Table of Contents
Overview
Definition of Traumatic Brain Injury
A traumatic brain injury (TBI) is defined as an injury to the brain caused by an external force that results in damage to brain tissue. This can occur due to a forceful bump, blow, or jolt to the head or body, or from an object that penetrates the skull and enters the brain.[4.1] TBIs can lead to a range of functional impairments, affecting how a person thinks, understands, moves, communicates, and behaves.[2.1] The severity of a TBI can vary significantly; mild cases may result in temporary symptoms, while moderate to severe injuries can lead to long-term disabilities or even death.[4.1] In the United States and globally, TBIs are a major cause of disability and mortality, highlighting the importance of understanding their causes and effects.[3.1] Common causes of TBIs include accidents involving cars, motorcycles, and bicycles, as well as falls and sports-related injuries.[2.1] The symptoms of TBIs can manifest immediately or may develop over time, necessitating prompt medical evaluation to assess the extent of the injury and initiate appropriate treatment.[43.1]Types of Traumatic Brain Injury
Traumatic brain injury (TBI) is categorized based on the severity of the impact and the resulting damage to brain tissue. TBI can be classified as mild, moderate, or severe, with each category reflecting the intensity of the external forces that cause the injury and the subsequent effects on brain function.[20.1] The mechanisms of injury vary significantly depending on the severity; for instance, mild TBIs may result from a minor bump or jolt to the head, while severe TBIs often involve penetrating injuries or significant acceleration and deceleration forces, such as those experienced in motor vehicle accidents.[22.1] The severity of the injury influences not only the immediate effects but also the long-term consequences. Mild TBIs may lead to temporary symptoms, while moderate to severe TBIs can result in lasting impairments, including cognitive deficits, visual difficulties, and other neurological issues.[23.1] Research indicates that different types of acceleration and deceleration forces can cause axonal damage through distinct mechanisms, which further complicates the treatment and rehabilitation processes.[21.1] Understanding these differences is crucial for developing targeted interventions that address the specific needs of individuals based on the severity of their TBI.[19.1]History
Ancient Practices and Understanding
Ancient civilizations exhibited a remarkable understanding of traumatic brain injury (TBI) and developed surgical techniques that laid the groundwork for modern neurosurgery. One of the earliest known surgical procedures, trepanation, involved creating a hole in the skull, often performed with rudimentary tools such as obsidian blades and stone instruments. This practice was prevalent in various ancient cultures, including those of Egypt and the Inca, and was executed to alleviate pressure on the brain following head injuries, among other reasons.[83.1] The Edwin Smith Papyrus, dating back over three millennia, is recognized as the oldest written guideline for treating trauma, with a significant focus on brain injuries. This ancient text provides insights into the medical examination and treatment of head-injured patients in ancient Egypt, highlighting the sophistication of their medical practices.[85.1] The surgical techniques documented in this papyrus, along with the understanding that the brain was the center of consciousness, reflect a profound early recognition of the brain's importance in human health.[82.1] Despite the lack of modern anesthesia and antiseptics, ancient surgeons managed to perform these procedures with a surprising degree of success, avoiding the high rates of infection that later characterized trepanning attempts in Europe during the Middle Ages. The varied motivations for trepanation, ranging from medical to spiritual, underscore its significance as a milestone in the history of neurosurgery.[81.1] Thus, the practices and medical theories of ancient civilizations not only contributed to the understanding of traumatic brain injuries but also influenced contemporary approaches to diagnosing and treating such conditions.Evolution of Medical Knowledge
The understanding and treatment of traumatic brain injury (TBI) have evolved significantly over the centuries, marked by key milestones that reflect advancements in medical knowledge and practices. The earliest known documentation of brain injuries is found in the Edwin Smith Papyrus, dating back to 1600 B.C. in ancient Egypt. This document is recognized as the first medical treatise in history and includes descriptions of brain injuries and surgical practices such as trephination, highlighting the ancient Egyptians' early attempts to understand and treat head trauma.[51.1] As history progressed, particularly in the 20th century, significant advancements in the treatment of head injuries emerged, largely driven by the dramatic increase in TBI cases due to urbanization and the rise of motor vehicle traffic.[52.1] This era saw the development of innovative surgical techniques, including decompressive craniectomy, which involves the removal of a portion of the skull to alleviate intracranial pressure. This procedure has ancient roots but was systematically described in the context of TBI by Theodore Kocher in the 20th century, marking a pivotal moment in neurosurgery.[65.1] The military conflicts of the 20th century also catalyzed advancements in TBI management, as the need for effective treatment strategies for severe head injuries became paramount. The surgical management of TBI evolved significantly during this time, with contributions from military medicine that improved patient outcomes compared to earlier methods.[63.1] In recent years, the understanding of TBI has shifted towards a more comprehensive view, recognizing it as a condition influenced by a multitude of factors, including physical, psychological, and social elements. This bio-psycho-socio-ecological model emphasizes the complexity of TBI and the necessity for multifaceted treatment approaches.[61.1] Furthermore, ongoing research and updated clinical guidelines continue to refine best practices for managing mild traumatic brain injury (mTBI), commonly known as concussion, reflecting the dynamic nature of medical knowledge in this field.[59.1]Recent Advancements
Neurointensive Care Protocols
Neurointensive care protocols for traumatic brain injury (TBI) have evolved significantly to address the complexities associated with these injuries. A comprehensive approach to TBI rehabilitation considers not only the injury itself but also its impact on a child's development, education, and family dynamics. Programs designed for pediatric TBI rehabilitation often emphasize collaboration with schools and provide extensive family education and support, ensuring that recovery encompasses all aspects of a child's life.[118.1] Long-term care planning for individuals with TBI is a multifaceted process that necessitates a personalized and dynamic approach. This involves understanding the diverse pathways of recovery, embracing a full spectrum of available treatments and support systems, and engaging with a multidisciplinary team to optimize outcomes for patients.[119.1] Such comprehensive treatment plans integrate cognitive rehabilitation strategies with psychological support, which is crucial for effective recovery.[119.1] Institutions like UC Health, which hosts the only Level I Trauma Center in the region, exemplify the integration of cutting-edge treatment protocols for TBI. Their Neurotrauma team employs a research-driven approach that incorporates patient experiences, real-time research, and physician expertise to continuously enhance treatment methodologies. This comprehensive care spans from emergency interventions to long-term rehabilitation, ensuring that patients receive the most advanced and compassionate care available.[120.1] The nature of traumatic brain injury itself is often described as a "silent epidemic," highlighting its prevalence and the frequently invisible effects it has on individuals. TBI can result from various external forces, including blows to the head or sudden acceleration/deceleration, leading to significant disruptions in daily life and unique challenges for recovery.[121.1] Neuro-rehabilitation plays a pivotal role in addressing these challenges, offering structured approaches that help individuals regain independence and navigate the complexities associated with head injuries.[122.1]Novel Pharmacological Therapies
Recent advancements in the pharmacological treatment of traumatic brain injury (TBI) have focused on addressing secondary injury mechanisms that occur following the initial trauma. While little can be done to treat the mechanical damage from the primary insult, therapeutic interventions targeting secondary injury mechanisms such as inflammation, excitotoxicity, and oxidative stress have shown promise in improving outcomes for TBI patients.[111.1] Research has highlighted the role of neuroinflammation in the progression of TBI, indicating that acute neuroinflammatory responses can lead to chronic neurodegeneration and cognitive deficits.[123.1] Emerging studies suggest that targeting neuroinflammation may provide novel therapeutic avenues, as prolonged neuroinflammation has been associated with neurodegenerative processes that can be treated even long after the initial injury.[124.1] For instance, preclinical studies have demonstrated that anti-inflammatory agents can mitigate neuroinflammation and improve neurological recovery when administered after TBI.[126.1] Additionally, innovative pharmacological strategies are being explored to enhance recovery outcomes. For example, recent findings indicate that certain compounds can reduce neuroinflammation and arrest lesion expansion, thereby sparing white matter and decreasing neurodegeneration.[126.1] These advancements underscore the potential for developing targeted therapies that not only address immediate injury but also promote long-term recovery and cognitive function in individuals affected by TBI.[109.1]Pathophysiology
Primary and Secondary Injuries
