Traumatic Brain Injury (TBI) HISTORY

In the 1970s, awareness of TBI as a public health problem grew and a great deal of progress

has been made since then in brain trauma research, such as the discovery of primary and

secondary brain injury. The 1990s saw the development and dissemination of standardized

guidelines for treatment of TBI, with protocols for a range of issues such as drugs and

management of intracranial pressure. Research since the early 1990s has improved TBI

survival; that decade was known as the "Decade of the Brain" for advances made in brain

research.

Until the 20th century, the mortality rate of TBI was high and rehabilitation was uncommon;

improvements in care made during World War I reduced the death rate and made rehabilitation

possible Facilities dedicated to TBI rehabilitation were probably first established during World

War I. Explosives used in World War I caused many blast injuries; the large number of TBIs that

resulted allowed researchers to learn about localization of brain functions. Blast-related injuries

are now common problems in returning veterans from Iraq & Afghanistan; research shows that

the symptoms of such TBIs are largely the same as those of TBIs involving a physical blow to

the head.

Medieval and Renaissance surgeons continued the practice of trepanation for head injury. In the

Middle Ages, physicians further described head injury symptoms and the term concussion

became more widespread. Concussion symptoms were first described systematically in the 16th

century by Berengario da Carpi.

The 20th century saw the advancement of technologies that improved treatment and diagnosis

such as the development of imaging tools including CT and MRI, and, in the 21st century,

diffusion tensor imaging (DTI).

The Edwin Smith Papyrus, written around 1650–1550 BC, describes various head injuries and

symptoms and classifies them based on their presentation and tractability. Ancient Greek

physicians including Hippocrates understood the brain to be the centre of thought, probably due

to their experience with head trauma. (wikipedia)

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Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI)is also known as intracranial injury. It occurs when an external

force traumatically injures the brain. TBI can be classified based on severity, mechanism

(closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). Head injury usually refers to TBI, but is a broader category

because it can involve damage to structures other than the brain, such as the scalp and skull.

Physical problems that occur after (TBI)

Physical problems may include hearing loss, tinnitus (ringing or buzzing in the ears, headaches,

seizures, dizziness, nausea, vomiting, blurred vision, decreased smell or taste, and reduced

strength and coordination in the body, arms, and legs.

Communication problems that occur after (TBI)

People with a brain injury often have cognitive (thinking) and communication problems that

significantly impair their ability to live independently. These problems depend on how

widespread brain damage is and the location of the injury. Brain injury survivors may have

trouble finding the words they need to express an idea or explain themselves through

speaking and/or writing. The person may have trouble with social communication, including:

-taking turns in conversation

-maintaining a topic of conversation

-using an appropriate tone of voice

-interpreting the subtleties of conversation (e.g., the difference between sarcasm and a serious

statement)

-responding to facial expressions and body language

-keeping up with others in a fast-paced conversation

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In addition to all of the above, muscles of the lips and tongue may be weaker or less

coordinated after TBI. The person may have trouble speaking clearly. The person may not be

able to speak loudly enough to be heard in conversation. Muscles may be so weak that the

person is unable to speak at all. Weak muscles may also limit the ability to chew and swallow

effectively.

Cognitive problems that occur after (TBI)

Cognitive difficulties are very common in people with TBI. Cognition (thinking skills) includes an

awareness of one's surroundings, attention to tasks, memory, reasoning, problem solving, and

executive functioning (e.g., goal setting, planning, initiating, self-awareness, self-monitoring and

evaluation). Problems depend on the location and severity of the injury to the brain and may

include the following: Trouble concentrating when there are distractions (e.g., carrying on a

conversation in a noisy restaurant or working on a few tasks at once). Slower processing or "taking in" of new information. Longer messages may have to be "chunked," or broken down into smaller pieces. The person may have to repeat/rehearse messages to make sure

he or she has processed the crucial information. Communication partners may have to slow

down their rate of speech. Problems with recent memory, new learning can be difficult but

Long-term memory for events and things that occurred before the injury, however, is generally

unaffected (e.g., the person will remember names of friends and family). Executive functioning problems, the person may have trouble starting tasks and setting goals to complete them.

