Traumatic Brain Injury and Central Tendencies Marshall University CD 315 By: Sara Alvey What is a TBI? • Traumatic Brain Injury (TBI), may also be referred to as an acquired brain injury or head injury (Centre for Neuro Skills, 2006). • TBI occurs when the brain is damaged by a sudden blow to the head. • Diffuse damage to the brain often occurs because the brain ricochets inside the skull during the impact. • This diffuse damage causes general features, or central tendencies, to arise in most people who have TBIs. • Brain damage following a traumatic brain injury is a result of the primary and secondary damage that occurs (Ferrand & Bloom, 1997). What is TBI? • The initial impact is referred to as COUP. • The secondary impact after the brain is thrown backward is called the CONTRACOUP (Ferrand & Bloom, 1997). What is TBI? • PRIMARY DAMAGE- caused by the impact to the head, which can range from large brain lesions to microscopic brain lesions • SECONDARY DAMAGE- caused by factors that include: – Infection – Hypoxia (oxygen deprivation) – Edema (swelling due to increased fluid around the brain) – Elevated intracranial pressure (due to increased brain mass from excess fluid such as blood from hematoma, or cerebrospinal fluid within intracranial spaces. – Infarction (death of brain tissue in a localized area) – Hematomas (localized areas of bleeding within the skull due to tearing of blood vessels (Centre for Neuro Skills, 2006). Diffuse Axonal Injury Stretching, shearing, and tearing of blood vessels and nerve fibers caused by rapid rotation of the brain in the skull resulting in widespread brain dysfunction (Ferrand & Bloom, 1997) Classifications of TBI • Closed head injury – In closed head injuries, the skull is not penetrated and the three layers that cover the brain, or meninges, remain intact. – Damage results from the inward compression of the skull at the point of impact and the subsequent rebound effects Classifications of TBI • Open head injury (Ferrand & Bloom, 1997) – Open head injuries occur when the scalp or skull is penetrated. – Damage results from the penetrating object along a localized path in the brain – Common objects involved in open head injuries may include: • Bone fragments from skull fractures • Bullets • Shell fragments • Stones • Knives • Blunt instruments Causes • Traumatic Brain Injury (TBI) have several causes including: – Motor vehicle accidents – Gun shot wounds – Falls – Sports related – Assault – Any trauma involving a blow to the head Central Tendencies • Cognitive deficits • Language deficits • Speech and Swallowing deficits • Emotional and Behavioral problems • Sensory processing problems Cognitive Deficits • Orientation- awareness of person, place, time and circumstance – Personal information learned before the accident must only be retrieved, and not relearned – Orientation after the accident requires the capability to store and recall new information. – Orientation to circumstance returns first, followed by place and time. Cognitive Deficits • Attention – This deficit may be mild or severe, and may go unnoticed. – The biggest problem for patients is concentration. – Types of attention include: • Focused attention- ability to respond discretely to specific stimuli • Sustained attention- ability to maintain a consistent behavioral response during continuous repetitive activities • Alternating attention- ability to shift the focus of attention and move between tasks with different behavioral requirements. • Selective attention- ability to maintain a behavioral set in the presence of distracting extraneous stimuli • Divided attention- the ability to respond simultaneously to multiple task demands (Centre for Neuro Skills, 2006) Cognitive Deficits • Memory – Encoding- coding of information to facilitate later recall – Consolidation- integrating new memories with old ones – “The most common cognitive impairment among severely head-injured patients is memory loss, characterized by some loss of specific memories and the partial inability to form or store new ones” (NINDS, 2002). Cognitive Deficits • Problem-Solving and Reasoning – Considered to be aspects of high-level thought processes – Problem-solving involves: strategy selection, application of strategy for resolution of the problem, and evaluation of the outcome – Deductive reasoning- drawing of conclusions based on premises or general principles in a step-by-step manner – Inductive reasoning- involves the formulation of solutions given information that leads to, but may not support, a general solution Cognitive Deficits • Executive Function – The frontal lobes are often damaged with a TBI. This is the house for executive functioning. – When executive functioning is impaired, all other cognitive systems may be effected. – Executive functioning includes activities related to achievement/completion or a goal, goal formulation, planning, implementing, self-monitoring, and using feedback (Centre for Neuro Skills, 2006). Language Deficits • Aphasia- is an impairment of language processes underlying receptive and expressive modalities caused by damage to areas of the brain that are primarily responsible for language function • Non-fluent aphasia, or Broca’s aphasia, is a condition in which patients have trouble recalling words and speaking in complete sentences. • Fluent aphasia, or Wernicke’s aphasia, is a condition in which patients display little meaning in their speech even though they speak in complete sentences. Language Deficits • Pragmatics – Refers to a system of rules that structures the use of language in terms of situational and social context – Those with prefrontal injury demonstrate problems with pragmatics and may display disorganized discourse, inappropriate social interactions, and abstract forms of language (Ferrand & Bloom, 1997) Speech and Swallowing Deficits • Dysarthria- is a speech disorder resulting from weakness or incoordination of the muscles that control respiration, phonation, resonation or articulation • Speech is often slow and slurred. • Problems with intonation or inflection may occur, which is known as prosodic dysfunction. Speech and Swallowing Deficits • Dysphasia- a condition in which the action of swallowing is difficult or painful to perform • Problems included: – Delayed triggering of the swallow response – Reduced tongue control – Reduced pharyngeal transit Emotional and Behavioral Problems Personality Problems that changes and may occur include: behavioral depression, problems are apathy, anxiety, often times the irritability, anger, most difficult paranoia, disabilities to confusion, handle for frustration, families. agitation, insomnia or other Emotional and Behavioral Problems • Behavioral problems may include: – Aggression and –Childish behavior violence –Impaired self-control – Impulsivity –Impaired self-awareness – Disinhibition –Inability to take – Acting out responsibility – Noncompliance –Egocentrism – Social –Inappropriate sexual inappropriateness activity – Emotional outbursts –Alcohol or drug abuse/addiction. Sensory-Processing Problems • Difficulty with vision and recognizing objects can occur. • Some may have problems with hand-eye coordination. • May have problems with hearing, touch, smell and taste “Damage to the part of the brain that controls the sense of touch may cause a TBI patient to develop persistent skin tingling, itching, or pain (Centre for Neuro Skills, 2006).” References Centre for Neuro Skills, TBI Resource Guide. (2006). Brain Injury. Retrieved October 30, 2006, from http://www.neuroskills.com Ferrand, C. T., & Bloom, R. L. (1997). Introduction to organic and neurogenic disorders of communication: Current scope of practice. Needham Heights, MA: Allyn & Bacon.