Traumatic brain injury (TBI) is characterized by both primary and secondary injury mechanisms that significantly impact patient outcomes. Primary injuries occur at the moment of impact and involve immediate mechanical damage to brain tissue. This damage is largely irreversible and includes the disruption of neuronal structures and the initiation of a cascade of pathological processes. In contrast, secondary injuries develop in the hours and days following the initial trauma and are often more amenable to therapeutic intervention. These secondary mechanisms include excitotoxicity, inflammation, oxidative stress, and blood-brain barrier (BBB) breakdown, which can exacerbate neuronal injury and lead to further cell death.[164.1] Excitotoxicity, particularly mediated by excessive glutamate release, is a critical pathway that contributes to secondary neuronal injury by causing intracellular calcium overload.[163.1] Additionally, the neuroinflammatory response, particularly involving the NLRP3 inflammasome, plays a significant role in mediating these secondary injuries through complex activation pathways that involve calcium signaling and mitochondrial disturbances.[166.1] Research has indicated that targeting these secondary injury pathways may offer novel therapeutic strategies to mitigate the effects of TBI. For instance, therapeutic agents aimed at reducing neuroinflammation, addressing mitochondrial dysfunction, and preventing excitotoxicity have shown promise in clinical trials.[165.1] Furthermore, the heterogeneity of TBI injuries leads to variability in recovery trajectories, necessitating tailored rehabilitation programs that consider individual pathophysiological profiles.[168.1] Understanding these mechanisms is crucial for developing effective interventions that can improve outcomes for TBI patients.Mechanisms of Brain Damage
Traumatic brain injury (TBI) is characterized by both primary damage resulting from the physical disruption of neural and vascular structures and the subsequent emergence of secondary pathogenic events, which collectively contribute to neurological deficits.[141.1] The initial mechanical forces that cause TBI can lead to immediate neurological dysfunction, while the pathophysiological processes may evolve as an indirect response aimed at mitigating damage.[132.1] This secondary damage, which is often delayed and non-mechanical, is influenced by various factors, including changes in cerebral blood flow.[133.1] The management of TBI requires a comprehensive understanding of these mechanisms, as the primary insult cannot be therapeutically influenced. Therefore, treatment strategies focus on limiting secondary damage.[133.1] Surgical interventions play a critical role in this context, particularly in cases of traumatic intracranial hematomas, where timely surgical intervention can prevent irreversible brain injury or death due to hematoma expansion and increased intracranial pressure (ICP).[135.1] Early craniectomy, for instance, has been suggested to prevent further brain injury and reduce cerebral edema accumulation, although outcomes may vary depending on the severity of the initial damage.[137.1] Furthermore, the cellular and molecular responses to TBI involve the rapid release of damage-associated molecular patterns (DAMPs), which trigger resident cells to release cytokines and chemokines. This process recruits neutrophils that help limit the spread of injury and clear cellular debris.[148.1] Understanding these cellular responses is crucial for developing targeted therapies aimed at mitigating the effects of TBI.Diagnosis And Assessment
Clinical Evaluation Techniques
Clinical evaluation of traumatic brain injury (TBI) involves a systematic approach to assess the severity and implications of the injury. The initial assessment typically includes the use of the Glasgow Coma Scale (GCS), which evaluates a patient's ability to speak, open their eyes, and move, providing a quick measure of their neurological status.[188.1] This scale categorizes brain injury severity into mild, moderate, or severe, which is crucial for predicting the injury's impact on the individual.[187.1] In emergency settings, a CT scan is often performed to visualize potential fractures, bleeding, blood clots, and swelling in the brain, allowing for rapid diagnosis and intervention.[186.1] For mild TBIs, symptoms may include headaches, confusion, dizziness, and changes in behavior or mood, which can be assessed through clinical interviews and neurological examinations.[189.1] Following the acute phase, cognitive assessments become essential in both postacute and chronic stages. Tools such as the Mini Mental State Examination and specific tests like the Wisconsin Card Sorting Test and Trail Making Test are utilized to evaluate cognitive domains including attention, memory, and executive functions.[183.1] The Neuropsychological Assessment Battery (NAB) is also employed to provide a comprehensive evaluation of cognitive strengths and weaknesses, guiding rehabilitation strategies tailored to the patient's needs.[184.1]Imaging and Monitoring Technologies
Imaging technologies play a crucial role in the diagnosis and assessment of traumatic brain injury (TBI). Non-contrast computed tomography (CT) is the primary imaging modality used in the acute setting, providing essential diagnostic information for patients with TBI. A systematic approach to interpreting CT scans optimizes the detection of various pathologies, including air, fractures, hemorrhagic lesions, brain parenchymal injury, and abnormal cerebrospinal fluid spaces. It is recommended to review both bone and brain windows to enhance injury detection.[176.1] Indications for performing a CT scan in cases of suspected concussion include loss of consciousness, post-traumatic amnesia, persistent altered mental status, focal neurological deficits, signs of skull fractures, and evidence of clinical deterioration. It is common for patients to present with multiple injuries, such as cerebral contusions alongside subarachnoid, subdural, and extradural hemorrhages, as well as skull and facial fractures.[177.1] The Marshall classification, a CT scan-derived metric, is widely utilized to predict outcomes in TBI patients by grading the severity of injuries based on specific CT findings.[178.1] The initial CT scan is critical for identifying intra- or extra-axial lesions, which necessitate close observation and follow-up imaging. Studies indicate that approximately 25–45% of parenchymal contusions may increase in size, and 16% of diffuse injuries can show significant evolution with new mass lesions on subsequent scans. The progression of primary lesions typically occurs within the first 24 hours after the baseline CT.[190.1] CT is also vital for detecting secondary injuries, such as cerebral edema, ischemia, and herniation, with specific signs and symptoms indicating the need for further intervention.[190.1] While CT is favored for its speed and high sensitivity for significant injuries requiring immediate attention, magnetic resonance imaging (MRI) is beneficial for patients exhibiting neurological symptoms that are disproportionate to initial CT findings. MRI assists in detecting brain injuries that may not be visible on CT scans.[192.1] Overall, the integration of these imaging modalities is essential for effective patient management and prognosis in cases of traumatic brain injury.Treatment Approaches
Surgical Interventions
Surgical interventions play a critical role in the management of severe traumatic brain injury (TBI), particularly in cases where elevated intracranial pressure (ICP) poses a significant risk to patient outcomes. Decompressive craniectomy (DC) is one of the most common surgical techniques employed to alleviate elevated ICP and is considered a life-saving option for patients with severe TBI. This technique has evolved over centuries, with detailed descriptions provided by early surgeons such as Kocher.[226.1] In the context of surgical decision-making, several factors are considered to determine the necessity of intervention. These include the patient's age, neurological status, and specific clinical indicators such as motor posturing and systolic blood pressure.[227.1] For instance, patients over 40 years of age or those exhibiting severe neurological deficits may be prioritized for surgical intervention, especially if they present with a Glasgow Coma Scale (GCS) score of 6 or lower.[243.1] The urgency of surgical evacuation is underscored by the potential for rapid deterioration in these patients, which can significantly worsen their prognosis.[240.1] Research has indicated that early craniectomy can prevent further brain injury and reduce cerebral edema accumulation, although outcomes can vary based on the severity of the initial injury.[230.1] A multicenter randomized controlled trial, known as RESCUEicp, evaluated the outcomes of patients undergoing DC for traumatic intracranial hypertension, highlighting the importance of timely surgical intervention.[227.1] Furthermore, the TRACK-TBI study reported that a significant proportion of patients received surgical treatment within four hours of injury, aligning with current guidelines that recommend surgery within six hours.[229.1] In addition to craniectomy, other surgical techniques such as external ventricular drainage (EVD) are utilized to manage ICP in patients with severe TBI. EVD is particularly indicated for those with a GCS of 6 or lower during the initial hours post-injury, as it can help mitigate the risk of secondary brain injury.[243.1] However, the decision to employ EVD must be carefully weighed against potential risks, as its placement in patients with a higher GCS may lead to increased mortality rates.[227.1]Rehabilitation Strategies
