of activities
related to:
- achievement/completion of a
goal
- goal formulation
- planning
- implementing
- self-monitoring
- use of feedback
- Language Disturbances
- Patient's receptive, integrative, and
expressive language can be become:
- Disoriented - not appropriated to the
situation, question, statement, or
discussion.
- Disorganized - fragmented and
incomplete understanding of what has been heard or
expressed by the patient.
- Confused - confabulatory,
circumlocutory, tangential in relation to the content of
the situation, question, statement, or
discussion.
- Stimulus bound - relevant to a part,
but not the whole idea of a statement, question, or
discussion.
- Reduced in initiation - reliant upon
others to stimulate the occurrence and structure of
language responses.
- Reduced in inhibition - Once language
response is initiated, it is not specific or precise to
the original question or statement.
- Consequences of cognitive
disorganization appear in patient's receptive and expressive
language in the form of combinations of the following
symptoms:
- Decreased auditory
comprehension
- Decreased visual and reading
comprehension
- Expressive language that does not
make sense
- Language expressions that are
grammatically correct but not relevant to the question,
statement, or discussion.
- Lack of ability to inhibit verbal
expressions;
- Inappropriate ordering of words in
sentences and/or inappropriate grammar.
- Inability to recall specific
words.
- Speech Disturbances
- Dysarthria - speech disorder resulting
from weakness or incoordination of muscles that control
respiration, phonation, resonance, and/or
articulation
- Mutism related to subcortical
lesions)
- Swallowing Disturbances
- Dysphagia - condition in which the
action of swallowing is difficult
- Brain Injury
Association
