Bspence, head trauma. sgp


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  • My personal relevance, is Christina flood. I met her when I was a freshmen trying out for the water polo team. She was one of the first ones to be my friend. In september 2010, she was jogging in rome, when she was hit by a car.She had massive brain injuries, and she had to have surgery on her legs. She was put into a medically induced coma. Two weeks after the accident, they took her off the medication, and she did not wake up. She was still in a coma for ...... months. For the longest time no one knew what was going to happen, or if she would make it through the night every night. Now she is awake, and aware of everything around her. She can answer by pointing to yes, and no cards. The doctors asked her questions, that proved she remembered most things about her life. Who she is, what school she went to, who her parents are, etc. She can not talk, eat on her own, or walk. \n
  • There are two types focal, and diffuse. \n Focal is where the damage is confined to one part of the brain. \nDiffuse is where it involves more than one area of the brain.\n a traumatic brain injury can come from either a closed head injury or a penetrating head injury. Which I will explain in a little. \n- A skull fracture happens when the bone of the skull, cracks or breaks. \n-a depressed skull fracture happens when the skull is broken, and the pieces press into the brain tissue. If the pieces cause bruising it’s called a contusion. \n-massive injury to a major blood vessel within the head can cause a HEMATOMA. A hematoma is where there is heavy bleeding in or around the brain. \n\n
  • 99.9 percent of the time a brain injury will have frontal lobe damage. The frontal lobes are controls motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior.When there is injury to the frontal lobe they lose control of these functions. \n\n If hit from the front of the head or the back, your brain will be pushed either forwards then backwards, or backwards then forwards. Or hit from the side the brain will go side to side against the skull. There is not much room in the skull so the brain will smack up against it. When It hits the skull, the brain will vibrate. Sometimes for days after the incident. It looks like when you have jello, and you shake it. It will move and squish, and vibrate. \n
  • open head- it happens when a object goes through the skull, and into the brain. Which can and mostly will lead to infection of the brain. They normally cause impairments to the functions, that the injured part of the brain normally controls. They must be treated immediately\n\n\n
  • closed head-happens when trauma happens to the brain, but nothing penetrates the skull. They are difficult to diagnose, there can be no physical signs of injury, example: concussions. \n
  • The GCS scale is the first assessment done when someone is thought to have a TBI. They use it, so the medical team can have an initial idea of severity of the injury. It is widely used it is easily observable, and can be pretty consistent. \n
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  • When you use the GCS, you also have to add the values of E+V+M. which is eye opening score +verbal response score + motor response score. \nThe number helps define chances of survival. The lower the score is the worse off the patient is. \nscore break down.\nmild brain injury- a score of 13 to 15\nmoderate brain injury- score of 9 to 12\nsevere brain injury is a score of 3 to 8. If you have an eight, it is considered a critical score. 90 percent of patients are in a coma at this level. \n
  • Also known as the pediatric glasgow coma scale (PGCS) It was created for children to young to talk. It gives the same results, as a GCS would but for children under the age of two. It was especially accurate for babies and toddlers, that needed acute intervention. \n\n\n\n\n\n
  • - loss of consciousness\n-loss of memory around the time of accident\n-changes in their mental state. Anything from feeling dazed, disoriented, or confused. \n- loss of consciousness or 30 or less minutes. \n- Their GCS score of 13-15\n- Their post-traumatic amnesia does not last past 24 hours. \n
  • -Their GCS score is between 9-12\n-They have loss of consciousness and/or their post-traumatic amnesia is greater than 30 minutes, but less than 24 hours and/ or they have a skull fracture.\n- there can be long-term physical or cognitive deficits. It depends on how bad the damage to the brain is, and where the damage occurred. \n- around 300,000 athletes suffer mild to moderate traumatic brain injuries each year. most are diagnosed as concussions. \n\n