Rehabilitation strategies for traumatic brain injury (TBI) have significantly evolved over the past two decades, reflecting advancements in medical science and a more comprehensive understanding of brain injury management. The rehabilitation process now often includes a multifaceted approach that encompasses cognitive, behavioral, sub-acute, and post-acute rehabilitation programs, which are widely accepted in clinical practice.[213.1] Current trends in TBI rehabilitation emphasize the importance of addressing various aspects of recovery, including consciousness, cognition, and psychological well-being. For instance, specialized rehabilitation has been shown to be effective for adults experiencing prolonged symptoms following mild TBI.[214.1] Cognitive rehabilitation therapy interventions aim to restore or compensate for memory deficits, employing techniques such as mnemonic strategies and visual imagery.[215.1] However, some studies indicate that traditional memory remediation treatments may not yield significant long-term improvements in cognitive function for TBI patients.[215.1] To assess the effectiveness of these rehabilitation strategies, various metrics and outcome measures are utilized. The TBI EDGE task force has reviewed numerous outcome measures, focusing on psychometrics and clinical utility to evaluate the progress of patients with TBI.[217.1] Additionally, the COMBI (Collaborative Outcome Measurement in Brain Injury) project has developed commonly used measures in brain injury rehabilitation, which are informed by a collaborative effort among multiple brain injury facilities.[216.1]In this section:
Long-Term Care And Outcomes
Rehabilitation Needs
Rehabilitation for individuals with traumatic brain injury (TBI) necessitates a comprehensive approach that addresses both physical and psychological needs. Psychological management is crucial from the onset of rehabilitation, as it forms an integral part of the rehabilitation needs assessment. This includes identifying risk factors in a patient's history that may influence their recovery, such as past psychological symptoms.[256.1] Assessment of psychological readiness is essential for engaging TBI patients in rehabilitation. Professionals utilize various psychological assessments to evaluate cognitive capabilities and develop tailored treatment plans aimed at alleviating symptoms and enhancing functionality.[254.1] Cognitive-behavioral therapy (CBT) is frequently employed as an effective intervention, focusing on challenging negative thought patterns and improving emotional well-being.[257.1] Other psychological interventions include psychoeducation, cognitive rehabilitation, and neuropsychological rehabilitation, which collectively aim to enhance mental health outcomes, quality of life, and daily functioning.[255.1] Long-term care models for TBI must be informed by a holistic understanding of chronic outcomes and the evolving care needs of patients. The United States Traumatic Brain Injury Model Systems of Care has been instrumental in following individuals with moderate-to-severe TBI for over 30 years, providing valuable insights into long-term rehabilitation needs and outcomes.[253.1] This longitudinal approach allows for the characterization of chronic care requirements and the development of predictive models that can guide future interventions.[252.1] Furthermore, the implementation of coordinated long-term care strategies is vital for promoting sustained health and well-being among TBI patients. Current public health policies must adapt to address the growing burden of TBI, particularly as the population ages and the incidence of severe TBI increases among older adults.[259.1] Effective policy changes should focus on enhancing access to comprehensive rehabilitation services and ensuring that care is tailored to the unique needs of this demographic.[260.1]Quality of Life Considerations
Quality of life (QoL) considerations following traumatic brain injury (TBI) are critical in understanding the long-term outcomes for survivors. The impact of TBI extends beyond the individual, affecting caregivers and society at large, highlighting the need for comprehensive care strategies that address both physical and psychological rehabilitation.[271.1] Early assessments of functional outcomes may not fully capture the long-term consequences of TBI, indicating that survivors often experience significant changes in their quality of life over time.[268.1] Successful cognitive and functional outcomes are contingent upon effective rehabilitation and longitudinal follow-up care after the initial stabilization of patients with severe TBI.[250.1] Rehabilitation pathways may vary widely, encompassing both inpatient and outpatient services tailored to the unique needs of each individual.[269.1] These services aim to address the multifaceted consequences of TBI, including physical, cognitive, emotional, and behavioral challenges.[269.1] Moreover, the expectation of long-term outcomes plays a crucial role in treatment decision-making for patients with severe TBI. However, there is a notable lack of conclusive data to guide these decisions, underscoring the necessity for further research in this area.[251.1] Surgical interventions, such as decompressive craniectomy and cranioplasty, are also pivotal in optimizing patient outcomes, with their effectiveness being assessed based on neurological and functional status, post-surgical complications, and mortality rates.[272.1]In this section:
Psychological AssessmentsNeuropsychological RehabilitationMental HealthQuality Of LifePublic Health
Public Health Implications
Epidemiology and Incidence
Traumatic brain injury (TBI) represents a significant public health issue, particularly in developed countries, where it is the leading cause of disability and mortality among young adults.[289.1] In the United States alone, approximately 1.7 million individuals sustain a TBI each year, resulting in an estimated 288,000 hospitalizations and over 56,000 deaths annually.[302.1] The burden of TBI extends beyond immediate physical injuries, as many survivors face long-term disabilities and psychological challenges, with around 5.3 million Americans living with TBI-related disabilities.[290.1] The epidemiological trends indicate a concerning increase in TBI-related emergency department visits, which have risen by 70% over the past decade, despite a decrease in mortality rates associated with TBI.[322.1] This discrepancy highlights the ongoing challenges in managing TBI and the need for effective public health interventions. The economic impact of TBI is substantial, with estimated costs of morbidity and mortality reaching $76.3 billion in 2010, encompassing both direct medical expenses and indirect costs such as lost productivity.[302.1] A public health approach to TBI emphasizes understanding the burden of the condition, identifying modifiable risk factors, and developing prevention strategies.[301.1] The Centers for Disease Control and Prevention (CDC) has focused on various prevention initiatives, including reducing sports-related concussions, preventing motor vehicle injuries, and addressing falls among older adults.[320.1] These efforts aim to mitigate the incidence of TBI and improve health outcomes for those affected by the condition.Prevention Strategies
Effective prevention strategies for traumatic brain injury (TBI) are essential for reducing the incidence and severity of this condition. One significant approach is the integration of psychological rehabilitation into standard neurorehabilitation programs. A recent study emphasizes that incorporating psychological support not only aids in the recovery of individuals with acquired brain injuries but also enhances interdisciplinary teamwork among healthcare professionals involved in the rehabilitation process.[299.1] This holistic approach can lead to improved outcomes by addressing both the cognitive and emotional needs of patients. Furthermore, research indicates that neuropsychological rehabilitation, which includes individualized cognitive and psychosocial therapies, is particularly beneficial. Such integrated rehabilitation strategies have been shown to produce the greatest overall improvements in activities of daily living (ADL) and community reintegration for patients with TBI.[300.1] By focusing on both cognitive deficits and psychosocial factors, these strategies can significantly enhance the quality of life for individuals recovering from traumatic brain injuries.In this section:
References
[2] Traumatic Brain Injury (TBI) | National Institute of Neurological ... — A traumatic brain injury (TBI) can be caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain. Some types of TBI can cause temporary or short-term problems with normal brain function, including problems with how the person thinks, understands, moves, communicates, and acts. More serious TBI can lead to severe and permanent disability, and even death. Other outcomes of TBI can be secondary, meaning they can occur gradually over the course of hours, days, or appear weeks later.
[3] Causes and effects of traumatic brain injury (TBI) - Medical News Today — Traumatic brain injury can happen when a sudden, violent blow or jolt to the head results in damage to the brain. In the United States and elsewhere, it is a major cause of disability and death.
[4] What causes traumatic brain injury (TBI)? - NICHD — A TBI is caused by an external force that injures the brain. It can occur when a person's head is hit, bumped, or jolted. It also can occur when an object, such as a bullet, pierces the skull or when the body is shaken or hit hard enough to cause the brain to slam into the skull.
[19] The neuropathology of traumatic brain injury - PMC - PubMed Central (PMC) — Severity of injury. Traumatic brain injury (TBI) occurs when a force transmitted to the head or body results in neuropathologic damage and dysfunction. ... These differences may based on hormonal differences, ... Gean AD, et al. Mechanisms of primary blast-induced traumatic brain injury: insights from shock-wave research. J Neurotrauma. 2011;28
[20] Traumatic brain injury: Mechanisms, manifestations, and visual sequelae ... — Traumatic brain injury (TBI) results when external physical forces impact the head with sufficient intensity to cause damage to the brain. TBI can be mild, moderate, or severe and may have long-term consequences including visual difficulties,
[21] Traumatic brain injuries - Nature Reviews Disease Primers — Whether different types of acceleration and deceleration forces cause axonal damage by different mechanisms is ... Stocchetti, N. & Bullock, R. Moderate and severe traumatic brain injury in adults
[22] Traumatic brain injury or traumatic brain disease: A scientific ... — Traumatic brain injury (TBI) is defined as damage to brain tissue caused by an external mechanical force to the head or face (bump, blow, jolt), a penetrating head injury by a projectile, a sudden acceleration and deceleration of motor vehicles during accidents, or propagation of supersonic blast waves, which leads to disruption of normal brain function , , , .
