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Indicators of TBI
- 1. LOC
- 2. Alteration of consciousness (confused right after injury) 3. Post-traumatic amnesia
- 4. concussion-like symptoms; nausea, headache, dizziness, balance problems
- 5. GCS Score
severity based on length of symptoms and GCS score
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GCS***
- 1. Eye (4) - open spontaneously, speech, pain, none
- 2. Verbal (5) - oriented, confused, inappropriate, incomprehensible, none
- 3. Motor (6) - obeys, localizes, withdraws, flexion, extension, none
mild 3-8, moderate 9-12, severe 13-15
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TBI Severity Levels ***
- Mild: (17%) most symptoms < 24 hrs, LOC < 30 min, normal brain scan ("complicated" if abnormal brain scan)
- Moderate: (77%) most symptoms > 24 hours, but for memory loss < 7 days. LOC > 30 min but less than a day.
- Severe: (1%) symptoms > 24 hrs, memory loss > 7 days, LOC > 24 hrs
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Types of blast damage
- primary: blast wave
- secondary: projectiles from blast
- tertiary: body thrown into something
- quaternary: everything else
most TBIs are closed head injury from IED
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Types of Brain Tissue Damage**
- 1. Diffuse Axonal Injury-- slowed processing speed, reduced inhibition of impulses
- 2. Contusions -- problems depends on site of injury
- 3. Penetrating Injuries
- 4. Secondary or Delayed effects (ICP, infection, blood loss, ichemia)
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Cognitive, Emotional and Functional Effects of MILD TBI
- -subtle and remit within 3 months
- 1. post concussive symptoms within first few days and weeks
- 2. subtle cognitive defects of processing speed, attention and memory
- 3. emotional problems exacerbated
- 4. functional deficits: problems with multitasking, complext tasks, slowed thinking and reaction time
--long term deficits might arise because of burden of post concussive symptoms
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Cognitive, Emotional and Functional Effects of Moderate-Severe TBI
- a lot of recovery in first 6 months, most within first year
- 1. post concussive symptoms lower
- 3. Emotional problems: common; depression, apathy, poor impulse control, greater risk of substance abuse or other addictive behaviors
- 4. functional deficits: related to severity of cognitive and emotional deficits. Any occupational or academic activities should be reengaged slowly to avoid possibility of failure and discouragement.
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