Traumatic Brain Injury (TBI) or Acquired Brain Injury (ABI)

Simply put, a traumatic brain injury is an injury to the brain that can change how the person acts, moves, and thinks.  The severity of a traumatic brain injury can range from a mild concussion to the extremes of coma or even death. A coma is a profound or deep state of unconsciousness.  No brain injury should ever be considered unimportant, as even a mild injury can have lasting and devastating effects on the quality of life.

An acquired brain injury is the impairment of normal brain function due to a neurological insult, such as: open or closed head injury (traumatic brain injury or TBI), select cerebral vascular lesions (i.e., aneurysm, hemorrhage, brain stem stroke), hypoxic event (loss of oxygen  such as in near drowning), intracranial tumor, and select neurological diseases (i.e., encephalopathy).   Acquired brain injury takes place at the cellular level within the brain. Therefore, injury from acquired brain injury can effect cells throughout the entire brain, instead of just in specific areas as with traumatic brain injury.  The causes of an ABI may be airway obstruction, near-drowning, throat swelling, choking, strangulation, crush injuries to the chest, electrical shock or lightening strike, trauma to the head and/or neck, blood loss from open wounds, artery impingement from forceful impact, shock, vascular disruption, heart attack, stroke, arteriovenous malformation (AVM), aneurysm, intracranial surgery, infectious disease, intracranial tumors, metabolic disorders, meningitis, certain venereal diseases, AIDS, insect-carried diseases, brain tumors, hypo/hyperglycemia, hepatic encephalopathy, uremic encephalopathy, seizure disorders, toxic exposure- poisonous chemicals and gases, such as carbon monoxide poisoning.

The symptoms, treatments, and results are  much the same for both conditions.  The real difference is just in the terminology.  Acquired brain injury includes more causes for the injury to the brain than the term traumatic brain injury.

The brain is enclosed inside the skull. The skull acts as a protective covering for the soft brain. The brain is made of neurons (nerve cells). Every cell is surrounded and connected by fascia.  The neurons form tracts that route throughout the brain. These nerve tracts carry messages to various parts of the brain from the body. The brain uses these messages to perform functions by sending messages out to the body using the nerves and fascia. The functions include coordinating our body's systems, such as breathing, heart rate, body temperature, and metabolism; thought processing; body movements; personality; behavior; and the senses, such as vision, hearing, taste, smell, and touch. Each part of the brain serves a specific function and links with other parts of the brain to form more complex functions.

When a brain injury occurs, the functions of the neurons, nerve tracts, or sections of the brain can be affected.  The fascia can become bound, just as it can in any other part of the body.  If the neurons and nerve tracts are affected, they can be unable or have difficulty carrying the messages that tell the brain what to do.  If fascial binding is putting pressure on a nerve or interrupting the nerve conductivity, this can change the way a person thinks, acts, feels, and moves the body. Brain injury can also change the complex internal functions of the body, such as regulating body temperature; blood pressure; bowel and bladder control. These changes can be temporary or permanent. They may cause impairment or a complete inability to perform a function.

Traumatic brain injury (TBI) is sudden physical damage to the brain. The damage may be caused by the head forcefully hitting an object such as the dashboard of a car (closed head injury) or by something passing through the skull and piercing the brain, as in a gunshot wound (penetrating head injury). The major causes of head trauma are motor vehicle accidents. Other causes include falls, sports injuries, violent crimes, and child abuse.

Traumatic brain injury (TBI) can significantly affect many aspects of each individual including cognitive, physical, and psychological skills. Physical deficits can include walking, balance, coordination, fine motor skills, strength, and endurance. Cognitive deficits of language and communication, information processing, memory, and perceptual skills are common. Psychological status is also often altered.  People who were once very calm may now experience explosive anger or fear with little provocation. Adjustment to disability issues are frequently encountered by people with TBI.

The term TBI is used for head injuries that can cause changes in one or more areas, such as: thinking and reasoning, understanding words, remembering things, paying attention, solving problems, thinking abstractly, talking, behaving, walking and other physical activities, seeing and/or hearing, and learning.

The definition of Traumatic brain injury (TBI) from the Individuals with Disabilities Education Act (IDEA) is "...an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma." [34 Code of Federal Regulations §300.7(c)(12)]. The IDEA is the federal law that guides how schools provide special education and related services to children and youth with disabilities.

Brain injury can occur in many ways. Traumatic brain injuries typically result from accidents in which the head strikes an object. This is the most common type of traumatic brain injury. However, other brain injuries, such as those caused by insufficient oxygen, poisoning, or infection, can cause similar effects.

