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					Traumatic Brain Injury
   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
• 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
  – Damage results from the penetrating object along a
    localized path in the brain
  – Common objects involved in open head injuries may
     •   Bone fragments from skull fractures
     •   Bullets
     •   Shell fragments
     •   Stones
     •   Knives
     •   Blunt instruments
• 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
  – 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
  – The biggest problem for patients is concentration.
  – Types of attention include:
     • Focused attention- ability to respond discretely to specific
     • 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
  – 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
Speech and Swallowing Deficits
• Dysphasia- a condition in which the action
  of swallowing is difficult or painful to
• Problems included:
  – Delayed triggering of the swallow response
  – Reduced tongue control
  – Reduced pharyngeal transit
  Emotional and Behavioral
Personality       Problems that
changes and       may occur
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
• 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
  Sensory-Processing Problems
• Difficulty with vision and recognizing
  objects can occur.
• Some may have problems with hand-eye
• 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).”
Centre for Neuro Skills, TBI Resource Guide. (2006). Brain Injury. Retrieved October 30,
   2006, from

Ferrand, C. T., & Bloom, R. L. (1997). Introduction to organic and neurogenic
           disorders of communication: Current scope of practice. Needham Heights, MA:
           Allyn & Bacon.

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