Traumatic brain injury (TBI) happens when any sudden trauma damages the brain. This damage can be localized, affecting only one part of the brain or it can be diffuse, affecting two or more parts of the brain. Traumatic brain injury ranges from mild to severe. Both a closed head injury and a penetrating head injury can cause TBI. A closed head injury means that something violently hits the head or the head violently hits something, but the object does not enter the skull. When an object does pierce the skull and enter the brain tissue, the resulting injury is called a penetrating injury. Both forms of injury can be severe.
When an obvious injury occurs to the head, the patient may be unconscious and in need of immediate medical care. If you have experienced trauma to the head, emergency medical workers will focus on your immediate needs. They will try to stabilize you, making sure that you are breathing and that your heart rate and blood pressure are under control. The great concern is that your brain is receiving adequate oxygen. Your airway may need to be opened. Sometimes CPR is necessary to make sure your heart is pumping enough blood through your body.
Many times, spinal cord injury is also a concern when you have suffered head trauma. Medical personnel will move you with great care to prevent further injury to the brain and spinal cord; they will likely immobilize your head in a special brace and place you on a stiff back board to transport you.
Once you are stable, the medics or other medical personnel will begin evaluating your condition. They will take your vital signs and check your reflexes, especially the size of your pupils when a light is shined in your eyes; pupil response gives some idea of how well the brain is functioning. Your neurological functioning and level of consciousness will be assessed using the Glasgow Coma Scale. Your ability to respond verbally, to move when asked to do so, and to open your eyes will all be assessed and measured by this standardized test; your responses will give the medical team some idea of the extent of your brain injury (or if you have brain injury at all).
Initial Hospital Care
If you have sustained a brain injury, your doctors will be concerned with preventing further injury and with your immediate survival. Nothing can be done to reverse the brain damage you have already sustained, but treatment can help prevent the damage from becoming worse. Treatment will focus on managing brain swelling.
Brain tissue may swell when injured. As your brain swells it can press against the skull causing the tissue and the blood vessels to be compressed and blood flow to be restricted. This can cause further brain damage.
Sometimes the initial injury tears blood vessels and blood clots or pooled blood also take up space within the skull. In addition, your blood pressure may drop dangerously low when you have had a brain injury, causing the brain to receive an even lower amount of oxygenated blood. Lack of oxygen to the brain will cause further brain damage.
To reduce brain swelling and increase the blood flow to your brain, doctors will use various medications. In some cases, surgery may also be needed.
• Diuretics You may be given a diuretic intravenously. Diuretics reduce swelling by increasing the output of urine and reducing the amount fluid in the brain tissue. Generally mannitol is the diuretic of choice for brain swelling; however, some research indicates that saline solution in certain concentrations may be as an effective diuretic as mannitol. Saline solution is thought to be especially effective in children.
• Anti-seizure medications During the first week after a moderate to severe traumatic brain injury you are more at risk of having a seizure. Your doctor may want you to take an anti-seizure medication during this time, so that your brain will not receive further damage from a possible seizure.
• Coma-inducing medications The brain does not need as much oxygen when in a comatose state, so your doctor may decide that placing you temporarily in a coma will help reduce the chance of further brain damage. If your brain’s blood vessels are compressed and not delivering the proper amount of oxygen and nourishment to your brain cells, inducing a coma can be very useful.
Surgery to relieve pressure and/or to repair damage may be necessary when you have experienced a traumatic brain injury.
• Surgery to remove hematomas. After a brain injury, blood may clot in your brain, forming hematomas which can cause additional pressure on the brain. If your doctor detects evidence of hematomas you may be operated on immediately to remove them.
• Removing foreign objects. If you have experienced a penetrating brain injury, you may need surgery to remove any foreign objects or bone fragments.
• Repairing the skull. If you have a fractured skull you may need surgery to repair it. Surgery is done to repair skull fractures if the bone is pressing on the brain. Fortunately, most skull fractures do not press on the brain and can heal without surgical intervention.
• Giving the brain more room. When brain swelling cannot be controlled by medicines or other means, your doctor may want to make more room for the brain within the skull. This is done by temporarily removing a section of skull so that the brain will have room to swell. Most brain swelling will subside in a few days and the piece of skull can be replaced.
Once you are stabilized and out of intensive care, you will begin a rehabilitation program tailored to your individual needs. This therapy will at first take place in a subacute care unit of the hospital or at a free-standing rehabilitation center. You may need a variety of different forms of therapy given by different specialists. Your physical, cognitive, and emotional needs may be assessed by a neuropsychologist, who will recommend what forms of help you need.
Physical therapy to get you back on your feet and walking if possible will take priority. You will be helped to do exercises which strengthen your muscles and help you regain motor skills you may have lost. Exercise will help prevent your muscles from becoming atrophied from disuse. You will be trained to use a walker or other adaptive equipment to help you get around. When it is time for you to return home, your therapists and social worker will help you with the services needed to adapt your home to your new limitations.
Occupational therapy will center on teaching you the skills you need for every day living. You will be taught ways to cope with personal hygiene, dressing, and so on.
If you are experiencing difficulty speaking or understanding what others say, you may need speech therapy to help you regain the skills you have lost. A speech therapist will also help you develop new ways of communicating in case your former skills do not return.
You will also receive emotional support so that you can cope with any limitations which result from your brain injury. Psychologist, psychiatrists, and social workers can help you adjust to your new lifestyle. You may need medications to help you cope with physical problems and with psychological problems, such as depression, anxiety, and mood-swings. Since people with brain injury are more sensitive to drug side effects, doctors need to take this into account when prescribing for your needs.
Rehabilitation from a traumatic brain injury is an ongoing process. You and your family have many options to choose from when deciding where you will continue to receive rehabilitation. Rehabilitation may be given on an outpatient basis from the hospital, at home, as an inpatient or an outpatient at a free-standing rehabilitation center, or through a supportive living center or independent living center. Club house programs are available in some areas. There are also school-based programs for children. Choosing a center should be done in consultation with medical personnel who understand your needs and can help you make sense of the different options.
Currently, many studies are being conducted in an attempt to find new treatments for traumatic brain injury. Scientists are looking at the cell processes by which brain damage occurs and spreads; an understanding of these processes may help researchers develop treatments that can stop or even reverse the damage. One promising new treatment is the use of neural stem cells taken from adult neural tissue; when they are introduced into the brain, it is hoped that these special cells may replace damaged brain cells or even repair them.