Brain injury is unpredictable in its consequences. The symptoms of brain injury can be very different depending on where the brain is injured and how severely. Symptoms may include headache, nausea, confusion or other cognitive problems, a change in personality, depression, irritability, and other emotional and behavioral problems. The person may have trouble speaking, seeing, hearing, and using their other senses. They may have difficulty with their sensation of touch, taste or smell.  They may become sensitive to light.  Their muscles may suddenly contract or tighten (this is called spasticity). Some people may have seizures as a result of a TBI.  They may be partly or completely paralyzed on one side of the body, or both sides.  They may experience sleep disorders.

Because the brain has been injured, it is common that the person's ability to use the brain changes. They may have trouble with short-term memory (being able to remember something from one minute to the next, like what someone just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may have difficulty processing information, think slowly and be inconsistent. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding abstract concepts, understanding the order in which events happen (called sequencing), and judgment.  They may not be able to follow multi-step instructions. 

The person may experience social, behavioral or emotional problems.  This may include sudden changes in mood, anxiety, and depression. Children with TBI may have trouble relating to others. The person may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.  They may have a decreased tolerance for stress.  They may also experience a lack of inhibition and therefore say or do things that are not considered socially acceptable.  They may become inflexible and only able to see one way to do or view things.

The results of a brain injury, whether TBI or ACI, are hard on both the person handling the consequences of the injury, as well as their extended family.  Often the family and friends do not understand that the person with a mild injury has a severe consequence and cannot control the symptoms they are experiencing.

A medical professional may suspect a brain injury if spinal fluid is coming out of the ears or nose, if there is a loss of consciousness, if the pupils (the black center of the eyes) are dilated (enlarged and do not get smaller in light) or unequal in size, or respiratory failure.  Injury may be seen using some tests such as an CAT Scans, Skull X-rays, and EEGs, but may also be too subtle for detection.

The damage in a brain injury may be focal, confined to one area of the brain, or diffuse, involving more than one area of the brain. TBI can result from a closed head injury or a penetrating head injury. Most traumatic brain injuries result in widespread damage to the brain because the brain ricochets inside the skull during the impact of an accident.

Focal damage, however, may result in long-term, permanent difficulties. Improvements can occur as other areas of the brain learn to take over the function of the damaged areas. Children's brains are much more capable of this flexibility than are the brains of adults. For this reason, children who suffer brain trauma might progress better than adults with similar damage.

A closed head injury occurs when the head suddenly and violently hits an object, but the object does not break through the skull. More of these injuries are now occurring in war. In previous times during war death usually resulted from bodily injury.  Today, with advanced body armor, there is often little or no physical injury, but the body receives an impact that causes the brain to experience rapid acceleration and deceleration of the brain within the confines of the skull, an injury called "countrecoup."  This is the same type of injury seen in shaken baby syndrome, which occurs when a baby is shaken forcibly enough to cause extreme countrecoup injury which includes shearing (tearing) of nerve fibers, contusion (bruising) of the brain tissue against the skull, brain stem injuries, and edema (swelling).  Brain injury may be present without tangible confirmation (i.e., CAT Scans, Skull X-rays, EEGs, etc.). 

A person with even a mild brain injury may continue to experience a wide variety of symptoms that can have life-changing implications. However, each injury is different and unique to each person.

A penetrating head injury occurs when an object pierces the skull and enters the brain tissue. Several types of traumatic injuries can affect the head and brain. A skull fracture occurs when the bone of the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. This can cause a contusion.

Damage to a major blood vessel within the head can cause a hematoma, or heavy bleeding into or around the brain. The severity of a TBI can range from a mild concussion to the extremes of coma or even death. A coma is a profound or deep state of unconsciousness.

Mild Traumatic Brain Injury (MTBI) is characterized by one or more of the following symptoms: a brief loss of consciousness, loss of memory immediately before or after the injury, any alteration in mental state at the time of the accident, or focal neurological deficits. In many MTBI cases, the person seems fine on the surface, yet continues to endure chronic functional problems. Some people suffer long-term effects of MTBI, known as postconcussion syndrome (PCS). Persons suffering from PCS can experience significant changes in cognition and personality.

Diffuse axonal injury occurs when the nerve cells are torn from one another. Localized damage also occurs when the brain bounces against the skull. The brain stem, frontal lobe, and temporal lobes are particularly vulnerable to this because of their location near bony protrusions in the skull.

The brain stem is located at the base of the brain. Aside from regulating basic arousal and regulatory functions, the brain stem is involved in attention and short-term memory. Trauma to this area can lead to disorientation, frustration, and anger. The limbic system, higher up in the brain than the brain stem, helps regulate emotions. Connected to the limbic system are the temporal lobes which are involved in many cognitive skills such as memory and language. Damage to the temporal lobes, or seizures in this area, have been associated with a number of behavioral disorders. The frontal lobe is almost always injured due to its large size and its location near the front of the cranium. The frontal lobe is involved in many cognitive functions and is considered our emotional and personality control center. Damage to this area can result in decreased judgement and increased impulsivity.

