Traumatic Brain Injury (TBI): Diagnosis, Rehab & Recovery

Instructor: Patricia Jankowski

Patricia has a BSChE. She's an experienced registered nurse who has worked in various acute care areas as well as in legal nurse consulting.

Traumatic brain injury (TBI) is a rather broad term that refers to an injury to the brain that is caused by some type of trauma or external force. This lesson is about the causes and diagnosis of traumatic brain injury, rehabilitation, and recovery.

What Is a Traumatic Brain Injury?

Have you ever seen the Saturday morning cartoons? Animated characters get hit in the head, and then see stars everywhere!

A traumatic brain injury, or TBI, is an injury to the brain from an external cause or force. The term is a very broad one covering a lot of territory, but TBI is mainly about brain injury that does not result from a congenital cause or from a degenerative disease or illness. TBI includes concussion or contusion (bruise to the brain) from an open or closed head injury, or from any other sort of acquired injury that does damage to the brain.

Causes and Diagnosis of TBI

The potential causes of TBI are almost infinite. TBI is caused by vehicle accidents, by falls, by injuries sustained in fights or in combat, by gunshot wounds, by toxic chemicals, or even by lack of oxygen to the brain. Infections, strokes, and tumors are also considered possible causes of TBI because they're acquired injuries that damage the brain.

Patient History

When a patient presents to the ER, the doctor will ask many questions to get an accurate history of what has occurred that led to the injury. The outcome of a TBI can be unpredictable and may not occur right away. The patient may not lose consciousness at all, or he can be knocked out by the injury immediately, or he may simply fall asleep and lapse into a coma. It is very important that someone give an accurate history of the occurrence, the length of time of any loss of consciousness, and any change in behavior in the patient or loss of sensation or motor skills.

Anatomy of the Brain

The symptoms of the TBI depend largely upon what area of the brain is affected. The brain stem regulates basic body functions like respiration and heart rate. An injury to this area can therefore be life-threatening. The cerebellum controls many fine motor skills and also affects balance. The cerebral cortex, which is the large area in front of the brain, is divided into bilateral lobes. The frontal lobes, posterior to (behind) the forehead, control behavior and intellect, while the temporal lobes, just behind the frontal lobes, are responsible for comprehension and speech. The parietal lobes are in the back of the head, and control perception of space.

Anatomy of the Brain
Brain anatomy

Glasgow Coma Scale

The Glasgow Coma Scale is a tool that's used to assess the severity of a TBI. It is based on measurement of the functions of eye opening, verbal response, and motor response. Each of these three functions has a list of criteria to check, with a numerical value assigned to each one. Then the values are added to give a total score. A total score of from 3 to 8 indicates a severe brain injury. A score from 9 to 12 indicates a moderate injury, and one from 13 to 15 means the injury is considered mild.

Diagnostic Tests

Computerized tomography, or CT scan, is often used to visualize details of a brain injury. This testing can show fractures, bleeding, swelling and other complications. Magnetic resonance imaging (MRI) is a test in which a magnet is used to see the brain in more detail. This is often used during the less acute phase of the TBI to check for healing and residual effects.

TBI Rehabilitation and Recovery

The treatment and length of recovery from a TBI depend mostly on the severity of the injury.

Mild TBI

If there is no loss of consciousness (LOC) or if the LOC is less than 30 minutes, the TBI is considered mild. When people mention the word concussions, they often really mean a TBI.

While this is the most common type of TBI, it isn't unimportant. The symptoms may last as long as a year, and may include headache, memory loss, and dizziness. Not much treatment is required besides rest and over-the-counter pain relief medications like Tylenol, but the patient should be watched by others for potential worsening of symptoms.

Moderate TBI

A moderate TBI involves an LOC that is longer than 30 minutes, but shorter than 24 hours. The symptoms of this injury are similar to those of the mild TBI, but are more intense and generally last longer. They may involve a brief hospital stay and then rest and some outpatient treatment or further testing. Follow-up care and examinations are important to ensure that the injury is healing and that the patient is not developing further complications.

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