Thomas G Seastrunk DO Past President Brain Injury Association of SC Associate Professor USCSOM College of Neuro Behavioral Sciences Volunteer Professor USCCOM Some General Facts ID: 780230
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Slide1
Traumatic Brain Injury (TBI) in 2013
Thomas G. Seastrunk, D.O.
-Past President Brain Injury Association of S.C.
-Associate Professor USC-SOM College of
Neuro
-
Behavioral Sciences
-Volunteer Professor USC-COM
Slide2Some General Facts:
“Traumatic brain injury means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment or both, that adversely affects a child’s educational performance.”
Slide3General Facts:
The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and speech.
Slide4General Facts:
Traumatic Brain Injuries
Open head injuries - penetrating wound to the brain
Closed head injuries - skull and protective tissue around brain remain intact; damage comes from acceleration-deceleration forces
Coup contra coup injury
Slide5General Trends
Each year, 230,000 persons are hospitalized with TBI and 22% of those persons with TBI die
Twice as many males experience TBI as females
From age 3 onward, boys are 2 - 4 times more likely to sustain BI, and 4 - 6 times more likely to die than females
Youth from ages 15 to 25 are at highest risk from brain injury
Preschoolers are the second highest risk group
Slide6Silent Epidemic
-
#1 cause of death in people under 44
yo
1.7
million people sustain a
TBI annually,
which is 8 times the number of people diagnosed with breast cancer and 34 times the number of new cases of
HIV/AIDS
80,000 people are left with permanent cognitive deficits annually
Slide7Other Demographic Trends
Brain injury victims are two times more likely to have a second injury.
After the second brain injury, survivors are eight times more likely to sustain a third injury. Socioeconomic class - low
Alcohol use - more than 50% of adults with brain injury were intoxicated at the time of injury.
Youth with preexisting problems such as hyperactivity, impulsivity, and aggression are four times more likely to incur a mild, but not severe, brain injury
Signature War Wound
We live in a military state
Signature wound of the Middle East wars
Soldiers do not want to undergo exams
Multiple reasons we will discuss
HUGE expense an drain on our government
Symptoms may not show for years after injury
Slide9Severity : Mild
Any
period of loss of consciousness
Any loss of memory for events immediately before or after the accident
Any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused)
Focal neurological deficits(s) that may or may not have been transient but where the severity if the injury does not exceed the following...
loss of consciousness of approximately 30 minutes or less
after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15 and
posttraumatic amnesia (PTA) not greater than 24 hours
.
Concussion considered Mild TBI
Slide10Severity : Moderate
Coma <24 hours duration
Neurological signs of Brain Trauma
skull fractures with contusion (tissue damage)
hemorrhage (bleeding)
Focal findings on EEG or CT scan
Slide11Severity : Severe
Coma >24 hours
Coma, vegetative state, minimally responsive state
Very poor outcome
Slide12Consequences of Brain Injury
Thinking Skills
Memory
Concentration
Problem Solving
Mental Speed
Slide13Consequences of Brain Injury
Physical Skills
Fatigue
Coordination
Balance
Spacticity
Weakness
Slide14Consequences of Brain Injury
Behavioral
Depression
Changes in Personality
Irritability
Impulsivity
Anxiety
Sexual inappropriateness
Slide15Definition of Concussion
From the Latin
concussus
or “action of striking together”
A complex process affecting the brain which is induced by traumatic forces
May be caused either by a direct blow to the head, face, neck, or body where force is transmitted to the head
Typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously
Slide16Definition of Concussion
May result in neuropathological changes but the acute clinical s/s largely reflect a functional rather than a structural injury
Results in a graded set of clinical s/s that may or may not involve LOC
Usually follow of sequential resolution but symptoms may be prolonged
NO
abnormality of standard structural neuroimaging studies
Slide17Depression in Concussion
It has been reported in multiple sources that depression follows moderate to severe TBI at an extremely high rate including sports related concussion
MRI studies have suggested “that a depressed mood following concussion may reflect an underlying pathophysiological abnormality consistent with a limbic-frontal model of depression”
Slide18Chronic TBI from concussion
Studies have suggested an association between repeated sports concussions and later-in-life cognitive impairment
Punch drunk syndrome-
Dementia pugilistica
No consensus reached on the significance of this observation
Clinicians should be mindful of long term problems occurring with multiple concussions
Slide19Factors Influencing Recovery
Initial neurological severity
Age
Existence of serial lesions
Second Impact Syndrome
Systemic co-morbidities
Substance use
Genetic factors
Educational Background
Slide20What Do We Know?
More studies ongoing because of Iraq War
Advocacy reaching new heights
More people involved in advocacy
Stronger National Organizations
ie
: BIAA, NASHIA, Military, State BIA affiliates
Pushing Doctors to learn more to help patients
Educating the public on TBI including concussion
Slide21What Do Doctors Know?
In my opinion, the 4 most important words a doctor can learn are:
I DO Not Know!!!!!!!!!!!
But I will try to find the answer
Slide22What Doctors Know
The importance of Rehab
Physical, occupational, cognative
The importance of continuing rehab by patients once they are released
Multiple studies show that people who continue their rehab at home daily-
DO MUCH BETTER
Slide23What We Do Know
People who discontinue their exercises, either physical or mental, Do Much Worse in the Long Run
Must develop discipline to continue what you have learned
Strong family or other social network, a definite plus may say a must
Rehab is
“The Key to Good Outcomes”
Slide24TBI Research in 2013
Most research conducted in rehab fields
Researching changes in brain chemistry post TBI
Prevention
Concussion- “Hot Topic Now”
Student Athlete Concussion Bill
signed into S.C. Law 8/15/2013
Post Acute Rehab
Slide25TBI Research 2013
A Lot of research with concussion
NFL, NHL, NCAA, High School Sports all involved
Long term effects of concussion and multiple concussions
Dementia
Pugilistica
- “punch drunk syndrome”
Increased risk of
Alzhiemer’s
Disease & Dementia
Imagining research- great deal being done now
Changes in brain structure post injury
Changes in brain structure post rehab
Slide26TBI Research 2013
Hormone therapy acute phase of recovery
Has been somewhat discredited recently
Recent study showed diabetes drug useful
Exendin-4 which promotes insulin secretion
Studies in mice as of now
Metformin
also shows promising results in mice
Helps damaged brain cells recover faster
Slide27Brain Injury Association of SC
Phone number: 803-731-9823
Director: Joyce Davis
Address: 800 Dutch Square Boulevard, Suite B-225
Columbia, SC 29210
Toll Free: 877-TBI-FACT (877-824-3228)