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What is Traumatic Brain Injury?

Traumatic Brain Injury or TBI is caused by an external physical force to the head.

 

The head might be struck by an object, impact against a solid surface, or be penetrated by a projectile. Like other injuries, TBIs vary in severity. Milder forms of TBI might recover sufficiently to allow the injured child to participate in most important activities of his or her life. More severe TBIs can lead to high levels of disability that can persist throughout life.

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What we know about brain injury

Causes of Brain Injury

The human brain consists of billions of interconnected neurons that act as the master control centre for the body and the mind. The brain is a fragile organ and it is protected by being completely encased in the skull. The brain obtains additional protection by being wrapped in fluid-filled membranes that absorb forces that impact on the skull. Still, in spite of this protection, some children will sustain blows to the head that are of sufficient severity to overwhelm the brain’s protective mechanisms, and a brain injury will occur.

 

Severity of Brain Injury

Brain injuries are often graded along a continuum of severity ranging from mild to moderate and severe. A number of factors will determine the severity of a TBI; some important factors will be the severity of the initial injury to the head, the part of the brain affected by the injury, the nature of complications arising from the injury (e.g., swelling, bleeding), and the type of treatment that was made available to injured individual.

The severity of a brain injury can be evaluated using a number of different tools and indicators. Information that will be considered in evaluating the severity of a brain injury will include the duration of loss of consciousness, the depth of coma, the extent of memory loss and the results of brain scans.

The severity of a TBI can be more challenging to assess in children than in adults. In children, some of the deficits associated with TBI might only become apparent months, even years after the injury. For example, if injury is sustained to parts of the brain involved in reading and writing, these might not be apparent if the child is pre-verbal. These deficits might only become apparent when the child reaches school age when reading and writing abilities are required.

Infants and young children with TBI may lack the communication skills to accurately report the symptoms they are experiencing, Close observation is at times required to determine if a child has sustained a TBI. Some clues that a child might have sustained a TBI include changes in eating and sleeping habits, and changes in mood such as increased sadness, persistent crying or heightened irritability. Observation might also suggest difficulties with attention and memory.

The Symptoms of Traumatic Brain Injury

The symptoms of TBI fall into three broad classes: physical symptoms, sensory symptoms and cognitive symptoms.

Physical Symptoms of TBI

There are a number of physical symptoms that might be experienced following a TBI.  Some of these might include loss of consciousness, feelings of disorientation, nausea or vomiting, headaches, dizziness and loss of balance. In more severe cases, additional symptoms might include coma, slurred speech, convulsions or seizures, loss of coordination, generalised weakness, dilation of pupils, and fluids draining from the nose or ears.

Sensory Symptoms of TBI

TBI can also affect the sense organs. Sensory symptoms might include blurred vision, ringing in the ears, changes in the ability to taste and changes in the ability to smell.

Cognitive Symptoms of TBI

TBI can affect the child’s ability to process information. Memory and concentration are common following TBI. In more severe cases, there might be signs of confusion. The child with a TBI might also experience changes in mood. These might include experiencing symptoms of depression or anxiety. In more severe cases, emotional changes might include agitation, uncontrollable crying, or aggressive behavior.

Duration of Symptoms

It is difficult to predict how long the symptoms of TBI will persist. The symptoms of TBI are most severe in the weeks immediately following the injury and then begin to show improvement. Many of the brain functions that were compromised immediately following the injury recover as the swelling of the brain decreases over time. In milder cases, the symptoms of TBI eventually resolve sufficiently to allow the child to resume most or all of the important activities of his of her life. In more severe cases, permanent impairment can lead to major changes in the child’s life.

Disability associated with TBI

When severe, the symptoms of TBI can interfere with a child’s’s ability to engage in many activities of daily living. TBI can restrict a child’s ability to participate in family, social and recreational activities, and can compromise academic development. A child with severe symptoms of TBI might require some degree of assistance to manage his or her activities of daily living. This additional assistance might be provided by members of the family or by an attendant. In severe cases, the injured child might require residential care.

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Other Problems Associated with TBI

Children who have had a TBI often complain of symptoms of pain. Headaches are the most frequent form of pain reported by children with TBI.

TBI affects not only the injured child but affects the family as well.  The changes in mood or behaviour of the child with TBI can bring new stresses to members of the family. Particularly if the child with TBI is very disabled, considerable readjustment of family activities might need to take place. In the same way as the child with the TBI might require assistance or care in order to effectively manage the life changes brought about as a result of the injury, the family might also require some degree of assistance and care.

The Treatment of TBI

The treatment needs of a child with a TBI will change along the path of recovery. Immediately following injury, emergency life-saving measures might need to be provided. As symptoms are stabilised, the child might require rehabilitation services in order to maximise the probability that he or she might be able to participate as fully as possible in important activities of his or her life. Some rehabilitation interventions might focus on assisting the child in completing basic activities of daily living; other rehabilitation interventions might focus on remediation of cognitive abilities that have been compromised by the injury. The child might require modifications to his or her environment so that necessary supports are in place to ensure safety and the highest level of independence possible.

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