Traumatic Brain Injury Education

A traumatic brain injury (TBI) is an injury to your brain usually caused by external force. A blow, jolt  or bump to the head can cause injury. Our brains are essentially the consistency of room temp butter. Additionally, an object may penetrate the skull causing severe injury to the brain.

Traumatic brain injuries can range in severity. A concussion is now considered a moderate to mild traumatic brain injury and then there is the severe traumatic brain injury. All can cause a change in how the brain works temporarily or on a more permanent basis.

A concussion or mild TBI can be diagnosed after a bump, jolt or hit to the head, usually the patient is checked out when they experience symptoms such as dizziness, headache, sleepiness, nausea and or vomiting. Loss of consciousness with the patient is not always a sign or symptom. 

A diffuse axonal injury occurs/ is caused by rapid acceleration, deceleration, twisting or rational forces. This causes the fiber neurons in the brain to tear  and cause widespread damage. A DAI can range from mild to devastating. It is usually accompanied with prolonged unconsciousness and or coma.

A penetrating brain injury is when an object enters through the skull and penetrates the brain damaging brain tissue.

A Coup -  Contrecoup injury is when the brain is injured at the point of impact (coup) and/or the opposite side of the brain moves within the skull (Contrecoup).

Intracranial Hemorrhage is common wording that you will hear when dealing with a brain injury. This is bleeding inside or around the brain. It can be epidural, subdural, subarachnoid or intracerebral hemorrhage. You also may hear the term cerebral edema. This is swelling of the brain following an injury which can become life threatening if the swelling causes too much pressure to build within the skull.

Acquired Brain Injuries (ABI) - An acquired brain injury happens after birth and is typical a brain injury that typically occurs without external physical trauma.

Some of the most common Acquired brain injuries include: 

Stroke

Brain damage from certain infections

Brain tumors and all of their lasting effects

Toxic or metabolic injuries

Anoxic and hypoxic brain injuries revolve around inadequate oxygen to the brain. An Anoxic brain injury typically means that the brain received essentially no oxygen. A hypoxic brain injury typically means that the brain received insufficient oxygen.

Anoxic and hypoxic brain injuries can occur during events like a cardiac event, drowning, overdose, respiratory failure and other events that halts or severely limits oxygen delivery to the brain.

Primary vs. secondary brain injury - This diagnosis is more commonly known and seen in patients that survive severe traumatic brain injuries. A primary brain injury is what happens at the moment of a traumatic event. For example, when the brain is bruised, compressed, torn and nerve fibers are stretched.  A secondary injury can develop after the initial trauma and can result from things such as brain swelling, increased intracranial pressure, reduced oxygen or blood flow and seizures. (For Addi's, her diagnosis of a secondary "impact" injury happened around 18 months post her initial injury. We were driving home from her therapies when we were rear ended on the freeway. Her baseline levels seemed to fall behind, her headaches became constant and involved nausea and vomiting.)

When looking a mild, moderate, severe and fatal TBI's the range of causes can be quite long. We are going to provide you with the list of the commonly seen causes behind moderate, severe and deadly TBI's:

Motor Vehicle Accidents

Pedestrian Accidents (Struck by vehicle)

Bicycle accidents (Head impact with pavement, hit by vehicle)

Motorcycle or ATV accidents

Sports injuries

Physical assault/Domestic violence/Child abuse

Gunshot/blast/explosion

Recreational injuries (Horseback riding, skiing, skateboarding)

The cause alone does not determine the severity of the traumatic brain injury. There are several different factors that the patients medical team will take into consideration. Factors that may be taken into consideration:

Force at impact

Speed at impact

Rotating or twisting of the head/neck

Bleeding or swelling in the brain

Damage to the brain tissue or neuron fibers

Loss of consciousness 

Length of loss of consciousness or coma

Age & overall health of the patient

One important thing to note is that whether the skull is fractured or not does not necessarily define the severity of a brain injury.