Planning and organizing a task is an effort, and it is difficult to self-evaluate work. Individuals

often seem disorganized and need the assistance of families and friends. They also may have

difficulty solving problems, and they may react impulsively (without thinking first) to situations

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How is TBI diagnosed?

The speech-language pathologist (SLP) works with the person.The SLP completes a formal

evaluation of speech and language skills. An oral motor evaluation checks the strength and

coordination of the muscles that control speech. Understanding and use of grammar (syntax)

and vocabulary (semantics), as well as reading and writing, are evaluated. Social

communication skills (pragmatic language) are evaluated with formal tests and the role-playing

of various communication scenarios. The person may be asked to discuss stories and the points

of view of various characters. Does he or she understand how the characters are feeling, and

why they are reacting a certain way? Can he or she explain how different characters' actions

affect what happens in the story? The person may be asked to interpret/explain jokes, sarcastic

comments, or absurdities in stories/pictures (e.g., what is strange about a person using an

umbrella on a sunny day?).

The SLP will assess cognitive-communication skills. Is the person aware of his or her

surroundings? Does the person know his or her name, the date, where he or she is, what

happened to him or her (orientation)? Recent memory skills are assessed, such as whether the

main details in a short story are retained. Executive functioning is evaluated. The SLP assesses

the patient's ability to plan, organize, and attend to details (e.g., completing all of the steps for

brushing teeth). The SLP may read an incomplete story and ask for a logical beginning, middle,

or conclusion. The person may be asked to provide solutions to problems (reasoning and

problem solving; e.g., "What would you do if you locked your keys in your car? How can this

problem be avoided in the future ?").

What does a speech-language pathologist do when working with people with TBI?

A treatment plan is developed after the evaluation. The treatment program will depend on the

stage of recovery, but it will always focus on increasing independence in everyday life.

In the early stages of recovery (e.g., during coma), treatment focuses on:

-getting general responses to sensory stimulation

-teaching family members how to interact with the loved one

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As an individual becomes more aware, treatment focuses on:

-maintaining attention for basic activities

-reducing confusion

-orienting the person to the date, where he or she is, and what has happened

Later on in recovery, treatment focuses on:

-finding ways to improve memory (e.g., using a memory log)

-learning strategies to help problem solving, reasoning, and organizational skills

-working on social skills in small groups

-improving self-monitoring in the hospital, home, and community

Eventually, treatment may include:

-going on community outings to help the person plan, organize, and carry out trips using

memory logs, organizers, checklists, and other helpful aids

-working with a vocational rehabilitation specialist to help the person get back to work or school

Traumatic Brain Injury (TBI) RESEARCH

However, clinical trials to test agents that could halt these cellular mechanisms have met largely

with failure.For example, interest existed in hypothermia, cooling the injured brain to limit TBI

damage, but clinical trials showed that it is not useful in the treatment of TBI.In addition, drugs

such as NMDA receptor antagonists to halt neurochemical cascades such as excitotoxicity

showed promise in animal trials but failed in clinical trials.These failures could be due to factors

including faults in the trials' design or in the insufficiency of a single agent to prevent the array of

injury processes involved in secondary injury.Recent research has gone into monitoring brain

metabolism for ischaemia, in particular the parameters of glucose, glycerol, and glutamate

through microdialysis Developments in technologies may provide doctors with valuable medical

information. (http://en.wikipedia.org/wiki/Traumatic_brain_injury#Research)

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IMAGE

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REFERENCE

Bibliographywikipedia. (n.d.). http://en.wikipedia.org/wiki/Traumatic_brain_injury#History.

wikipedia. (n.d.). http://en.wikipedia.org/wiki/Traumatic_brain_injury#Research.

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