Traumatic Brain Injury

© Springer International Publishing Switzerland 2017
Maggi A. Budd, Sigmund Hough, Stephen T. Wegener and William Stiers (eds.)Practical Psychology in Medical Rehabilitation10.1007/978-3-319-34034-0_12

12. Traumatic Brain Injury

Mark Sherer1  
(1)
TIRR Memorial Hermann, Houston, TX, USA
 
 
Mark Sherer
Email:
Keywords
Traumatic brain injuryRecoveryCognitionPsychological services

Topic

TBI is “damage to brain tissue caused by an external mechanical force as evidenced by medically documented loss of consciousness or post traumatic amnesia (PTA) due to brain trauma or by objective neurological findings that can be reasonably attributed to TBI on physical examination or mental status examination. Penetrating wounds fitting the definition listed above are included. This definition of TBI excludes several conditions when the criteria above are not met: Lacerations or contusions of the face, eye, or scalp, without other criteria listed above; Fractures of skull or facial bones, without criteria listed above; Primary anoxic, inflammatory, toxic, or metabolic encephalopathies which are not complications of head trauma; Brain infarction (ischemic stroke); Intracranial hemorrhage (hemorrhagic stroke) without associated trauma; Airway obstruction (e.g., near-drowning, throat swelling, choking, strangulation, or crush injuries to the chest); Seizure disorders (grand mal, etc.); Intracranial surgery; Neoplasms” [1].

Importance

Epidemiology of TBI. Surveillance data provided by the Centers for Disease Control and Prevention [2] indicate that:
  • Approximately 1.7 million persons sustain TBI each year in the U.S.
  • Of these, 52,000 die, 275,000 are hospitalized, and 1.365 million are treated and released from emergency departments. The number of persons who sustain mild TBI and fail to seek medical care is unknown.
  • TBI is a contributing factor to almost 1/3 of all injury-related deaths.
  • Most frequent for children aged 0–4 years, older adolescents aged 15–19 years, and adults aged 65 years or older.
  • Incidence of TBI is greater for males than females in every age group.
  • Falls are the most common cause of TBI followed by being struck by an object and motor vehicle incidents.

Practical Applications

  1. A.
    Classification of TBI Severity . Severity of TBI is most commonly classified based on level of responsiveness at arrival to the Emergency Department.
    1. 1.
      Glasgow Coma Scale ( GCS )
      Measures eye opening, motor movement, and verbal communication. Scores range from 3 to 15 so that a person with a score of 3 has no eye opening even to pain, no movement, and no vocalizations while a person with a score of 15 has spontaneous eye opening, follows commands, and is able to answer questions to indicate that he/she is oriented.
      • Severe TBI: GCS scores ranging from 3 to 8. Note: Sometimes this group is divided between extremely severe (3–5) and severe (6–8).
      • Moderate TBI: GCS scores ranging from 9 to 12.
      • Mild TBI: GCS scores ranging from 13 to 15.
      • Complicated Mild TBI: Persons with GCS scores indicating mild TBI but who have positive CT scan findings or focal neurologic findings. Outcomes for this group are similar to outcomes for persons with moderate TBI.
       
    2. 2.
      Duration of Loss of Consciousness ( LOC )
      Another index of TBI severity with longer intervals associated with more severe injuries and poorer eventual outcomes.
      • Also known as time to follow commands (TFC), is the interval from injury till the patient regains the ability to follow commands.
      • Note: Some persons with mild TBI may never lose the ability to follow commands.
      • Unfortunately, there is no empirically supported, commonly agreed upon scheme for translating LOC durations to severity categories roughly equivalent to GCS categories.
       
    3. 3.
      Duration of Posttraumatic Amnesia ( PTA )
      Another index of TBI severity that refers to the inability of persons early after TBI to store and later recall new memories.
      • Persons in PTA are disoriented and may exhibit a range of other neurobehavioral deficits.
      • Galveston Orientation and Amnesia Test (GOAT) or the Orientation Log (O–Log) are common scales used in clinical practice and in research to assess duration of PTA through frequent administrations.
      • As with LOC, greater duration of PTA is associated with greater injury severity and poorer outcome.
      • The period of LOC, if present, is included in the PTA duration.
      • There are empirically derived classification schemes for PTA such as that provided by Nakase-Richardson et al. [3].
      • Nonetheless, different psychologists may use different classification schemes making comparison between studies difficult and complicating communication between clinicians.
       
     
LOC and PTA have advantages over GCS as indices of TBI severity as they can be influenced by various secondary causes of injury such as brain swelling, biochemical and physiologic changes in the brain, neurosurgical interventions, infection, etc. that occur after initial GCS scores are recorded. However, these factors also complicate comparison between indices of severity as persons given one classification based on one index may receive a different classification based on a different index. See Sherer et al. [4] for a discussion of this issue.
  1. B.
    Recovery from TBI
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Jun 25, 2017 | Posted by in PSYCHOLOGY | Comments Off on Traumatic Brain Injury

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