CAUSES AND EVALUATION OF TBI: TRAUMA

     Trauma, caused by motor vehicle accidents, falls, acts of violence, or sports injuries, is one of the most common causes of brain injury. In the U.S. alone, 1.5 - 2 million people incur TBI each year as a result of trauma. 70,000 - 90,000 survive with a significant, long-term loss of functioning. Estimates of the number of people living with a brain injury range from 2.5 - 6.5 million. Approximately 300,000 hospital admissions each year are for mild to moderate TBI.

     Traumatic head injuries are classified as open or closed and as coup or countercoup injuries:

  • Open head injuries result from skull fractures or penetrating wounds.
    • Skull fractures vary in form and severity. The brain structures and tissues affected depend largely on the type of fracture.
    • Penetrating wounds vary be the velocity or speed of impact. Generally, the faster the speed of a bullet or motor vehicle, the more extensive the injury.

  • Closed head injuries involve concussion, contusions, and/or lacerations.
    • Concussion is usually the least severe type of brain injury.
    • Contusions or bruising of brain tissue is usually accompanied by bleeding.
    • Lacerations involve the actual tearing of the brain's surface tissues.

     All closed injuries can cause swelling of brain tissue, which may increase the amount of pressure in the skull and make the injury worse.

  • Coup injuries (A) are due to impact against an object. They are usually accompanied by contusions or lacerations directly beneath the site of impact and involve shearing of veins and trauma to the base of the brain.
  • Contracoup injuries (B) are due to impact of the brain within the skull and follow the striking of an object by the head (coup). They are usually accompanied by injury opposite the site of impact.

     Sometimes as a result of trauma, a person can sustain both a brain injury and a Spinal Cord Injury, making additional rehabilitation necessary. Severe brain injury usually results in coma, a state of unconsciousness during which a person cannot be aroused and/or cannot respond. The therapist may initiate a Coma Stimulation program in an effort to increase the patient's level of arousal and responsiveness.

Based on Brain Injury Patient Care and Education Manual, by Pinecrest Rehabilitation Hospital; Neuro section of the Trauma Manual, Jackson Memorial Hospital; and Recovering from Head Injury; a Guide for Patients, by Nova University Neuropsychology Service, and edited for PoinTIS by the Louis Calder Memorial Library of the University of Miami School of Medicine and the PoinTIS Advisory Committee, and on Rehabilitation of Persons with Traumatic Brain Injury, NIH Consensus Statement 1998 Oct. 26-28.