[23] What are the possible effects of traumatic brain injury (TBI)? — TBI can have a range of effects that depend on the type of injury, how severe the injury is, and what part of the brain is injured. 1 According to the Centers for Disease Control and Prevention, these health effects can sometimes remain for a long time or even be permanent. 2 Immediate Problems
[43] Symptoms of Mild TBI and Concussion | Traumatic Brain Injury ... — Seek immediate emergency medical care if you have any danger signs. Symptoms. Some mild TBI and concussion symptoms may appear right away, while others may not appear for hours or days after the injury. Symptoms generally improve over time, and most people with a mild TBI or concussion feel better within a couple of weeks. ... A traumatic brain
[51] PDF — American Journal of BioMedicine AJBM 2015; 3(7): 381- 409 doi:10.18081/2333-5106/015-07/381-409 Copyright © 2015 AJBM 384 The first written evidence of brain injuries is documented in Egypt in the Edwin Smith Papyrus, 3,000-2,500 years B.C. when the pyramids were built, being the first medical document recognized in the history of medicine (Fig. 3).
[52] The History of Brain Injuries - Intrepid Fallen Heroes Fund — Significant advances were made to head injury treatments in the 20th Century. Why? There were dramatic increases in head injuries. This was a result of growing urbanization and skyrocketing road traffic as cars became the dominant method of transportation. Recent numbers in the US show falls as the leading cause of traumatic brain injuries.
[59] ACS Releases Revised Best Practices Guidelines in Management of ... — The original Best Practices Guidelines in the Management of Traumatic Brain Injury were launched in 2015. The revised guidelines are available on the ACS website, offering a detailed framework for implementing these new best practices.
[61] Understanding Patients with Traumatic Brain Injury — Traumatic brain injury (TBI) needs to be viewed and managed as a condition, not a one-time event, and it needs to be viewed through a framework that considers multiple factors. The bio-psycho-socio-ecological model recognizes that injury and recovery are influenced by an interplay among many elements—physical and medical, psychological and behavioral, and social and economic, among others
[63] Severe Traumatic Brain Injury: Evolution and Current Surgical Management — Because many of the significant advances in surgery occur during wartime, this review focuses on contributions to the surgical management strategies for severe TBI made during military conflict. ... The approach to patients with severe penetrating or closed head traumatic brain injury (TBI) is guided by the certainty that, as time progresses
[65] The History of Decompressive Craniectomy in Traumatic Brain Injury — Abstract. Decompressive craniectomy consists of removal of piece of bone of the skull in order to reduce intracranial pressure. It is an age-old procedure, taking ancient roots from the Egyptians and Romans, passing through the experience of Berengario da Carpi, until Theodore Kocher, who was the first to systematically describe this procedure in traumatic brain injury (TBI).
[81] Trepanation: The Dawn of Neurosurgery in Ancient Civilizations — Trepanation: The Dawn of Neurosurgery in Ancient Civilizations Trepanation: The Dawn of Neurosurgery in Ancient Civilizations Long before the advent of anesthesia, antiseptics, or modern surgical tools, ancient civilizations practiced cranial surgery—particularly the procedure known as trepanation. This article explores trepanation in ancient cultures like those of Egypt, the Inca, and other early civilizations, shedding light on one of humanity's earliest known surgical techniques. The procedure appears to have been performed using rudimentary tools such as obsidian blades and other stone instruments, yet these ancient surgeons managed to avoid the high rates of infection that plagued later trepanning attempts in Europe during the Middle Ages. The Techniques and Tools of Ancient Trepanation While the reasons for trepanation in ancient times may have varied from medical to spiritual, the procedure stands as a significant milestone in the history of neurosurgery.
[82] History of Neurotrauma in Ancient Greece - PMC — A fascinating trait of ancient Greek civilization is that they might be one of the first civilizations to recognize the brain as the center of consciousness or spirit (psyche). ... and head injuries, associated with bone contusion, referencing and describing the surgical technique . ... Bertullo G. History of Traumatic Brain Injury (TBI
[83] Ancient Legacy of Cranial Surgery - PMC - PubMed Central (PMC) — The history of brain surgery dating to the Neolithic Age was often accompanied with trepanation. Trepanation is defined as a procedure in which a hole is created through the skull, sometimes with a stone tool. ... They did so to alleviate pressure on the brain following an injury to the head, ... Pursuing the surgical teachings and techniques
[85] Traumatic brain injuries in the ancient Egypt: insights from the Edwin ... — Background: Traumatic brain injury (TBI) is probably as old as human beings. The Edwin Smith Papyrus is the first treatise describing the treatment of patients with TBI and allows insights into the medical examination and treatment of head-injured patients in ancient Egypt.
[109] 5 New Treatments for Traumatic Brain Injury: Hope for Recovery — Traumatic brain injury (TBI) affects millions of individuals annually, leading to significant challenges for both patients and their families. Recent advancements in medical research have introduced new treatments for traumatic brain injury, offering renewed hope for improved recovery outcomes. This article explores five emerging therapies
[111] Revisiting Traumatic Brain Injury: From Molecular Mechanisms to ... — Little can be done to treat the mechanical damage that occurs during the primary insult of a TBI; however, secondary injury mechanisms, such as inflammation, blood-brain barrier (BBB) breakdown, edema formation, excitotoxicity, oxidative stress, and cell death, can be targeted by therapeutic interventions. 387.Maas A.I.R., Menon D.K., Lingsma H.F., Pineda J.A., Sandel M.E., Manley G.T. Re-Orientation of Clinical Research in Traumatic Brain Injury: Report of an International Workshop on Comparative Effectiveness Research. 388.High W.M., Jr., Briones-Galang M., Clark J.A., Gilkison C., Mossberg K.A., Zgaljardic D.J., Masel B.E., Urban R.J. Effect of growth hormone replacement therapy on cognition after traumatic brain injury. 392.Sabirzhanov B., Stoica B.A., Zhao Z., Loane D.J., Wu J., Dorsey S.G., Faden A.I. miR-711 upregulation induces neuronal cell death after traumatic brain injury.
[118] Comprehensive Traumatic Brain Injury Programs: Care and Recovery — Pediatric Traumatic Brain Injury Rehabilitation: Comprehensive Approaches for Recovery takes into account not just the injury itself, but how it impacts a child's development, education, and family dynamics. These programs often involve close collaboration with schools and a heavy emphasis on family education and support.
[119] How to Plan for Long-Term Care Needs After a TBI — Planning for long-term care after a traumatic brain injury is a multifaceted process that requires a personalized, comprehensive, and dynamic approach. By understanding the diverse pathways, embracing the full spectrum of available treatments and support systems, and engaging with a multidisciplinary team, individuals with TBI and their
[120] Traumatic Brain Injury Treatment Guide - UC Health — At UC Health, home to the only Level I Trauma Center in the region, our dedicated Neurotrauma team provides cutting-edge traumatic brain injury treatment for patients at all stages of recovery. UC Health’s Learning Health System integrates patient experiences, real-time research, and physician expertise to continuously improve traumatic brain injury treatment. At UC Health, we take a research-driven approach to traumatic brain injury treatment. At UC Health, we offer a full spectrum of traumatic brain injury treatment, from emergency care to long-term brain injury rehabilitation. Why Choose UC Health for Traumatic Brain Injury Treatment? UC Health’s Neurotrauma team is dedicated to providing the most advanced, research-driven, and compassionate traumatic brain injury treatment available.
