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As discussed in part one, traumatic brain injury (TBI) occurs when sudden trauma causes damage to the brain¹. Depending on the extent of the damage, the symptoms can be mild, moderate or severe. Post-injury complications may include: seizures, hydrocephalus (an accumulation of serous fluid within the cranium, also know as water on the brain) or post-traumatic ventricular enlargement, CSF (cerebrospinal fluid) leaks, infections, vascular injuries, cranial nerve injuries, pain, bed sores, organ system failure in unconscious patients and polytrauma (trauma to other parts of the body)². Each complication must be addressed and treated accordingly.

Long-term disabilities caused by TBI depend on the severity of the injury as well as the age and general health of the patient. Some common disabilities include problems with cognition, sensory processing, communication, behavior and mental health. For example, it is estimated that forty percent of TBI patients develop postconcussion syndrome (PCS)³. Symptoms include headache, dizziness, vertigo, memory problems, restlessness, depression and anxiety, and may persist for a few weeks. Memory loss characterized by the loss of specific memories and the partial inability to form and store new ones is the most common cognitive impairment among severe TBI patients⁴.

Once patients have been stabilized, rehabilitation is very important to the recovery process. The overall goal of rehabilitation is to improve the patient's ability to function at home and in society⁵. The U.S. National Institutes of Health (NIH) recommends that TBI patients be provided with individual rehabilitation programs based on their strengths and capacities, and that the programs be modified over time⁶. A wide range of specialists may be required to provide rehabilitation that could include physical therapy, occupational therapy, speech/language therapy, physical medicine, psychology/psychiatry and social support. There are a wide variety of rehabilitation settings, varying from home-based to inpatient rehabilitation centers to independent and supportive living centers, and the most appropriate setting must be selected based on the needs of the TBI patient and his or her family.

Head injuries can be prevented by taking precautions such as⁷:

• Wearing a seatbelt and using child safety seats
• Wearing a helmet when cycling, skating, skiing, horseback riding, playing contact sports such as football, and batting and running the bases in baseball and softball
• Locking firearms and bullets in a safe place
• Avoiding falls by using handrails on stairs, using a step-stool with a grab bar, and using safety gates at the top and bottom of stairs when young children are present
• Putting shock-absorbing material such as mulch or sand on children's playgrounds

These precautions greatly reduce the risk of TBI.

Discussion questions

1. Please summarize the article. What is the main point of the article?
2. What are some of the potential post-injury complications of TBI?
3. What are some of the potential long-term disabilities caused by TBI?
4. What does rehabilitation involve?
5. In what setting is rehabilitation provided?
6. How can head injuries be prevented?

References:

1. NINDS Traumatic Brain Injury Information Page. National Institute of Neurological Disorders and Stroke. U.S. National Institutes of Health. (Accessed November 15, 2007)
2. Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National Institutes of Health. (Accessed December 17, 2007)
3. Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National Institutes of Health. (Accessed December 17, 2007)
4. Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National Institutes of Health. (Accessed December 17, 2007)
5. Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National Institutes of Health. (Accessed December 17, 2007)
6. National Institutes of Health Consensus Development Conference Statement, October 26-28, 1998.
7. Heads Up: Preventing Brain Injuries. Centers for Disease Control (CDC), Department of Health and Human Services. (Accessed December 17, 2007)

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