Initial treatment for TBI involves surgery to control bleeding in and around the brain, monitoring and controlling intracranial pressure, insuring adequate blood flow to the brain, and treating the body for other injuries and infection.  Sometimes, a patient may be put into a coma state with drugs in order to allow the brain time to heal and to reduce swelling.

Immediately following the injury, a neurologist (a physician who specializes in nervous system disorders) or another physician may conduct an informal, bedside evaluation of attention, memory, and the ability to understand and speak. Once the person's physical condition has stabilized, a speech-language pathologist may evaluate cognitive and communication skills, and a neuropsychologist may evaluate other cognitive and behavioral abilities. Occupational therapists assess cognitive skills related to the individual's ability to perform "activities of daily living" (ADL) such as dressing or preparing meals. An audiologist should assess hearing. All assessments continue at frequent intervals during the rehabilitative process so that progress can be documented and treatment plans updated. The rehabilitative process may last for several months to a year depending upon the individual.  Rarely, if ever, are fascial restrictions or their consequences, ever considered or addressed by the medical professionals.  Most of the professionals look at the body in terms of their specialty, rather than considering the body as a whole and looking at the overall balance of the body.  Therapy will focus on regaining lost skills as well as learning ways to compensate for abilities that have been permanently changed because of the brain injury.

The outcome of TBI depends on the cause of the brain injury and on the location, severity, and extent of neurological damage.  Outcomes range from good recovery with no noticeable effects to a physically and or mentally impaired state to death. Doctors often use the Glasgow Coma Scale to rate the extent of injury and chances of recovery. The scale (3-15) involves testing for three patient responses: eye opening, best verbal response, and best motor response. A high score indicates a good prognosis and a low score indicates a poor prognosis.   Some people may appear to recover from a brain injury with few lasting effects while other suffer impairment for life.

The medical and allied health literature indicate that an estimated 1.5 to 2 million individuals each year in the United States sustain a TBI and approximately 2 million people sustain an acquired brain injury.  Every 21 seconds one person in the US sustains a TBI.  Approximately 270,000 people experience a moderate or severe TBI.  Another 200,000 have serious problems that may require institutionalization or some other form of close supervision.  These figures do not include those injuries sustained in war. More than one million children receive brain injuries each year. More than 30,000 of these children have lifelong disabilities as a result of the brain injury.  Approximately 50,000 to 70,000 people die from head injury.  TBI is a major public health problem, especially among male adolescents and young adults ages 15 to 24, due to their high-risk lifestyles, as well as among elderly people of both sexes 75 years and older.  Half of all TBIs are due to transportation accidents, and are the major cause of TBI in people under age 75. For those 75 and older, falls are the cause for the majority of traumatic brain injuries.  Males are about twice as likely as females to sustain a TBI.  An estimated 5.3 million people in the US (more than 2% of the population) live with diabilities from TBI.  More than 50,000 people each year die from TBI's. 

The Iraq war is producing record numbers of TBI's due to the use of body armor.  It protects the body from severe damage, but the force of impact causes TBI that often goes undiagnosed.

The major causes of traumatic brain injury are cars, shaken baby syndrome, bicycles, scooters, sports, soccer, guns and war.  Soccer is one of the most dangerous sports for children to play because of the impact of the ball on their developing brains.

In the case of children, it is important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as children grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the child's difficulty comes from the earlier injury. Although TBI is very common, many medical and education professionals may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are thought to have a learning disability, emotional disturbance, or mental retardation. As a result, they don't receive the type of rehabilitation, educational help and support they really need.

Far too many brain injuries remain undiagnosed and unreported.  Most medical professionals do not consider brain injuries or the effects of a brain injury if the person has not lost consciousness and has no visible head injury.  This is especially true in the case of war veterans where medical care is often provided under far from optimal conditions.  This prevents these people from receiving the help they really need.

Windsong Therapy and Wellness, uses very specialized manual techniques to remove fascial restrictions, open the ventricles and improve fluid flow in the brain and spinal column without invasive procedures.  This can help the brain to create new neural pathways.  A body that is balanced gains strength much more easily and quickly.  Most individuals respond best to programs tailored to their backgrounds and interests. The most effective therapy programs involve family members who can best provide this information. We concentrate on making the patient aware of their body and giving them tasks to do on a daily basis within the structure of their lifestyle to improve their ability to function as a whole and resume a rewarding life.

Resources for Web Links:

http://www.neuroskills.com/

National Resource Center for Traumatic Brain Injury http://www.neuro.pmr.vcu.edu/

This website last updated on 31 July 2010

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