[121] Comprehensive Traumatic Brain Injury Treatment and Recovery — Traumatic brain injury is a complex beast, often described as a "silent epidemic" due to its prevalence and the often-invisible nature of its effects. But what exactly constitutes a TBI? At its core, it's an injury to the brain caused by an external force, whether that's a blow to the head, a sudden acceleration or deceleration, or an
[122] Head Injuries and Neuro Rehabilitation: Recovery and Treatment Options ... — Whether caused by a sports-related accident, a fall, or a more severe traumatic brain injury (TBI), these incidents often disrupt daily life and present unique challenges. Neuro-rehabilitation plays a pivotal role in helping individuals recover and regain independence, offering a structured approach to address the complexities of head injury
[123] Chronic traumatic brain injury induces neurodegeneration ... - PubMed — Traumatic brain injury (TBI) can lead to chronic neuroinflammation, and neurodegeneration associated with long-term cognitive deficits. Following TBI, the acute neuroinflammatory response involves microglial activation and the release of proinflammatory cytokines and chemokines which induce the recruitment of peripheral immune cells such as monocytes and ultimately T cells.
[124] Current understanding of neuroinflammation after traumatic brain injury ... — Traumatic brain injury (TBI) remains a major cause of death and disability worldwide. ... emerging preclinical studies indicate that posttraumatic prolonged and progressive neuroinflammation is associated with neurodegeneration which may be treatable long after the initiating brain injury. This review provides an overview of recent
[126] Neuroinflammation in the Evolution of Secondary Injury, Repair, and ... — Mice given CHPG at 1 month after focal brain injury had improved neurological recovery, decreased neuroinflammation, arrested lesion expansion, sparing of white matter, and reduced neurodegeneration at 4 months. 201 Similarly, although with a more generalized anti-inflammatory approach, administration of the phosphodiesterase inhibitor
[132] Pathophysiology of Traumatic Brain Injury | SpringerLink — Traumatic brain injury (TBI) is initiated by mechanical forces to the head that disrupt neurological function. Pathophysiology may begin immediately with the mechanical forces or evolve as an indirect response in an attempt to alleviate damage. ... Despite decades of research on the topic of pathophysiology of TBI, many mechanisms remain poorly
[133] Pathophysiology of traumatic brain injury - British Journal of Anaesthesia — The knowledge of the pathophysiology after traumatic head injury is necessary for adequate and patient-oriented treatment. As the primary insult, which represents the direct mechanical damage, cannot be therapeutically influenced, target of the treatment is the limitation of the secondary damage (delayed non-mechanical damage). It is influenced by changes in cerebral blood flow (hypo- and
[135] The Role of Surgical Intervention in Traumatic Brain Injury — The role of surgery in traumatic intracranial hematomas is to prevent irreversible brain injury or death caused by hematoma expansion, increased ICP, and herniation of the brain. 28-30 An initial assessment of neurologic deficits, pupil abnormalities, degree of midline shift, hematoma volume, and the presence/severity of associated trauma are
[137] Neuroprotection: Surgical approaches in traumatic brain injury — This review is centered on the pivotal role of surgical interventions within the comprehensive management of traumatic brain injury (TBI). The following are the inclusion and exclusion criteria established for article selection: we included articles that directly address surgical neuroprotection strategies in the context of TBI and that focus on the prevention, reduction, or mitigation of brain injury after a TBI event. According to some authors, early craniectomy can prevent later brain injury and markedly decrease cerebral edema accumulation. Others, however, obtained different results. The various outcomes might be related to TBI models’ diverse damage severity since the severity of the original damage has a strong correlation with the results of craniectomy. More research is needed to determine which types of TBI are suited for DC and which physiological and pathological pathways are associated with functional results following DC in TBI patients.
[141] Understanding Pathophysiological Changes - Nutrition and Traumatic ... — Traumatic brain injury (TBI) is characterized by both the primary damage resulting from physical disruption of neural and vascular structures and the early emergence of secondary pathogenic events, which collectively contribute to neurologic deficits (Andriessen et al., 2010; Dash et al., 2010; Marklund et al., 2006). The identification of nutrients, dietary supplements, or specific diets that
[148] Cellular infiltration in traumatic brain injury | Journal of ... — Traumatic brain injury leads to cellular damage which in turn results in the rapid release of damage-associated molecular patterns (DAMPs) that prompt resident cells to release cytokines and chemokines. These in turn rapidly recruit neutrophils, which assist in limiting the spread of injury and removing cellular debris. Microglia continuously survey the CNS (central nervous system) compartment
[163] Cellular and Molecular Mechanisms of Secondary Neuronal Injury ... — Excitotoxicity—the cascade of intracellular events initiated by excessive stimulation by neurotransmitters leading to intracellular calcium overload—is hypothesized to play an important role in mediating secondary neuronal injury after traumatic brain injury (TBI). While a variety of neurotransmitters could potentially trigger excitotoxic cell injury, glutamate is thought to be the primary
[164] Revisiting Traumatic Brain Injury: From Molecular Mechanisms to ... — Little can be done to treat the mechanical damage that occurs during the primary insult of a TBI; however, secondary injury mechanisms, such as inflammation, blood-brain barrier (BBB) breakdown, edema formation, excitotoxicity, oxidative stress, and cell death, can be targeted by therapeutic interventions. 387.Maas A.I.R., Menon D.K., Lingsma H.F., Pineda J.A., Sandel M.E., Manley G.T. Re-Orientation of Clinical Research in Traumatic Brain Injury: Report of an International Workshop on Comparative Effectiveness Research. 388.High W.M., Jr., Briones-Galang M., Clark J.A., Gilkison C., Mossberg K.A., Zgaljardic D.J., Masel B.E., Urban R.J. Effect of growth hormone replacement therapy on cognition after traumatic brain injury. 392.Sabirzhanov B., Stoica B.A., Zhao Z., Loane D.J., Wu J., Dorsey S.G., Faden A.I. miR-711 upregulation induces neuronal cell death after traumatic brain injury.
[165] Traumatic brain injury and molecular biology: A new narrative — Preclinical and clinical trials are investigating the role of various TBI diagnostic markers like S100β, glial fibrillary acidic protein, and ubiquitin carboxy-terminal hydrolase L1. Therapeutic agents targeting neuroinflammation, mitochondrial dysfunction, and excitotoxicity show promise in treating traumatic brain injury complications.
