Brain & Neuro Health

Understanding Traumatic Brain Injury


Based on CDC data,1 the rate of brain injuries treated by hospital emergency departments is increasing. Whether from something as seemingly mundane as a fall or sports injury, or something more tragic like a car accident, traumatic brain injuries (TBI) can occur unexpectedly and have long-lasting, even permanent effects. March is Brain Injury Awareness Month, so let’s look at TBI and the research being done toward better understanding traumatic brain injury and previously overlooked causes.

Whether mild or serious, TBI is caused by a bump, blow, or sudden jolt to the head. The violent motion can severely damage brain cells and cause chemical changes.2 A concussion is another type of TBI, and the degree can range from mild to severe.

Signs of a Serious TBI3  

In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body, and can squeeze the brain against the skull.

Seeks emergency treatment for any of these signs:

  • One pupil larger than the other
  • Drowsiness or cannot be awakened
  • A headache that gets worse and does not go away
  • Weakness, numbness or decreased coordination
  • Repeated vomiting or nausea
  • Slurred speech
  • Convulsions or seizures
  • Difficulty recognizing people or places
  • Increasing confusion, restlessness or agitation
  • Unusual behavior
  • Loss of consciousness (even brief)

According Centers for Disease Control and Prevention (CDC) data, TBIs are a major cause of disability and death in the United States. The majority of TBIs that occur annually in the nation are mild concussions, but every year in the U.S. about 2.8 million people sustain a brain injury.

Falls are the leading cause of brain injury, accounting for 48% of related emergency department visits, and tend to happen most often to children and older adults:

  • 49% of TBI-related emergency department visits among children up to 17 years are caused by falls.
  • 81% of TBI-related ER visits in adults aged 65 years and older are caused by falls.4

Increased isolation from the COVID-19 pandemic lockdowns causes concern for an increase in older adult falls and consequently TBIs. A 2020 study out of University College London identified an association between little social contact and a higher risk of falls and hospitalization due to falls, “individuals living alone showed an 18% higher risk of reporting a fall than those living with a friend or relative. Individuals who had the least social contact were 24% more likely to report a fall and 36-42% more likely to be admitted to hospital for a fall than those with the most social contact.”5 While the authors studied data collected between 2002-2017, they acknowledged the importance of continuing research to investigate the impact of lockdowns and social distancing on falls.

Motor vehicle crashes are the second leading cause of all TBI-related hospitalizations. Traumatic brain injury can also result from being struck by or against an object, as in an industrial accident, in contact sports such as football, boxing and hockey, and in violent crimes and self-harm incidences.

Player advocates and researchers have been working on understanding traumatic brain injury and the effect repeated concussions have on football players. In any given season, 10% of all college players and 20% of all high school players sustain brain injuries. Notably, brain injuries resulting from playing football account for 65% to 95% of all football-related fatalities.6 This type of repeated TBI is suspected in chronic traumatic encephalopathy (CTE) which causes dementia-like symptoms years after injury. 7

One 2017 study found CTE in 99% of deceased NFL players’ brains donated to help understand traumatic brain injury.8

In addition to athletes, military and law enforcement personnel exposed to repeated small blasts are also at risk for brain injury, another of the previously unexpected places doctors are seeing the effects of TBI. Researchers found “significant differences in blood flow, brain structure and brain activity” in these personnel highlighting the need for more research and likely more personal protection.9

The National Institutes of Health (NIH) lists TBI treatment options, which depend on the severity of the injury and its location in the brain:

Mild TBI

A concussion may not require treatment beyond rest, according to the NIH.10 But it is important to follow the doctor’s instructions for complete rest and a gradual return to normal activities. If a person resumes normal activities and starts experiencing TBI symptoms, the healing process may take much longer. Multiple concussions, even if mild, can cause significant and long-term neurological problems.

Researchers have experimented with harnessing the body’s circadian rhythm to help heal mild TBI through blue light therapy. The blue light helped to regulate participants’ sleep cycle and address sleep problems associated with mild TBI which helped their brains heal.11

Moderate to Severe TBI

Most people with a moderate to severe brain injury need rehabilitation to address physical, emotional, and cognitive issues from TBI. Therapies may include relearning old skills or learning new ways to make up for lost skills.12 Treatment may include physical, occupational and speech therapy, counseling and cognitive therapy. Therapy usually begins in the hospital and, depending on the individual, can continue in a skilled nursing facility, at home, in a school or in an outpatient clinic. Therapy can be long-term depending on the type of injury.

Traumatic brain injuries can be a minor headache or a life-changing injury. Doctors and public health officials are working tirelessly to understand traumatic brain injury, develop novel treatments and most importantly, educate the public on how to prevent it.

 


1 CDC, “Brain Injury: Get the Facts”

2 CDC, “A Fact Sheet for Parents”

3 Mayo Clinic, “Traumatic Brain Injury”

4 CDC, “Brain Injury: Get the Facts”

5 Scientific Reports, “A longitudinal analysis of loneliness, social isolation and falls amongst older people in England”

6 Brain Injury Research Institute, “What is a Concussion?”

7 Brainline, “Repetitive Head Injury Syndrome”

8 JAMA, “Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football”

9 Journal of Neurotrauma, “Functional and Structural Neuroimaging Correlates of Repetitive Low-Level Blast Exposure in Career Breachers”

10 National Institute of Child Health and Human Development, “What are the treatments for traumatic brain injury (TBI)?”

11 Neurobiology of Disease, “A randomized, double-blind, placebo-controlled trial of blue wavelength light exposure on sleep and recovery of brain structure, function, and cognition following mild traumatic brain injury”

12 National Institute of Child Health and Human Development, “What are the treatments for traumatic brain injury (TBI)?”

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