To touch on anoxic and hypoxic brain injuries one more time, these injuries are considered an acquired brain injury. Acquired brain injuries can occur when the patient has a stroke, a cardiac event, drowning, overdose and other "Non-traumatic" injuries or health crisis:

Anoxic brain injuries mean that the brain stopped receiving oxygen 

Hypoxic brain injuries mean that the brain received limited oxygen

Life after surviving a brain injury differs from one survivor to the next. There simply is not 2 survivors that have had the same outcome or journey. That's okay! 

Some people recover faster than others and they are able to return back to their usual routines while others will experience life altering changes from their injury and it alters ever aspect of their life.

For families and friends of the patient, they sometimes notice that their loved ones injuries have affected more than just their loved one. Life with a brain injury can change relationships, parenting, employment, housing, transportation and honestly, the emotional well being of the entire family.

For a survivor, living with a brain injury may affect their thinking, memory, how they communicate, their physical movements, their emotions, behaviors, senses and even the ability to fully care for themselves.

While some patients eventually may return to most or all of their previous activities - others may need some assistance or even require life long assistance and care.

Recovery, as I tell every family that I speak with...has a mind of it's own. Recovery in not linear. It is completely unpredictable. Life goes from a race, to a sprint. For some, progress may seem to come fast at first and then come to a halt. A survivors abilities may approve months or even years after the injury takes place.

For many families, they find themselves having to adjust to life's new normal. Learning how to navigate a world that you never saw yourself or your loved one in can be really difficult mentally and emotionally. Please don't feel like you have to walk the journey alone! This is one area that we are happy to provide advocacy and/or support care for your family - at any point of your journey! We are also happy to provide you with resources in your area that we have seen help others, or that have helped us in the past! Please don't hesitate to reach out.

It's difficult when your family now finds themselves in unfamiliar roles.

A Husband or wife may now be the caregiver.

A Parent might find themselves as their child's advocate!

A child may have a parent or sibling that can no longer do the things that they used to do.

There may also be significant hardships that follow such as:

Medical bills and insurance issues like denials

Rehabilitation and therapy approvals and costs

Lost income

A change in transportation needs

Home modifications requirements 

Medical equipment

Long term care or attendant/respite care

Changes in employment or education

Coordinating multiple specialists, therapies and appointments

Navigating disability benefits & community resources

It's absolutely common and normal for there to be an emotional side to all of this for the patient as well as the family that is going through changes. You may start to see or feel emotions and or behaviors tied to grief, fear, guilt, uncertainty, anxiousness, depression and frustration...All simultaneously celebrating survival and both small and large victories! 

Remember that nobody is expecting you to wade the waters of this new journey alone. We are here to help you, just reach out!

Over 65 million American's live with a TBI. On average, an additional 2.5 million are added on every year. 65 million is a low ball number considering that many patients with mild injuries are never checked out and are never truly diagnosed by a medical professional.

14.5 million American's are living with TBI related disabilities. 1 in 5 adult TBI survivors experience a secondary injury within the first year of their initial injury.

Over 500,000 United States Military members have been diagnosed with a TBI since 2000. Roughly 25% of service members screen positive for a TBI.

**More coming soon!**

Coming soon!

These are things that have been important  in our life as we have adjusted to having our little survivor. They are all things that I believe are important for you to know and that we have passed on to families we have advocated for!

*The brain injury has not erased the person that you love.

*They may have different abilities now, they might communicate different, they might have a hard time with memory, maybe they ask the same questions several times in a row...But no matter what, their injury does not DEFINE them. It is so important that you believe that and that you encourage your loved one to believe that about themself.

*Recovery does not mean chasing the person that they were before their injury. It means accepting the amazing person that they are now! If they were in a place where they didn't quite know who they were yet before their injury ...recovery for them means discovering who they are and that is beautiful!

*The hardest question that you can ask an advocate or of your loved one is "When will they recover? When will they be back to themself?!" You are most likely only setting yourself up for a lot of frustration and setting your loved one up to feel frustration, guilt, shame and anger. 

The better question that you can ask is "What does my loved one need to have the best quality of life and how can we best support them along the way?