Traumatic Brain Injury (TBI) remains a major public health concern in the United States today and the statistics are alarming.  According to the Centers for Disease Control and Prevention, almost 5.3 million Americans are living with disabilities associated with traumatic brain injuries. Hospital emergency rooms treat and release well over a million victims of head injury every year. Of those injured, at least 80,000 experience disabilities and another 50,000 people die. Behind these disturbing statistics are people’s lives that have changed forever by the devastation, uncertainty, confusion and financial hurdles that surround a Traumatic Brain Injury. Divorce, suicide, unemployment and substance abuse are some of the fall-out of a serious head injury. The physical, cognitive, and behavioral consequences of TBI are felt by victims, their families, social service agencies, law enforcement and the justice system. TBI touches the lives of us all. 

According to the Brain Injury Association of America, a TBI is caused by a physical force impacting the brain that produces a diminished or altered state of consciousness.  The force to the head causes the brain to move within the skull or causes the skull to break and directly harm the brain.  Bruising, tearing and swelling are processes that can occur from the rotation of the brain against the skull. Head injuries are classified as either closed or penetrating. In a closed head injury, the head sustains a blunt force by striking against an object, while an open head injury is caused by a penetrating object that leaves visible bleeding and exposed brain tissue.

Our brain makes up only 2% of our body weight, yet it is responsible for the thought process, voluntary and involuntary movements and other vital body functions. The cerebrum is the Latin word for “brain” and controls a persons’ behavior, eyesight, sense of smell, some motor skills, language and emotions. The cerebellum is in charge ofbalance for walking and standing and other complex motor functions.  Located at the base of the brain is the brain stem which attaches to the spinal cord and supervises physical growth, body temperature, hormones and sexual functions.  Damage to any one or all of these areas of the brain can result in permanent disability, seizures, headaches or migraines, loss of taste or smell, memory loss,  double vision or loss of vision, speech impairments, anxiety, behavioral problems and depression.  One of the most tragic consequences of TBI is the loss of self due to memory impairment. The loss of identity, learning and personal power is intense and difficult to adjust to. Interpersonal relationships, work and studies suffer.

The leading causes of TBI include motor vehicle incidents, falls, acts of violence and sports injuries. The results of these injuries may include:

• Diffuse Axonal Injuries are caused by the shaking or strong rotation of the head that may occur in car accidents and Shaken Baby Syndrome. This type of brain injury can result in temporary or permanent widespread brain damage and sometimes death.
• Concussionshappen when the brain receives trauma from an impact or violent change in momentum or movement. Effects vary from disorientation to temporary amnesia and the loss of consciousness.
• Coup-Contrecoup injuries are contusions that occur on the side of impact as well as the direct opposite side of the brain. The force of impact is so great that the impact slams the brain into the opposite side of the skull.
• Recurrent Traumatic Brain Injury or Second Impact Syndrome. As the name suggests, these injuries occur prior to the healing of a previous traumatic brain injury. This second impact increases the chance of brain swelling and damage.
• Penetration Injuries result from a bullet, knife or other sharp object forcing hair, skin and bone into the brain. “Through-and-through” injuries happen when a penetrating object enters the skull, passes through the brain and exits the skull causing additional shearing, stretching and rupture of brain tissue.
• Shaken Baby Syndrome occurs when an aggressor violently shakes a baby or young child. The whiplash-like motion causes the brain to be injured.  Shaken Baby Syndrome can result in seizures, coma, permanent disabilities and death.
• Comas are prolonged periods of unconsciousness where there is no awareness of self or the environment; however, the person may have simple reflex responses to touch or pain.

Recognizing the Symptoms of TBI

The Glascow Coma Scale (GCS) is often used to assess the severity of neurological injury to the brain. While Mild Brain Injury, Moderate Brain Injury and Severe Brain Injury are medical terms used to describe the level of neurological damage to the brain, any injury to the head has the potential for serious and long term effects. Brain injury symptoms can vary greatly and depend on the location and its’ severity of the damage. After a forceful impact to the head, immediately seek a physician, go to the emergency room or contact 911 for immediate help.

A person with TBI may exhibit (immediate or deferred) symptoms that include:

• Persistent headaches
• Memory, concentration, mood changes
• Trouble concentrating
• Feeling lethargic
• Changes in mood or sleep
• Blurred vision, seeing double, and sensitivity to light or blindness.
• Ringing in the ears
• Sudden confusion
• Neck Pain
• Slow breathing rate, increased blood pressure, slow pulse rate
• Paralysis, problems moving, weakness or poor coordination
• Respiratory problems
• Spinal fluid leaking from the ears or nose (watery looking fluid)
• Vomiting
• Difficulty in speech or swallowing
• Balance problems including dizziness
• Numbness or tingling

Treatment and Rehabilitation

The currently used treatments may include cognitive-behavioral remediation, pharmacologic therapy, assistive technology, environmental stimulation, education, and counseling. TBI patients receive help in independent rehabilitation hospitals, rehabilitation departments in general hospitals, a variety of day treatment or residential programs, skilled nursing facilities, schools, the community, and in the home.

The requirements of individuals stricken with TBI are complex and changing. Acute care and rehabilitation for new cases of TBI costs this nation an estimated $9 to $10 billion.  Average lifetime cost of care for a person with severe TBI may range from $600,000 to $1,875,000. These numbers do not include lost earnings of the injured, their families who sacrifice income to become caregivers, and the costs to the social service system. Insurance may not exist or be insufficient to cover the mounting costs of long-term care and the rehabilitation so vital to helping the brain-injured lead fulfilling, productive and dignified lives. TBI victims and their families deserve to have access to the best treatment, best support and best future; however overwhelming financial problems add even more pain and uncertainty to their lives.