Class notes
Traumatic Brain Injury and Rehabilitation
- Institution
- University Of Cape Town (UCT)
Summary notes for Traumatic Brain Injury and Rehabilitation for Clinical Neuropsychology
[Show more]
Seller
Follow
Content preview
Traumatic Brain Injury and RehabilitationLecture 1
• TBI is defined as an alteration in brain function, or other evidence of brain
pathology, caused by an external force (Menon et al., 2010, p. 1638)
• “a disruption in the normal function of the brain that can be caused by a bump,
blow, or jolt to the head, or penetrating head injury” (CDC, 2019)
• Different to a head injury
TBI vs Head Injury
Head Injury is a nonspecific and antiquated term, which includes clinically evident external
injuries to the face, scalp, and calvarium, such as lacerations, contusions, abrasions, and
fractures, and may or may not be associated with TBI
Epidemiology of TBI
• Traumatic brain injury (TBI)—the “silent epidemic”—continues to contribute to
worldwide death and disability more than any other traumatic insult (Dewan et al.,
2018). One may recover from physical effects but don’t recover from cognitive
effects etc as they’re not visible
• Sixty-nine million (95% CI 64–74 million) individuals worldwide are estimated to
sustain a TBI each year, serious public health problem (Dewan et al., 2018).
• Head injury following road traffic collision is more common in LMICs (low middle-
income countries), and the proportion of TBIs secondary to road traffic collision is
likewise greatest in these countries (Dewan et al., 2018).
• Although traumatic brain injury (TBI) is a global problem, the effects thereof are
reportedly more potent in low- and middle -income countries (LAMICs, e.g., South
Africa (SA)) than high-income countries (HICs; Bener et al., 2010; Harris et al., 2008;
Hyder et al., 2007).
• Incidence, cause, & nature of TBI reported to vary with age, sex & psychosocial
context, e.g., Causes of TBI differ with ages, higher amongst males than females
• Mechanisms of injury: Road traffic accidents (passengers / pedestrians), falls,
violence / assault – struck by / against an object, sport-related injuries
• Direct impact or acceleration / deceleration (+ rotational) forces especially when it
comes to close head injuries, 1) head is stationary and gets hit by object which sets
brain in motion, or 2) individual is moving at particular pace and then comes into
contact with an object or comes to an abrupt stop, in both situations brain gets jolted
around within skull cavity
• Brain floats in CSF in the skull, moves in forward and backwards motion, e.g., frontal
lobes, occipital lobes and bony surface at bottom of skull, therefore temporal lobe
areas can also be affected
Open Vs Closed TBI
1
, Closed/ Non-penetrating TBI
• The skull is ‘closed’ - no object has penetrated it, injury to brain happens to skull
cavity
• Most common cause of such injuries = MotorVehicleAccidents (high-velocity
deceleration forces)
• Kinetic potential = the physical forces acting on the brain
– brain is shaken around within the skull cavity
– marked acceleration and/or deceleration and rotational forces.
– at the point of impact (where injury happen), (an impact injury) or its opposite
pole (countrecoup injury), happen at axonal level
– may shear, tear, & rupture nerves, blood vessels, and the covering of the brain
• Frontal lobes and temporal poles vulnerable to diffuse injury - uneven, “sandpaper-
like” surface of the tentorial plates that hold it in place
Penetrating/ Open TBI
• Penetration of the skull by some foreign object e.g. a knife, scissors, or a bullet from a
gun
• Cerebral pathology tends to be localised around the path of movement through the
brain
• Extremely dangerous to the cortical integrity because of 2 factors:
1. location & extent of damage (e.g. brainstem), eg. at level of brain stem injury can
be quite fatal
2. complications typically associated – infections & haemorrhaging
Pathophysiology: Closed TBI
Mechanism of Impact
• Physical forces placed on the axon & cell body of neuron
• Damage occurs at level of axon
• Tensile strength
– resistance to longitudinal stress, measured by the minimal amount of stress
required to rupture the axon
• Brain trauma may deform, stretch, & compress brain & its tissue (esp. axons)
2
, • Result:
– Retrograde degeneration –
axon torn and degenerates back to the cell body
– Anterograde degeneration – rupture cell body and axon fibres degenerate
– Because the neuron dies, the damaged axon not activated
– “domino effect”, i.e., metabolic changes in the postsynaptic neuron & possible
cell death or necrosis
Measuring injury severity
• TBI severity typically mild, ±80%; moderate, ±10%; and severe, ±10%
• Loss of consciousness (LOC), posttraumatic amnesia (PTA) and the Glasgow Coma
Scale (GCS) have been described as the “gold standard” (Malec et al., 2006, p. 1422)
• Post-traumatic amnesia (PTA)
– the period of confusion and disorientation following TBI or emergence from
coma.
Duration of Loss of Consciousness
TBI Classification Coma Duration
Mild < 20 mins
Moderate < 6 hrs of admission
Severe > 6 hrs of admission
3
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through EFT, credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying this summary from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ameerahpangarker. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy this summary for R155,00. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
78861 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy summaries for 14 years now