Preventing Traumatic Brain Injuries

We will wrap up our discussion of traumatic brain injuries (TBI) this week by discussing things that we can do to help prevent these injuries.

How can traumatic brain injuries be prevented?

We cannot prevent all brain injuries, but there are things that you can do to help reduce the risk of a traumatic brain injury. This includes:

• Always wear a seat belt in a motor vehicle.
• Don't drive under the influence of alcohol or drugs, including prescription medications that can impair the ability to drive. Warn your children, particularly teenagers, never to ride with a driver who is impaired in any way.
• Always wear a helmet when riding a bicycle, skateboard, motorcycle, snowmobile, or any all-terrain vehicle.
• Always wear appropriate head protection when playing baseball or contact sports, skiing, skating, snowboarding, or riding a horse.
• Never use your phone while driving. Distracted driving is just as bad as driving under the influence of substances when it comes to causing accidents.
• Pay attention to your surroundings. Distractions are not only a problem when driving, but also when walking. Don't walk or especially cross the street while looking at your phone. Even talking on the phone using headphones, without looking at the screen, can often distract you from paying attention to things going on around you. Distractions can lead to falls, getting hit by a passing car, or wandering into dangerous situations unaware.

Special considerations for preventing TBI in children include:

• Children should always ride in the back seat of a car, properly secured in a child safety seat or booster seat that is appropriate for their height and weight. Many parents allow children to ride without a booster seat or in the front seat much earlier than is recommended. Read the American Academy of Pediatrics guidelines here: Child Passenger Safety (aap.org)
• Young children should not ride all-terrain vehicles such as 4 wheelers, even with an adult driver.
• Install safety gates at the top of a stairway.
• Install window guards to prevent falls from windows.
• Don't let children play on fire escapes or balconies.
• Use a nonslip mat in the bathtub or shower.
• When possible, choose playgrounds that have shock-absorbing materials on the ground.
• Regarding sports:
  • Young children should not play tackle football, they should play flag football instead. When playing soccer, they should not be using their head to hit the ball. This way they can learn the game and have fun without risking a TBI during a critical time of brain development.
  • All children should wear appropriate head protection when playing baseball or contact sports, skiing, skating, snowboarding, or riding a horse.
  • Headband devices promoted as "protection" for soccer players have not been shown to significantly decrease the risk of TBI or concussion. Read more here: Headbands for soccer players: Pros and Cons.: SportsSafe: Pediatric Concussion Clinics (sportssafect.com) and here Study: 'Protective' headgear does not prevent sport-related concussions in soccer players (wisc.edu)

Special considerations for older adults to help prevent falls include:

• Install handrails or grab bars in bathrooms.
• Put a nonslip mat in the bathtub or shower.
• Make sure there is adequate lighting in the home, particularly around stairways.
• Keep stairs and floors clear of clutter.
• Make sure stairways have adequate handrails.
• Remove throw rugs.
• Get regular vision checkups and always wear prescribed glasses.
• Get regular exercise. Core strengthening exercises, as well as exercise such as Tai Chi and Yoga, are particularly helpful in improving balance as we get older.

If you have any questions about brain injuries, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Brain Injury – Part III

This week, we will continue our discussion of brain injuries with a discussion of the diagnosis and treatment of traumatic brain injury (TBI).

How are TBIs diagnosed?

Remember that TBIs can be emergencies. Severe brain injuries can worsen rapidly if not treated appropriately and quickly. Doctors need to make a quick assessment of the situation.

If you see someone sustain a head injury, or arrive on the scene immediately after, you may be able to provide valuable information to help health care providers assess the situation. Try your best to remember and pass on details of the injury, such as:

• How the injury happened
• What part of their head was hit, and how hard, and if other body parts were struck
• If there was a fall, from what height the person fell
• Whether or not the person lost consciousness, and for how long
• Whether the person had trouble speaking or seemed confused immediately after the injury
• Whether the person's body was whipped around or severely jarred

What is the Glasgow Coma Scale?

This is a checklist that assesses and gives a certain number of points to things such as how well a person can follow directions, move their eyes, move their limbs, and speak coherently. It helps a doctor to make an initial assessment of the severity of the brain injury.

Are imaging tests required for diagnosis?

Tests such as a CT scan or MRI may or may not be used, depending on the severity of the injury. Mild TBIs usually do not require imaging unless there are underlying risk factors, such as being on blood thinner medication.

How is TBI treated?

Treatment for a TBI, particularly in the acute stage, depends on the severity of the injury.

