Traumatic Brain Injury (TBI)

Also known as: TBI, head injury and head trauma, brain injury.

What is a traumatic brain injury?

TBI is an injury to the brain from direct or indirect physical force to the head and/or brain. Blunt TBI is from an impact with another object, whereas penetrating TBI occurs when typically a bullet or spear-like object pushes through the skull and penetrates the brain. TBI is further classified based on initial severity and duration of depression of consciousness using the Glasgow Coma Scale. Although less than ideal, the GCS score usually correlates with outcome, with higher scores associated with better outcome. Concussion falls in the “mild” TBI category, although as many have said, “there is nothing mild about concussion.”

What causes traumatic brain injury?

The most common causes (etiologies or mechanisms) of TBI vary depending on the age of the child. Very young children most commonly sustain TBI from falls and physical abuse, whereas in teenagers the most common mechanism of TBI are motor vehicle accidents, sports trauma and acts of violence such as gunshot wounds and assault.

What are the symptoms of traumatic brain injury?

Symptoms of TBI fall under 4 main domains: cognitive, physical, emotional/behavioral and sleep disturbances. Coma of variable depth and duration is a feature of severe TBI, whereas brief loss of consciousness occurs in only 10-15% of concussions.

  • Cognitive dysfunction after severe TBI is typically severe and permanent, whereas with mild TBI problems with concentration, memory and attention usually resolve over time.
  • Physical symptoms of severe TBI include seizures, loss of important functions of the brain such as the ability to see, swallow, speak, walk, movement of the arms, hands and legs, chronic pain, etc. In mild TBI the most common physical symptoms are headache, fatigue, balance or vestibular dysfunction, eye movement problems, and sensitivity to light and noise.
  • Emotional or behavioral problems include reduced attention, concentration and focus, loss of impulse control, anger management, depression and anxiety.
  • Sleep disturbance usually manifests as difficulty falling asleep, night time awakening and daytime fatigue, all of which worsen the cognitive, physical and emotional challenges of the primary injury.

In addition, neck injuries are very common with even mild TBI and need to be assessed early so that effective therapy can be provided.

What are traumatic brain injury care options?

Management of TBI of all severities is basically a symptom- or problem-driven process. There is no medication or treatment of the primary traumatic injury of the brain. Therapy is directed at recovering lost function(s), reducing or eliminating debilitating symptoms, and teaching the child and family how to cope with and manage persistent loss of abilities when they do occur. Multiple disciplines – physical therapy, occupational therapy, speech therapy, neuropsychological, psychological, orthopedic, neurological, neurosurgical, and others - may be needed to address the challenges children and families face in the aftermath of TBI.

Fortunately, the developing brain has a great capacity for neuroplasticity, which is when healthy parts of the brain assist with or take over lost functions of injured regions. The best outcomes are achieved through persistent attention to all the needs of the whole child with TBI and their family, and in preventing secondary injuries.

Long term services involving many Rehabilitation Specialists may be needed. Nicklaus Children's Hospital, as a designated Pediatric Trauma Center has all the Specialists and facilities to provide for the full range of short and long term services needed.

Reviewed by: John W Kuluz, MD

This page was last updated on: September 09, 2020 09:46 AM

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