[166] Combination therapies and other therapeutic approaches targeting the ... — Objectives: Traumatic brain injury (TBI) precipitates a neuroinflammatory cascade, with the NLRP3 inflammasome emerging as a critical mediator. This review scrutinizes the complex activation pathways of the NLRP3 inflammasome by underscoring the intricate interplay between calcium signaling, mitochondrial disturbances, redox imbalances, lysosomal integrity, and autophagy. It is hypothesized
[168] Understanding individual variability in symptoms and recovery following ... — The pathophysiology associated with mild traumatic brain injury (mTBI) includes neurometabolic and cytoskeletal changes that have been shown to impair structural and functional connectivity. ... Understanding individual variability in symptoms and recovery following mTBI: A role for TMS-EEG? Neurosci Biobehav Rev. 2018 Sep:92:140-149. doi
[176] Head computed tomography interpretation in trauma: a primer — Abstract Noncontrast computed tomography (CT) provides important diagnostic information for patients with traumatic brain injury. A systematic approach to image interpretation optimizes detection of pathologic air, fractures, hemorrhagic lesions, brain parenchymal injury, and abnormal cerebrospinal fluid spaces. Bone and brain windows should be reviewed to enhance injury detection. Findings of
[177] Traumatic brain injury | Radiology Reference Article - Radiopaedia.org — Traumatic brain injury | Radiology Reference Article | Radiopaedia.org Potential indications for performing CT in the acute setting for patients with concussion (to exclude more serious forms of traumatic brain injury such as intracranial hemorrhage) may include the following: loss of consciousness, post-traumatic amnesia, persistent altered mental status, focal neurology, signs of skull fractures or evidence of clinical deterioration 8. It is common for multiple injuries to be present simultaneously, such as the combination of cerebral contusions and traumatic subarachnoid, subdural and extradural hemorrhage as well as skull fractures and facial fractures (discussed separately). {"current_user":null,"inclusions":[{"imageId":12495595,"studyId":38230,"caseSlug":"multiple-cerebral-contusions-and-temporal-bone-fracture","caption":"Case 1","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/12495595/5c1d20517e3100ddcbe399ba1e7ace_big_gallery.jpg"},{"imageId":14950044,"studyId":40865,"caseSlug":"traumatic-intracranial-haemorrhage-with-intracranial-pressure-monitor","caption":"Case 2","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/14950044/a70bf185b6f626edfa7483ae1f0790_big_gallery.jpeg"},{"imageId":1288285,"studyId":14430,"caseSlug":"fatal-gunshot-wound-to-the-head","caption":"Case 3: gun shot injury","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/1288285/9db6488caa5eab62fc7b2832b129de_big_gallery.jpg"},{"imageId":14950665,"studyId":40865,"caseSlug":"traumatic-intracranial-haemorrhage-with-intracranial-pressure-monitor","caption":"Case 4: with ICP monitor","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/14950665/f0f713022ff124d428631034e4a108_big_gallery.jpeg"},{"imageId":21798915,"studyId":48452,"caseSlug":"diffuse-axonal-injury-grade-2-1","caption":"Case 5: diffuse axonal injury","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/21798915/a401f358b9b5c8d344a7f91694b2a5_big_gallery.jpeg"},{"imageId":23874681,"studyId":50784,"caseSlug":"penetrating-head-injury-1","caption":"Case 6: penetrating head injury (stabbing)","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/23874681/c554bdfcef71a5be19b3453f2beb03_big_gallery.jpeg"},{"imageId":52175425,"studyId":86067,"caseSlug":"chronic-penetrating-traumatic-brain-injury-intracranial-bullet","caption":"Case 7: intracranial bullet","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/52175425/36885eff3b86650fd1b8b4fdc2d2cf_big_gallery.jpeg"},{"imageId":54995086,"studyId":106280,"caseSlug":"non-penetrating-brain-trauma-due-to-plastic-bullet","caption":"Case 8: non penetrating due to plastic bullet","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/54995086/IM-0001-0033_big_gallery.jpeg"},{"imageId":53174160,"studyId":93722,"caseSlug":"cerebral-abscess-due-to-foreign-bodies","caption":"Case 9: with cerebral abscess ","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/53174160/bbe2f5f44fc5e5aa33615a2016711a_big_gallery.jpeg"},{"imageId":69373239,"studyId":159714,"caseSlug":"traumatic-brain-injury-8","caption":"Case 10","isStack":true,"diagnosticCertainty":"confirmed_substantiated","thumbnail":"https://prod-images-static.radiopaedia.org/images/69373239/0f7c761854b2170824142b70dfe469f94bce8c1e6ec90d254ed2ad3c459fa9d8_big_gallery.jpeg"}],"ddx_inclusions":[],"lang":"us"}
[178] Marshall classification of traumatic brain injury — The Marshall classification of traumatic brain injury is a CT scan-derived metric using only a few features and has been shown to predict outcomes in patients with traumatic brain injury (TBI). Usage. This system was first published in 1992 1, building on findings from a large cohort of head injury cases described in 1990 2, and is in common use (c. 2024 7) for grading acute TBI based on CT
[183] Cognitive Rehabilitation for Adults with a History of Traumatic Brain ... — Cognitive rehabilitation following traumatic brain injury (TBI) involves a targeted, individualized approach to address deficits in attention, memory, executive functions, and/or other cognitive domains. This overview highlights the importance of thorough assessment to inform cognitive rehabilitation, a multidimensional approach, and current best practices in intervention strategies. It
[184] Cognitive rehabilitation following traumatic brain injury: assessment ... — Cognitive rehabilitation following traumatic brain injury: assessment to treatment - PubMed Cognitive rehabilitation following traumatic brain injury: assessment to treatment Cognitive rehabilitation following traumatic brain injury: assessment to treatment Cognitive rehabilitation begins with a thorough neuropsychological assessment to identify cognitive strengths and weaknesses and the degree of change in cognitive ability following a brain injury. Is there a trade-off between cognitive and motor recovery after traumatic brain injury due to competition for limited neural resources? Efficacy of traumatic brain injury rehabilitation: interventions of QEEG-guided biofeedback, computers, strategies, and medications. Cognitive rehabilitation for military personnel with mild traumatic brain injury and chronic post-concussional disorder: Results of April 2009 consensus conference. Randomised controlled clinical trial of a structured cognitive rehabilitation in patients with attention deficit following mild traumatic brain injury: study protocol.
[186] Traumatic brain injury - Diagnosis & treatment - Mayo Clinic — In the case of more-severe traumatic brain injuries (TBIs), consequences can worsen rapidly without treatment. Doctors or first responders need to assess the situation quickly. This test is usually the first performed in an emergency room for a suspected traumatic brain injury. A CT scan can quickly visualize fractures and uncover evidence of bleeding in the brain (hemorrhage), blood clots (hematomas), bruised brain tissue (contusions), and brain tissue swelling. Mild injury Mild traumatic brain injuries usually require no treatment other than rest and over-the-counter pain relievers to treat a headache.
[187] Brain Injury Severity - Brain Injury Association of America — Brain injury severity is the primary factor in predicting the injury's impact on an individual. A brain injury can be classified as mild, moderate or severe. ... Signs of brain trauma; Contusions or bleeding; Signs of injury on neuroimaging; Unconsciousness exceeding 24 hours (coma) ... Brain Injury Diagnosis Next. Brain Injury Assessments
[188] How do healthcare providers diagnose traumatic brain injury (TBI ... — The GCS gives healthcare providers a way to measure a person's functioning in three key areas: Ability to speak, such as whether the person speaks normally, speaks in a way that doesn't make sense, or cannot speak at all Ability to open eyes, including whether the person opens his or her eyes only when asked Ability to move, ranging from moving one's arms easily and on purpose to not
[189] Symptoms (and Signs) of Concussion or Traumatic Brain Injury — A person with a mild concussion or traumatic brain injury may experience: Headache Confusion Lightheadedness Dizziness Blurred vision Ringing in the ears Tiredness or sleepiness A bad taste in the mouth A change in sleep habits Behavior or mood changes Trouble with memory, concentration, attention, or thinking Loss of consciousness lasting a few seconds to minutes Sensitivity to light or sound
[190] MDCT imaging of traumatic brain injury - PMC - PubMed Central (PMC) — Therefore, the presence of intra- or extra-axial lesions on the initial CT scan warrants close observation and imaging follow-up.13 Approximately 25–45% of parenchymal contusions increase in size and 16% of diffuse injuries demonstrate significant evolution with evidence of new mass lesions on subsequent CT (Figure 1).14,15 Progression of primary lesions typically occurs within the first 24 h after the baseline CT.16 CT is also essential in detecting secondary injuries, such as cerebral oedema, ischaemia and herniation.17,18 Signs and symptoms include arterial haemorrhage, cervical bruits, expanding neck haematomas, focal neurological deficits, major discrepancies between neurological and imaging findings, and ischaemic stroke on follow-up CT.35–37 Risk factors considered as predictors of BCVI include cervical spine fractures, mid-face Lefort II and III fractures, DAI with a GCS score of <6, skull base fractures with involvement of the carotid canal, and near hanging with anoxic brain injury.
[192] Neuroimaging Update on Traumatic Brain Injury - Diseases of the Brain ... — MRI is useful in patients who suffer from neurologic symptoms out of proportion to initial CT imaging findings and to assist in the detection of brain injuries below the sensitivity of CT. Benefits of CT over other imaging modalities include speed, availability, and high sensitivity for significant injuries requiring immediate intervention or close observation such as intracranial hemorrhage, infarction, herniation, cerebral edema, and skull fracture . Following a fall from a ladder, a non-contrast CT scan was performed in the emergency department that demonstrates multicompartmental post-traumatic intracranial hemorrhage including a subdural hematoma, SAH, and a small contusion (left image, arrows) (more...) Correlation between the skull base fracture and the incidence of intracranial hemorrhage in patients with traumatic brain injury.
[213] The effectiveness of traumatic brain injury rehabilitation: a review — The rehabilitation of traumatic brain injury (TBI) has undergone tremendous development over the past 20 years. A much more aggressive, extended and comprehensive approach is now common and clinically accepted. Multiple new forms and sites of treatment are utilized such as cognitive, behavioural, sub-acute and post-acute rehabilitation programmes.