Mild TBI treatment may include:

• Rest - Limited (but not complete avoidance of) both physical and mental activity
• Avoiding screen time, including television and electronic devices
• Over the counter pain relievers for headache
• Close monitoring to watch for any worsening signs or symptoms or persistent symptoms

Moderate to severe TBI treatment may include one or more of the following:

• Medications or fluids to maintain blood pressure
• Assuring the patient gets adequate oxygen, which may include a ventilator in severe cases
• Monitoring the pressure inside the skull
• Medications to prevent seizures
• Medication to help reduce pressure inside the brain
• Medication to temporarily induce a coma - because a comatose brain needs less oxygen and nutrients to function
• Emergency surgery - to remove blood clots, repair skull fractures, stop bleeding in the brain, or sometimes to open a window in the skull to help relieve pressure on the brain

What happens after the acute phase of treatment?

After a mild TBI, or concussion, a person is usually able to gradually return to normal activities over a period of a few days to several weeks.

After moderate to severe TBI, most people will require some type of rehabilitation. This may be done initially in a hospital or rehabilitation facility. Most people will require continued rehabilitation in the outpatient setting after returning home. Treatment may include:

• Physical therapy - to work on mobility, relearning movement patterns, strengthening, balance, and walking, including learning to use any mobility devices needed
• Occupational therapy - to work on fine motor skills, hand function, and skills to perform everyday activities
• Speech therapy - to improve communication skills and use any new communication devices that might be needed
• Neuropsychology - to assess and improve thinking and behavioral challenges, and help with emotional well being and coping with the injury
• Vocational retraining - may be necessary to help a person to return to work

I thought we might be able to discuss prevention today but I seem to have run out of space! We will discuss the important subject of how to decrease the risk of TBI next week.

If you have any questions about brain injuries, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Brain Injury Part II

Let's continue our discussion of brain injury. In Part I, we talked about some functions of the brain, defined some terms that apply to brain injuries, and talked about some common causes of acquired brain injuries. Today we will talk more specifically about TBIs including concussion.

How does the brain get injured in a closed head injury?

It seems obvious how the brain is injured in an open (penetrating) injury, but it may not be so obvious how the brain is injured when nothing penetrates the brain. The brain is enclosed by the skull, which is a very strong bony structure. The cerebrospinal fluid surrounds the brain within the skull. Most of the time, this fluid protects the brain from impact with the skull. However, when there is rapid acceleration or deceleration of the head, the brain may hit the inside of the skull with enough force to cause injury. Rapid rotational movement of the head can also result in damage to the brain.

This bouncing or twisting of the brain inside the skull may cause:

• Blood vessels in the brain to stretch or bleed
• Cranial nerves and brain cells to be damaged
• Tearing or stretching of the connections between brain/nerve cells
• Chemical changes in the brain

What is a concussion?

There are three main types of traumatic brain injury (TBI): mild, moderate, or severe. A mild TBI is also called a concussion. Although they are considered "mild" TBIs, this is because they are usually not life-threatening. It is not because they are not serious injuries. Here are some facts about concussions.

• Concussions should always be taken seriously.
• Concussion is the most common type of TBI.
• Both closed and open head injuries can lead to a concussion.
• An imaging test of the brain, such as a CAT scan is not needed to diagnose a concussion. In fact, concussion may or may not show up on these tests.
• Brain imaging may sometimes be used for patients at risk for bleeding in the brain after mild trauma.
• Falls are the most common cause of concussion. Concussions are also common if you play a contact sport, such as football or soccer.
• Skull fracture, brain bleeding, or swelling may or may not be present.
• A concussion can cause injury that results in temporary or permanent damage.
• It may take a few months to a few years for a concussion to heal. Nerve and brain cells, and the connections between them, take longer to heal than other types of cells in the body.
• Most people usually recover fully after a concussion.
• A person with a history of multiple or repeated mild TBI/concussions may experience longer recovery time, or more severe symptoms. This is especially true if the second concussion happens before the initial concussion has had time to heal.

What are the symptoms of concussion?

Here are some of the common signs and symptoms of a concussion. Keep in mind that a person with concussion may not experience all of these symptoms.

• Brief loss of consciousness immediately after the injury (which would not exceed 20 minutes)
• Feeling or appearing dazed or confused
• Headache or feeling of pressure in the head
• Memory loss surrounding the traumatic event
• Dizziness
• Ringing in the ears
• Nausea or vomiting
• Slurred speech
• Delayed response to questions
• Double vision
• Fatigue

If you or someone you know experiences symptoms of concussion, seek medical attention immediately. Any brain injury needs to be evaluated and treated promptly.

Next week, we will talk about treatment and prevention of TBIs.

If you have any questions about brain injuries, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor