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Traumatic Brain Injuries

Posted December 20, 2017

By Beth Druvenga, M.S. Ed, LAT, ATC

Traumatic brain injuries (TBI) are a current hot button topic of both healthcare practitioners and caregivers. We have come to know so much, but there is so much left to learn. Traumatic brain injuries occur as a result of a blow to the head or a penetrating head injury that disrupts normal brain function, or a blow to the body which causes the brain to bounce against the skull and disrupt normal brain function.1 Every 13 seconds, someone in the United States suffers a TBI, and 1 out of every 60 people in the U.S. live with a TBI-related disability.2 There are 2.5 million children and adults who experience TBI in the U.S. each year.2 This number does not take into account those who experience TBI but do not seek medical treatment.

TBI can range from mild to severe, with mild TBI being the most common.3 Concussions are a form of mild TBI and the most common type of TBI we see in the field of athletic training.3 The Department of Defense (DoD) defines the various classification of TBI with the following characteristics:

Classification

Definition

Mild TBI/concussion

Confused or disoriented state, lasts <24 hours; or loss of consciousness up to 30 minutes; or memory loss lasting <24 hours. Excludes penetrating TBI. A CT scan is not indicated for most patients with a Mild TBI. If obtained, it is normal.

Moderate TBI

Confused or disoriented state >24 hours; or loss of consciousness >30 minutes but <24 hours; or memory loss >24 hours but <7 days; or meets criteria for Mild TBI except an abnormal CT scan is present. Excludes penetrating TBI. A structural brain imaging study may be normal or abnormal.

Severe TBI

Confused or disoriented state >24 hours; or loss of consciousness >24 hours; or memory loss >7 days. Excludes penetrating TBI. A structural brain imaging study may be normal but is usually abnormal.

Penetrating TBI/open head injury

A head injury in which the scalp, skull and dura mater are penetrated. Penetrating injuries can be caused by high-velocity projectiles or objects of lower velocity such as knives or bone fragments from a skull fracture that are driven into the brain.

Source taken from the Department of Defense website: http://dvbic.dcoe.mil/dod-worldwide-numbers-tbi

From 2000 through quarters 1 and 2 of 2017 the DoD concluded that of all TBI sustained in those 17 years, 82.3 percent of them fell under the classification of mild TBI/concussion.4 This hits close to home for Athletic Trainers (ATs) because we handle concussions on a daily basis. As a result of the far-reaching effects of concussion in the military and athletics, healthcare providers and researchers have called for further extensive study on concussion assessment, recognition and education.

The National Collegiate Athletic Association and DoD collaborated to create the Concussion Assessment, Research and Education (CARE) Consortium to study clinical and neurobiological recovery following concussion.5 We know repetitive injuries may be associated with slower recovery and increased symptoms post-concussion, and we are learning more about the possibility of a higher risk for developing other neurological, psychological and behavioral issues after numerous concussive events.5 Additionally, the topic of chronic traumatic encephalopathy is on the tip of everyone’s tongues as researchers continue to find a correlation between repeated head trauma and chronic outcomes such as, brain matter and brain chemistry changes, although no clear causal relationship has been established.5 The CARE Consortium is attempting to close these gaps in our understanding of mild TBI and point us in the right direction to change how clinicians provide care for these injuries.5

While we continue to learn more about TBI, and mild TBI/concussion specifically, we can take what we currently know and use it to educate others. With the public becoming increasingly aware of mild TBI/concussion and the effects it may have,6 bridging the gap and identifying the needs of your demographic is important in providing the best care for our patients. As stated earlier an estimated 2.5 million children and adults seek treatment for a TBI each year,2 but it does not account for those not being treated. Not only does increasing public knowledge of TBI have the potential to encourage people to seek treatment for their injuries, but it also gives us the opportunity to showcase the importance of the ATs’ role in the concussion detection, evaluation, rehabilitation and return to participation processes.

References

1. About Traumatic Brain Injury. (2016, August 8). Retrieved October 24, 2017, from Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury: http://www.dcoe.mil/traumatic-brain-injury

2. Brain Injury Facts and Statistics. (2015). Retrieved October 24, 2017, from Brain Injury Association of America: http://www.biausa.org/brain-injury-awareness-month...

3. Doan, N., Patel, M., Doan, H., Janich, K., Nguyen, H. S., & Shabani, S. (2016). Traumatic Brain Injury. International Journal of Physical Medicine & Rehabilitation.

4. DoD Worldwide Numbers for TBI. (2017, October 23). Retrieved October 24, 2017, from Defense and Veterans Brain Injury Center: http://dvbic.dcoe.mil/dod-worldwide-numbers-tbi

5. Broglio, S. P., McCrea, M., McAllister, T., Harezlak, J., Katz, B., Huck, D., et al. (2017). A National Study on the Effects of Concussion in Collegiate Athletes and US Military Service Academy Members: The NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium Structure and Methods. Sports Medicine, 1437-1451.

6. McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., et al. (2017). Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 1-10.

About the Author

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Beth Druvenga is an Athletic Trainer currently living in northern Virginia. She has experience working in both a collegiate and high school setting. Druvenga is originally from Iowa where she earned her Bachelor of Arts degree in Athletic Training from Central College in 2012. She graduated from Old Dominion University in 2014 with a Master of Science in Education. Her professional interests include patient-reported outcomes, psychology of injury and rehabilitation as well as using yoga to increase flexibility.