[214] Effectiveness of specialized rehabilitation after mild traumatic brain ... — Objective: To determine the effectiveness of specialized rehabilitation in adults with prolonged symptoms, or risk of prolonged symptoms, following mild traumatic brain injury. Data sources: Randomized controlled trials or non-randomized controlled studies published between 1 Jan 2000 and 10 Mar 2019 in Cochrane Controlled Register of Trials, PubMed, EMBASE, CINAHL or PsycINFO.
[215] Cognitive Impairment and Rehabilitation Strategies After Traumatic ... — Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury - PMC Cognitive rehabilitation therapy interventions aim either to restore or compensate the memory deficits. Restorative approaches for memory intervention include the word list, paragraph listening, visual imagery, and mnemonic strategies. Cappa et al. and Cicerone et al. in their review, reported that memory remediation treatments like memory drills, computer-assisted cognitive rehabilitation are not much helpful for TBI persons for long-term memory. In contrast, Zafonte et al. did not find in any significant improvement in cognition and functional status even after 90 days trial of citicholine in traumatic brain injured persons. The effect of internet-based cognitive rehabilitation in persons with memory impairments after severe traumatic brain injury.
[216] Traumatic Brain Injury Outcome Measures Overview — The measures included in the COMBI are commonly used in the field of brain injury rehabilitation and assessment. The COMBI is a collaborative project of 16 brain injury facilities or centers, most of them Traumatic Brain Injury Model Systems, through grants funded by the National Institute on Disability and Rehabilitation Research.
[217] PDF — The TBI EDGE task force reviewed 88 outcome measures covering the domains of body structure and function, activitiesnd participation evaluating each for psychometrics and clinical utility for patients with traumatic brain injury. Through iterature review, analysis, and a modified Delphi procedure, recommendations were formulated for outcome
[226] Decompressive Craniectomy in Severe Traumatic Brain Injury: The ... — Introduction: Traumatic brain injury (TBI) represents a severe pathology with important social and economic concerns, decompressive craniectomy (DC) represents a life-saving surgical option to treat elevated intracranial hypertension (ICP). ... (DC) is a surgical technique developed over the centuries, and Kocher described it in detail more
[227] Surgical interventions for severe traumatic brain injury - Fong ... — Surgical interventions for severe traumatic brain injury - Fong - Journal of Emergency and Critical Care Medicine It is also indicated for severe TBI with a normal CTH scan with two or more of the following criteria: age >40 years, motor posturing, or SBP <90 mmHg. For severe TBI, the TBF also report Level III recommendations for EVD, used as a CSF draining device, to help manage ICPs in patient who have a GCS ≤6 during the initial 12 hours after injury (as EVD placement in patients with a GCS >6 may increase mortality rates). The trial of DC for traumatic intracranial hypertension (RESCUEicp) is another large multicenter randomized controlled trial, which evaluated the 6-month outcomes data of 398 severe TBI patients after medical management vs.
[229] A Snapshot of Surgical Care for Traumatic Brain Injury in the U.S. — A recent analysis led by researchers at UC San Francisco, the University of Washington, and other U.S. institutions offers the first comprehensive report on the contemporary neurosurgical practice for patients hospitalized with traumatic brain injury (TBI). Using the TBI Common Data Elements standards outlined by the National Institute of Neurological Disorders and Stroke, the results summarize the clinical profile of surgical patients in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. In accordance with the current guidelines recommending surgery within six hours from time of injury, 71 percent of patients in the TRACK-TBI surgical cohort received surgery within four hours. Clinical profile of patients with acute traumatic brain injury undergoing cranial surgery in the United States: report from the 18-centre TRACK-TBI cohort study.
[230] Neuroprotection: Surgical approaches in traumatic brain injury — This review is centered on the pivotal role of surgical interventions within the comprehensive management of traumatic brain injury (TBI). The following are the inclusion and exclusion criteria established for article selection: we included articles that directly address surgical neuroprotection strategies in the context of TBI and that focus on the prevention, reduction, or mitigation of brain injury after a TBI event. According to some authors, early craniectomy can prevent later brain injury and markedly decrease cerebral edema accumulation. Others, however, obtained different results. The various outcomes might be related to TBI models’ diverse damage severity since the severity of the original damage has a strong correlation with the results of craniectomy. More research is needed to determine which types of TBI are suited for DC and which physiological and pathological pathways are associated with functional results following DC in TBI patients.
[240] Guidelines for the Surgical Management of TBI — In patients with indications for surgical intervention, evacuation should be performed as soon as possible because these patients can deteriorate rapidly, thus, worsening their prognosis. Methods Suboccipital craniectomy is the predominant method reported for evacuation of posterior fossa mass lesions, and is therefore recommended.
[243] Surgical interventions for severe traumatic brain injury - Fong ... — Surgical interventions for severe traumatic brain injury - Fong - Journal of Emergency and Critical Care Medicine It is also indicated for severe TBI with a normal CTH scan with two or more of the following criteria: age >40 years, motor posturing, or SBP <90 mmHg. For severe TBI, the TBF also report Level III recommendations for EVD, used as a CSF draining device, to help manage ICPs in patient who have a GCS ≤6 during the initial 12 hours after injury (as EVD placement in patients with a GCS >6 may increase mortality rates). The trial of DC for traumatic intracranial hypertension (RESCUEicp) is another large multicenter randomized controlled trial, which evaluated the 6-month outcomes data of 398 severe TBI patients after medical management vs.
[250] 6 Rehabilitation and Long-Term Care Needs After Traumatic Brain Injury ... — Once acute interventions have stabilized the condition of a person experiencing traumatic brain injury (TBI) (see Chapter 5), the need for rehabilitation and follow-up services becomes paramount.This chapter begins by identifying target outcomes for people with TBI as they move to post-acute care, rehabilitation, and recovery or long-term care.
[251] Long-term outcome after severe traumatic brain injury: a systematic ... — Background Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI. Methods A systematic search was conducted using PubMed
[252] Predictive Modeling of Long-Term Care Needs in Traumatic Brain Injury ... — Background: Traumatic brain injury (TBI) research often focuses on mortality rates or functional recovery, yet the critical need for long-term care among patients dependent on institutional or Respiratory Care Ward (RCW) support remains underexplored. This study aims to address this gap by employing machine learning techniques to develop and validate predictive models that analyze the
[253] Traumatic brain injury as a chronic disease: insights from the United ... — Chronic brain injury care models must be informed by a holistic understanding of long-term outcomes and the factors that can affect how care needs evolve over time. The United States Traumatic Brain Injury Model Systems of Care follows up individuals with moderate-to-severe TBI for over 30 years, allowing characterisation of the chronic (2-30
[254] Psychological Assessment After a Traumatic Brain Injury — Undergoing a psychological assessment is essential for individuals suspected of having a TBI. Professionals can test a person's cognitive capabilities and devise a treatment plan to help with symptoms and functionality. ... Rehabilitation employs the body's natural healing abilities and the brain's relearning processes so a person can
[255] Psychological Intervention in Traumatic Brain Injury Patients — Type of psychological interventions Cognitive behavioural therapy (CBT) (n = 26) [44–69] Psychoeducation (n = 16) [18–22, 24–26, 53, 70–76] Cognitive rehabilitation (n = 9) [23, 27, 36, 56, 77–81] Neuropsychological rehabilitation (n = 3) Other (e.g., dialectical behaviour therapy, mindfulness therapy, energy therapy, acceptance and commitment therapy, compassion-focused therapy, and positive psychology) (n = 9) [7, 28, 34, 84–89]Main outcome measures Mental clinical profile, dysfunctional behaviour, anger, aggressiveness (n = 20) [20, 21, 26, 28, 34, 49, 51, 53, 54, 56, 57, 63, 71–74, 83, 84, 89, 90] Quality of life, life satisfaction, hope, psychological distress (n = 19) [21, 27, 28, 47, 52, 57, 58, 60, 64, 65, 68, 72–74, 76, 80, 86–88] Depression, anxiety (n = 15) [7, 20, 46, 50, 54, 55, 58–60, 62, 65, 68, 69, 77, 81] Daily living, self-care, autonomy, return to work (n = 15) [7, 21, 23–26, 55, 57, 70, 72, 76, 77, 80, 81, 89] Cognitive deficits (e.g., attention, memory, emotion regulation, executive function) (n = 15) [27, 34, 36, 45, 56, 57, 67, 69, 72, 73, 78–82] Postconcussive symptoms (n = 10) PTSD (n = 8)
[256] Psychological and psychosocial interventions for people with complex ... — Psychological management should be included from the start of a person's rehabilitation journey, forming part of the rehabilitation needs assessment. The committee wanted to highlight the risk factors that may be present in a patient's history or background, including past and current psychological symptoms beyond what is expected from an
[257] Cognitive Behavioral Therapy after Traumatic Brain Injury — Mental health is affected when there is a brain injury. Treatments for the physical symptoms of traumatic brain injury (TBI) are critical, but so is the emotional component. Cognitive-behavioral therapy (CBT) is a popular treatment for these patients at the best brain injury rehabilitation centers. CBT focuses on challenging and…
[259] Long-Term Outcomes after Severe Traumatic Brain Injury in ... - PubMed — Rationale: Older adults (≥65 yr old) account for an increasing proportion of patients with severe traumatic brain injury (TBI), yet clinical trials and outcome studies contain relatively few of these patients.Objectives: To determine functional status 6 months after severe TBI in older adults, changes in this status over 2 years, and outcome covariates.
