DIAGNOSING A TBI
The majority of brain injuries are classified as mild injuries or concussions. All types of injuries can have serious health consequences. All brain injuries need prompt assessment by a professional that has experience evaluating brain injuries.
While it can be difficult to formally diagnose a brain injury, the Centers for Disease Control and Prevention (CDC), the American College of Rehabilitation Medicine, and some others have published guidelines for diagnosing TBI.
A medical exam is the first step. Assessment usually includes a neurological exam including an evaluation of thinking, motor function (movement), sensory function and coordination. It will also test hearing and speech, mental status, and changes in mood or behavior, among other abilities.
Imaging tests, including computerized tomography scans (CT scans) and magnetic resonance imaging (MRI) tests do not diagnose TBI, but these tests can help health care providers rule out a life-threatening injury to the brain (particularly bleeding that resulted from the traumatic injury that can require immediate medical or surgical attention).
Sometimes a mild injury or concussion is missed at the initial injury. MRI and CAT scans are often normal. Common symptoms can include:
- Memory Problems
- Mood Swings
Moderate to Severe Brain Injury:
Health care providers may use one or more tests that assess a person’s physical injuries, brain and nerve functioning, and level of consciousness. The Glasgow Coma Scale (GCS) evaluates the functioning of an individual in three areas. An individual’s ability to speak, open their eyes and move. This scale allows the level of injury to be determined.
In most situations when this type of injury occurs the injury is often self evident and often other life threatening injuries have also occurred. Other tools used in the diagnosis process:
Mild TBI, sometimes called concussion, may not require specific treatment other than rest. However, it is very important to follow a health care provider’s instructions for complete rest and gradual return to normal activities. If a person resumes normal activities and starts experiencing TBI symptoms, the healing and recovery process may take much longer than if he or she had followed the health provider’s instructions. Certain activities, like working on a computer and concentrating hard, can tire the brain even though they are not physically demanding. The person with the concussion might need to reduce these kinds of activities or might need to rest between periods of such activities to let the brain rest. In addition, alcohol and other drugs can slow recovery and increase the chances of re-injury.
Children and teens who may have sustained a concussion during sports should stop playing immediately. They should not return to play until a health care provider who is experienced in evaluating concussion confirms they are ready. Re-injury during recovery can slow healing and increase the chances of long-term problems. On rare occasions in which a person gets another concussion before healing from the first one, permanent brain damage and even death may result.
Emergency Treatment for TBI:
In most cases, emergency care focuses on stabilizing the patient and promoting survival. This care may include ensuring adequate oxygen flow to the brain, controlling blood pressure, and preventing further injury to the head or neck.3 Once the patient is stable, other types of care for TBI and its effects can begin.
Surgery may be needed as part of emergency care to reduce additional damage to the brain tissues. Surgery may include:
- Removing clotted blood. Bleeding in the brain or between the brain and skull can lead to large areas of clotted blood, sometimes called hematomas (pronounced hee-ma-TOH-muhz), that put pressure on the brain and damage brain tissues.
- Repairing skull fractures. Setting severe skull fractures or removing pieces of skull or other debris from the brain can help start the healing process of the skull and surrounding tissues.
- Relieving pressure in the skull. Making a hole in the skull or adding a shunt or drain can relieve pressure inside the skull and allow excess fluid to drain.
Types of Therapies for TBI:
Most people with a moderate to severe brain injury will need some type of rehabilitation therapy to address physical, emotional, and cognitive issues from the TBI. Therapies will likely include relearning old skills or learning new ways to make up for lost skills. A treatment program should be designed to meet each person’s specific needs and to strengthen his or her ability to function at home and in the community.
Therapy usually begins in the hospital and can continue in a number of possible settings, including in a skilled nursing facility, at home, in a school, and in an outpatient program at a clinic. Therapy can be brief or long-term, depending on the type of injury, and it may need to change over time. Rehabilitation generally involves a number of health care specialists, the person’s family, and a person who manages the team. When devising a long-term treatment plan, patients, their families, and their providers should be aware that moderate and severe TBI impairs patients’ ability to make sound medical decisions even a month after injury.
Types of Rehabilitation Therapy May Include:
- Physical Therapy. This treatment works to build physical strength, coordination, and flexibility.
- Occupational Therapy. An occupational therapist helps a person learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing.
- Speech Therapy. This therapy works on the ability to form words and other communication skills as well as how to use special communication devices if necessary. Speech therapy can also include evaluation and treatment of swallowing disorders (dysphagia).
- Psychological Counseling. A counselor can help a person learn coping skills, work on relationships, and improve general emotional well-being.
- Vocational Counseling. This type of rehabilitation focuses on a person’s ability to return to work, find appropriate opportunities, and deal with workplace challenges.
- Cognitive Therapy. This includes activities designed to improve memory, attention, perception, learning, planning, and judgment. For many people with TBI, cognitive therapy is among the most common types of rehabilitation.