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Traumatic Brain Injury (TBI) in 2013 Traumatic Brain Injury (TBI) in 2013

Traumatic Brain Injury (TBI) in 2013 - PowerPoint Presentation

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Traumatic Brain Injury (TBI) in 2013 - PPT Presentation

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

injury brain concussion tbi brain injury tbi concussion times rehab people research studies head physical multiple state severity 2013

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Presentation Transcript

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

Slide2

Some 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.”

Slide3

General 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.

Slide4

General 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

Slide5

General 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

Slide6

Silent 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

Slide7

Other 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

 

Slide8

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

Slide9

Severity : 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

Slide10

Severity : 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

Slide11

Severity : Severe

Coma >24 hours

Coma, vegetative state, minimally responsive state

Very poor outcome

Slide12

Consequences of Brain Injury

Thinking Skills

Memory

Concentration

Problem Solving

Mental Speed

Slide13

Consequences of Brain Injury

Physical Skills

Fatigue

Coordination

Balance

Spacticity

Weakness

Slide14

Consequences of Brain Injury

Behavioral

Depression

Changes in Personality

Irritability

Impulsivity

Anxiety

Sexual inappropriateness

Slide15

Definition 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

Slide16

Definition 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

Slide17

Depression 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”

Slide18

Chronic 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

Slide19

Factors Influencing Recovery

Initial neurological severity

Age

Existence of serial lesions

Second Impact Syndrome

Systemic co-morbidities

Substance use

Genetic factors

Educational Background

Slide20

What 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

Slide21

What 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

Slide22

What 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

Slide23

What 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”

Slide24

TBI 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

Slide25

TBI 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

Slide26

TBI 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

Slide27

Brain 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)