[260] American Health Care Association Releases 2025 Policy Priorities For A ... — Washington, D.C. - The American Health Care Association (AHCA) today unveiled its 2025 policy priorities, "The Better Way," encouraging the Trump Administration and Congress to work with nursing homes to protect access to care and prepare for a growing elderly population. With more Americans living longer and requiring long term care (LTC), AHCA is advocating for bold solutions that ensure
[268] Long-Term Functional Outcome and Quality of Life in Long-Term Traumatic ... — Abstract Early functional outcome assessments of traumatic brain injury (TBI) survivors may underestimate the long-term consequences of TBI. We assessed long-term temporal changes in functional outcome and quality of life in intensive care unit-managed long-term TBI survivors.
[269] 6 Rehabilitation and Long-Term Care Needs After Traumatic Brain Injury ... — 6 Rehabilitation and Long-Term Care Needs After Traumatic Brain Injury Chapter Highlights People who experience traumatic brain injury (TBI) may follow multiple care pathways and receive multiple types of interventions to assist them in recovering from the physical, cognitive, emotional, and behavioral consequences of their injuries. Care options include inpatient and/or outpatient
[271] Long-term outcome after severe traumatic brain injury - PMC — Introduction Traumatic brain injury is a major public health issue, which results in significant mortality and long-term disability [ 1, 2 ]. The profound impact of TBI is not only felt by the individuals who suffer the injury but also their caregivers and society as a whole. In this study we observed the long-term outcome of patients with severe traumatic brain injury admitted to our
[272] Navigating the Role of Surgery in Optimizing Patient Outcomes in ... — Navigating the Role of Surgery in Optimizing Patient Outcomes in Traumatic Brain Injuries (TBIs): A Comprehensive Review - PMC Navigating the Role of Surgery in Optimizing Patient Outcomes in Traumatic Brain Injuries (TBIs): A Comprehensive Review In this review, we have summarized the indications and patient outcomes based on neurological and functional status, post-surgical complications, and mortality rates for various life-saving interventional procedures including surgery for brain contusions, intracranial hematomas and penetrating injuries, and craniectomy and ventriculostomy for elevated intracranial pressure and hydrocephalus. 75.Management of severe traumatic brain injury by decompressive craniectomy. 107.Early versus delayed cranioplasty after decompressive craniectomy in traumatic brain injury: a multicenter observational study within CENTER-TBI and Net-QuRe. Vreeburg RJ, Singh RD, van Erp IA, et al.
[289] Traumatic Brain Injury as a Public Health Issue: Epidemiology ... — Traumatic Brain Injury as a Public Health Issue: Epidemiology, Prognostic Factors and Useful Data from Forensic Practice - PMC Traumatic brain injury (TBI) is a major public health concern, ranking as the leading cause of disability and mortality among young adults in developed countries . 126.Rosenfeld J.V., Maas A.I., Bragge P., Morganti-Kossmann M.C., Manley G.T., Gruen R.L. Early Management of Severe Traumatic Brain Injury. 131.Ashley M.J., Schultz J.D., Bryan V.L., Krych D.K., Hayes D.R. Justification of Post-Traumatic Brain Injury Rehabilitation Using Net Present Value Techniques: A Case Study. 132.Rockhill C.M., Fann J.R., Fan M.-Y., Hollingworth W., Katon W.J. Healthcare Costs Associated with Mild Traumatic Brain Injury and Psychological Distress in Children and Adolescents.
[290] The epidemiology and impact of traumatic brain injury: a brief overview — Abstract Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. The estimated 5.3 million Americans living with TBI-related disability face numerous challenges in their efforts to return to a full and productive life. This article presents an overview of the epidemiology and impact of TBI.
[299] Psychological Rehabilitation Plays Vital Role in Brain Injury Recovery — A new study has highlighted the importance of integrating psychological rehabilitation into standard neurorehabilitation programmes for individuals recovering from acquired brain injuries. Researchers found that including psychological support not only benefits patients but also strengthens interdisciplinary teamwork among healthcare professionals.
[300] Impact of neuropsychological rehabilitation on activities of daily ... — The present study was targeted to observe the impact of neuropsychological rehabilitation on activities of daily living (ADL) and community reintegration of patients with traumatic brain injury (TBI). Evidence exists that holistic/integrated rehabilitation that includes both individualized cognitive and psychosocial interpersonal therapies produces the greatest overall improvements in functioning by persons with TBI. This study was thus targeted to rehabilitate neuropsychological deficits of patients with TBI and to see its impact on ADL and community reintegration.
[301] Traumatic Brain Injury in Older Adults—A Public Health Perspective — A public health approach for TBI supports a better understanding of the burden of TBIs in this population, identifies modifiable risk and protective factors, and develops and tests prevention strategies to help assure widespread adoption of effective prevention principles and strategies.
[302] PDF — • Increase access to patient-centered rehabilitation services delivered in residential or transitional treatment programs, and community-based outpatient clinics.4 • Encourage the safe operation of electric scooters (e-scooters) by requiring all e-scooter riders to wear a helmet and abide by traffic laws.3 • Implementation of TBI education for first responders, including the development of crisis intervention protocols related to interacting with persons with TBI.4 • Comprehensive, integrated, and effective community strategies that ensure that TBI survivors minimize risk of further damage or re-injury and are appropriately supported in their efforts to regain and maintain health and function.1 2 • Collaboration among federal agencies, state and local health departments, national and community-based organizations that serve at-risk populations, and the health care community (e.g., insurers, local trauma systems, and emergency medical services).1 Justification Traumatic Brain Injury is considered a major cause of death and disability in our nation,5 with an estimated 1.7 million people in the United States sustaining a TBI each year.6 In 2014, there were approximately 288,000 TBI-related hospitalizations, and over 56,000 deaths that occurred in the United States.6 The estimated economic costs of TBI morbidity and mortality in 2010 was $76.3 billion, with $11.5 billion attributed to medical costs and $64.8 billion attributed to indirect costs of TBI, such as lost productivity.1 From 2006 to 2014, TBI-related ED visits have increased by 54%, while TBI-related hospitalizations and death rates decreased by 8% and 6%, respectively.
[320] Using the public health model to address unintentional injuries and TBI ... — Using the public health model to address unintentional injuries and TBI: A perspective from the Centers for Disease Control and Prevention (CDC) - PMC Using the public health model to address unintentional injuries and TBI: A perspective from the Centers for Disease Control and Prevention (CDC) CDC’s current work in TBI prevention includes activities in the prevention of sports and recreation-related concussion, motor vehicle injury prevention, and older adult fall prevention. CDC is poised to reduce the incidence and burden of TBI by using the public health model to reduce sports-related concussion, motor vehicle injuries, and older adult falls and to improve health outcomes for individuals who are living with TBI.
[322] Ten-year trends in traumatic brain injury: a retrospective cohort study ... — Although traumatic brain injury (TBI) mortality rates have decreased over the last decade, 1 TBI-related disability has not declined, 2 and TBI-related emergency department (ED) visits have increased by 70%, 1 with a recent report by the Centers for Disease Control and Prevention (CDC) estimating 2.8 million TBI-related ED visits in 2013. 3 TBI