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Overview of Traumatic Brain Injury

Each year, over two million people in America sustain a brain injury including an estimated 1,500 individuals in New Hampshire. Brain injury is the leading cause of death and disability of children and young adults. Child abuse accounts for 64% of all infant brain injuries, and over 50,000 children sustain bicycle related brain injuries in the United States each year.

Causes of brain injury are varied and include motor vehicle crashes, sports injuries, falls, violence, stroke, brain tumors, anoxia (loss of oxygen) during surgery or near drowning, encephalitis, meningitis, poisoning, and seizure disorder.

Every brain injury is unique and the extent of the injury can vary from "mild" to severe.

People who experience a "mild" brain injury often appear fine, yet can have some lingering effects that impact their ability to resume their normal life activities at home, school, or work. They may exhibit difficulties with, but not limited to, concentration, organization, managing multiple tasks simultaneously, memory, relationships with family, business associates and friends, and/or personality changes.

People whose injuries are considered to be moderate or severe exhibit varying degrees of difficulty in cognitive (thinking), emotional, behavioral, physical, and social areas. They suffer permanent disabilities which effect their ability to return to a pre-injury lifestyle.

Not all outcomes of brain injury are immediately obvious, which is why Acquired Brain Injury has been called the silent epidemic. In children and teenagers, some impairments do not become obvious until future growth and maturity require more complex skills that have been affected by the injury.

One of the best defenses after an injury occurs is to arm oneself with the best information and resources available for timely treatment, rehabilitation and support. This Directory lists resources which are available to New Hampshire families and survivors.

Definitions

In the evolution of the rehabilitation field, the term "head injury" has given way to "brain injury" and more currently "acquired brain injury" or "acquired brain disorder." This is happening to more accurately reflect the fact that it is damage to the "brain" which results in the disabilities. Furthermore, injury to the brain can occur as a result of a traumatic injury or an acquired trauma, both conceivably having the same outcome: damage to the brain. Using the term "brain injury," although appropriate for both a traumatic or acquired brain injury, frequently leads one to think in terms of a traumatic injury from an accident only; thus, we use the more inclusive term: acquired brain injury. We prefer to use the term: acquired brain disorder which is a broader category including acquired brain injury and other neurological disorders. Acquired brain injury and acquired brain disorder will frequently be used interchangeably.

Brain injury: A more descriptive term than head injury. Damage to the brain that results in impairments in physical, cognitive, speech/language, and behavioral functioning. The damage may be caused by external physical force, insufficient blood supply, toxic substance, malignancy, disease-producing organisms, congenital disorders, birth trauma, or degenerative processes.

Traumatic Brain Injury (TBI): Damage to living brain tissue caused by an external mechanical force or motion. It is usually characterized by a period of altered consciousness (amnesia or coma) that can be very brief (minutes) or very long (months/indefinitely). The term does not include brain injuries that are caused by insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congenital disorders, birth trauma, or degenerative processes. A traumatic brain injury can be a closed or open brain injury:

Closed Brain Injury: Occurs when the head accelerates and then rapidly decelerates or collides with another object (for example, the windshield of a car) and brain tissue is damaged, not by the presence of a foreign object within the brain, but by violent smashing, shaking, stretching, and twisting of brain tissue. The nerve endings connecting the skull to the brain are often torn or become completely separated from the brain. Closed brain injuries typically cause diffuse tissue damage that results in disabilities which are generalized and highly variable.

Open (Penetrating) Brain Injury: Occurs when an object (e.g. bullet, knife) fractures the skull, enters the brain, and injures the brain tissue in the process. These injuries tend to damage localized areas of the brain and result in discrete and relatively predictable disabilities.

Acquired Brain Injury (ABI): The implication of this term is that the individual experienced normal growth and development from conception through birth, until sustaining an insult to the brain at some later time which resulted in impairment of brain function. ABI is caused by the shearing of brain nerve fiber due to trauma or by cell death related to swelling, bleeding, disease or loss of oxygen to the brain (anoxia). Whether mild, moderate or severe, ABI can cause physical, cognitive, speech/language, and behavioral dysfunction. Common causes:

Traumatic Brain Injury (TBI) Disease Motor Vehicle Crashes Benign/Malignant Tumors Falls Meningitis Assaults Encephalitis Sports/Recreational Injuries Anoxic Event Cerebrovascular Accident Near Drowning (CVA or Stroke): Drug Overdose Atherosclerosis Subsequent to TBI/CVA Aneurysm Kidney/Heart Failure Arteriovenous Malformation Industrial Chemical Exposure Electrical Shock

Acquired Brain Disorder (ABD): Acquired brain disorder is a broader category which includes neurological disorders as well as acquired brain injury. They each may result in trauma or disruption to the brain and nervous system from a variety of sources.

The brain is the control board for all functions of the body. It is comprised of the cortex which controls most thinking functions, the cerebellum which coordinates movement, and the brain stem which controls consciousness, alertness, and basic functions such as breathing, respiration and pulse. The brain function can be disrupted in a number of ways: injuries, toxins, illness, and unrelated medical conditions. These disorders to the brain and nervous system include, in addition to acquired brain injuries, neurological brain disorders such as Multiple Sclerosis, Huntington's Disease, Parkinson's Disease, and rare neurological disorders.

Description of Program/Service/Facility Type

Definitions of program and service categories ("levels of care") can be confusing, both in terms of what they provide and the timeframes of service they apply to. Currently, there is no standardized nomenclature. These should not be viewed as rigid categories but rather as a communication tool in understanding the range of rehabilitation and living settings available. There is considerable overlap and, in reality, a program may provide a continuum of several services.