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Running head: Traumatic Brain Injury (TBI)Traumatic Brain Injury (TBI)Gregory CordesGeneral PsychologyPSY7310 Physiological PsychologyWinter 2009jgcordes@comcast.net AbstractThis paper will discuss the nature of Traumatic Brain Injury (TBI), the scope ofthe disorder, the types of TBI, and how psychologists can divide these types into2 classes. In addition, this paper will discuss the cognitive, emotional, andphysiological consequences of TBI in the context of the type and class. Therewill be some discussion on detection of TBI, early determination, first aid, andfuture research and work, as well as the developmental variables.Traumatic Brain Injury (TBI)IntroductionWhat is TBI?Traumatic Brain Injury (TBI) is a physical insult to the brain as a result of anexternal physical force which produces an altered or diminished state ofconsciousness (Brain Injury Association of New Jersey, 2008). The consequences ofTBI are typically an impairment of physical or cognitive abilities and may resultin disturbance of emotional and behavioral functioning. The cognitiveconsequences of TBI include reduced ability to process information, organizationalproblems, trouble concentrating, poor judgment, memory loss, and difficultystarting activities. The physical consequences of TBI include muscle spasticity,seizures, headaches, fatigue, and balance problems. An observer may expect to seemood swings, depression, impulsivity, anxiety, and agitation as the emotionalconsequences of TBI (BIANJ, 2008). TBI has 2 cousins that mimic some symptoms ofTBI, but are categorically different.While the symptoms may be similar, observers should not confuse TBI with AcquiredBrain Injury (ABI) as a result of anoxia, aneurysms, encephalitis, stroke,metabolic disorders, and meningitis or brain tumors (BIANJ, 2008). Mild BrainInjury usually comes in the form of a mild concussion (BIANJ, n.d.). In sports,concussion is the most frequent cause of brain injury, loss of consciousness isnot necessary for all concussions, people are a greater risk with each successiveconcussion, and multiple concussions may result in a life time of consequences(BIANJ, n.d.). The incidence of TBI is enormous.In the United States, more than 1.4 million people sustain TBI annually, only asixth seeks help (BIANJ, 2008). This paper will discuss the significance of the1.4 million victims later on. More than 50,000 people die annually from a TBIrelated injury. Approximately 80,000 to 90,000 experience a long term disabilityafter receiving a TBI. In fact, more people sustain TBIs than breast cancer,spinal cord injury, multiple sclerosis, and HIV/AIDS combined. Many times,healthcare professions do not attribute behavioral issues, physical impairment,and cognitive deficits to TBI. Public recognition of TBI is low, despite thelarge number of injuries, mental healthcare professionals call it "the silent

epidemic" (BIANJ, 2008). There are several leading causes of TBI.The American population sustains 28% of TBIs in falls, 20% to motor vehicleaccidents, 19% in struck by events, and 11% in assaults (Brain Injury Associationof America, 2006). The majority of military TBIs are a result of blast injury.This paper will discuss blast injury later in the paper. The Centers for DiseaseControl estimate approximately 5.3 million Americans live with a TBI (BIAA, 2006).This number may grossly underestimate the number of TBIs, with 1.4 TBIs a year(BIANJ, 2008) - the actual numbers could be as high as 70 million over the last 50years. Typically, males are 1.5 times more likely to sustain a TBI (BIAA, 2006).Children ages 0 to 4 and young adults ages 15 to 19 are the highest at riskgroups. The group with the highest death rates for TBIs is African Americans.Americans hospitalize 235,000 people each year for TBI, at a cost of 60 billiondollars. Of this 235,000, 40% require outpatient assistance after release. Themost common service needs are problem solving and memory, emotional upsets andmanaging stress, controlling temper, and job skill improvement (BIAA, 2006).DiscussionWhat are the types of TBI?Psychologists can map the types of TBI across several dimensions, againstthe effected area, force of the blow, nature of the assault, general symptoms, andthe physical consequences of the shock (BIAA, n.d.). General symptoms of the TBImay include loss of bladder and bowel control, tingling or body numbness, slurredspeech, difficulty swallowing and speaking, irrational and emotional responses,thinking skills problems, ear ringing, confusion, headache, lethargy, andvomiting. In addition, the victim may have increase blood pressure with slowbreathing. Other symptoms include slow pulse, paralysis, coma, respiratoryfailure, blurred and double vision, inability to tolerate light, eye movementloss, blindness, dilated eyes, lost consciousness, and spinal and intracranialfluid loss (BIAA, n.d.). There are several categories in the nature of theinsult.Diffused Axonal Injury (DAI) occurs when the brain cannot physically keep up withthe movement of the skull (BIAA, n.d.). Typically, the cause of a DAI is strongrotational forces applied to the head as might occur in an automobile accident.These rotational forces tend to stretch and tear nerve tissue across the brain.When the brain's nerve tissue is torn, it interrupts the brain's ability tocommunicate between its various structures and disturbs its chemical processes.In addition, a DAI is likely to release brain chemicals creating additionalinjury. DAI is especially dangerous because the inside of the skull is rough,rotational shifting the skull, but not the brain is likely to cause widespreadlacerations across the surface of the brain. DAI causes widespread permanentdamage that can result in coma or death (BIAA, n.d.).Another type of TBI is concussion (BIAA, n.d.). Concussion can come in many formsincluding gun shot wounds, a violent shaking, whiplash, or head blow. It is themost frequent type of TBI. Concussion can come in the form of an open or closedhead injury. The sudden impact of the concussion causes cranial nerves and bloodvessels to stretch. The stretching of blood vessels can cause them to tearresulting in a blood clot that can be fatal. Brain bleeding, skull fracture, orswelling may be present, and their need not be a loss of consciousness.Interestingly, physicians cannot always detect concussion in a ComputerizedTomography (CT) (BIAA, n.d.). Contusion is another type of TBI.A contusion is the result of a focal impact on the brain (BIAA, n.d.). The focalimpact results in a bruise and subsequent bleeding. In many cases, largecontusions require surgical removal. A coup - contrecoup injury is similar tocontusion. But, the force of the blow is strong enough to cause a contusion onthe opposite side of the brain. This is the result of the brain, which isessentially floating in intracranial fluid, slamming against the opposite side ofthe skull (BIAA, n.d.). Multiple assaults to the brain are another type of TBI.Recurrent Traumatic Brain Injury (RTBI) or Second Impact Syndrome (SIS) occurswhen a TBI sustains a second TBI before the first TBI has healed (BIAA, n.d.).

This insult is likely to cause widespread damage and brain swelling and can causedeath quickly. Increased muscle tone, muscular spasms, unstable emotions,difficulty learning and thinking as well as hallucinations are the long-termeffects symptomatic of SIS. Physicians and Psychologists can characterizepenetration injury as the contamination of the brain by a foreign object (BIAA,n.d.).A penetration injury such as a bullet wound or knife forces fragments of hairboned and skin into the skull (BIAA, n.d.). A “through and through” TBI occurswhen an object penetrates and then exits the skull. This results in shearing,stretching, rupture, and penetration injury. If the object is unable to penetratethe skull, it will begin to ricochet causing additional damage. Of all causes ofTBI, firearms are the largest. Similar to DAI, is shaken baby syndrome (BIAA,n.d.).Mental health professionals characterize shaken baby syndrome as the violentshaking of a young child or baby where whiplash like motion results in TBI (BIAA,n.d.). In this scenario, the skull ruptures and bleeds as blood vessels are torn.This causes brain tissue to swell and compress damaging the cells. Shaken babysyndrome can result in a lifelong disability, seizures, death, and coma (BIAA,n.d.). One of the last of these TBI types on this axis of the map is lockedsyndrome.While rare, locked in syndrome sufferers can only move their eyes, but they retaintheir ability to think and remain conscious (BIAA, n.d.). Typically they use eyeblinking and vertical eye movements to communicate and manage environmentalcontrols (BIAA, n.d.). The final type on this axis is blast injury.Blast injury occurs when a complex over-pressurized wave passes through thecranium (Defense Veterans Brain Injury Center, n.d.). The brain essentiallyfloats in intracranial fluid, and fluid filled cavities are especially susceptibleto blast injury (Elsayed, 1997; Mayorga, 1997). Victims of blast injuryexperience slower thinking, depression, irritability, sleep disturbances,headaches, and decreased attention/concentration, and memory (DVBIC, n.d.). Onecharacteristic of a blast injury TBI are small voids filled with intracranialfluid within structures in the brain that are normally solid (Glasser, 2007). Oneexplanation for these voids is cavitation.Cavitation is a mechanical effect that when a solid object moves through a liquidmedium at a high speed the fluid is unable to move out of the way fast enoughcreating tiny vacuums behind the trailing edge of the solid object. An observercan see this when the blade of a propeller on a boat turns and producescharacteristic voids that appear like bubbles. Of all TBIs, blast injury is themost aggressive because the assault comes at about the speed of sound. It may bepossible that the speed of the shock produces cavitation in the brain as it passesthrough nerve tissue and tearing it, then allowing low viscosity intracranialfluid to fill the cavitation before the high viscosity nerve tissue can fill avoid. Another axis of TBI is open and closed wound.Open head injuries occur when the skull is penetrated. The brain may swell, butbecause it is no longer contained may result in squeezing nerve tissue. Open headinjuries are more likely to be penetration injuries, where a foreign object lodgesits self in brain tissue. Without the protection of the scalp and skull, thevictim’s brain is subject to infection. On the other hand, with a closed headinjury the brain may still swell, but was no place to expand, an intracranialincrease of pressure on the brain tissues results in further damage. In anattempt to relieve pressure, brain tissue may attempt to force its way through theeye sockets resulting in pressure on the optic nerve.Whole Brain versus Localized InjuryUp to now, this paper has discussed the types of TBI from the perspective of aphysical insult to the brain. It is possible to divide these insults into twoclasses, whole brain and local. Whole brain insults would include DAI, shakenbaby syndrome, blast, and concussion because damage as a result of these injurieswould be widespread. Contusion, Coup-Countrecoup, and penetration injuries fall

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Traumatic Brain Injury (TBI)

This paper will discuss the nature of Traumatic Brain Injury (TBI), the scope of the disorder, the types of TBI, and how psychologists can divide these types into 2 classes. In... (More)

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