  • - Their GSC score is lower then a 9\n-loss of consciousness or post traumatic amnesia lasting more then 24 hours.\n-You can die from a severe brain injury, very dangerous, and life threatening. \n-if they live, they will have long-term physical and cognitive impairments. \n- the deficits can be a severe as a vegetative state, or minor impairments that may allow the person to function independently.\n- they will need extensive rehabilitation, that may overcome SOME deficits, and learn how to cope with the others. \n
  • -headache\n-nausea\n-confusion-cognitive problems\n-change in personality\n-depression\n- irritability\n-may have seizures. \n-emotional and behavioral problems. \n\n\n%2C851&itbs=1&iact=rc&dur=700&oei=ze9rTa2GEoet8AbcyqGmCw&page=3&ndsp=18&ved=1t:429,r:1,s:35&tx=48&ty=81&biw=1140&bih=603\n
  • They differ due to the severity, location of the injury, and the age, and health of the person. They will have issues with thinking, memory, and reasoning. They will have problems with sensory processing, like sight, hearing, touch, taste, and smell. Problems with communication, as expression, and understanding. They will also experience problems with behavior, and mental health. such as depression, anxiety, personality changes, and social inappropriateness. \n
  • *Skull fracture\n*Lacerations to the scalp and resulting hemorrhage of the skin\n*Traumatic subdural hematoma, a bleeding below the dura mater which may develop slowly\n*Traumatic extradural, or epidural hematoma, bleeding between the dura mater and the skull\n*Cerebral contusion, which in medical terms is a bruise of the brain\n*Concussion\n*Dementia pugilistica, or “punch-drunk syndrome”, which happens after repetitive hit’s to the brain/head. \n*It can lead to death. \n*Shaken Baby Syndrome – a form of child abuse\n\n\n,r:2,s:66&tx=80&ty=39&biw=1140&bih=631\n
  • Aphasia is the impairment of language. It effects your ability to speak, read, or write. \n-global aphasia is where the patient can say some recognizable words. They can understand some language, but they can not read or write.\n-broca’s aphasia - Is where the patient understands they have the impairment. They may be able to read, and write but with much difficulty. When speaking, they can only form short words. \n- Wernicke’s aphasia- They have a very hard time reading and writing, if they can at all. When they try and talk, it is very hard to understand. Mostly comes out as rambles, and gibberish. Most do not know about their impairment. They believe when they talk, it is normal, and people can understand it. \n-anomic aphasia- is when the patient has trouble finding the words they want to say. They can understand speech, and can read. \n\n
  • 1. Dysarthria- It is where they know what language they should use, but they can not speak it. If they can say the word’s it is very difficult. Because they can not use the muscles around the mouth that, can form and produce the sound to make the words. It is due to neurological damage. If they can manage to speak, the words will be slow, and slurred\n2. Swallowing Disorders- it’s exactly what it sounds like, problems swallowing because of muscle loss, or not able to control the muscle.\n3. Spasticity- When certain muscles, contract. It causes stiffness, and tightness of the muscles. It can effect movement, and speech. \n4. Memory- They have loss of memory, it can be short term or long term. Some gain their memories back, other never do. \n5. executive- function problems planning, organizing, abstract reasoning, problem solving, and making judgements. \n\n\n\n
  • Fall’s are the leading cause of TBI’s. Fall’s cause half of the TBI’s with children from 1 to 14 years old. and 61% of all TBI’s in adults 65 and older.\nmotor vehicle-traffic crashes are the second leading cause, and result in the largest percentage of TBI-related deaths. \nstruck by/against includes colliding with a moving or stationary object, It’s the second leading cause of TBI in children.\nassault account for 2.9% in children aged 0 to 14 and 1% in adults 65 or older.\n\nother known causes are \n-sport injuries\n-near drowning\n-strokes\n-brain tumors\n-aneurisms\n- seizure activity\n-infectious diseases\n\n\n\n
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  • ER- the first step. It is where they work to stabilize the patient. \nICU- where they will stay until they move past immediate danger stage.\nNeuro ICU- called the “step-down-unit” Nero-trained nurses care for, and evaluate if the patient can be moved to the general neuro floor\nNeuro floor- general neurological floor staffed by specially trained staff to help patient recover, and prepare to go home\nRehab unit- intensive therapy Is done here. Where patients can get better/recover, or learn to deal with the impairments they will have for the rest of their lives. \nHome- when they can go home, but will have a long hard road to recovery.\n
  • A computed tomography scan creates X-ray images of the head and brain. This imaging test can show bone fractures, hemorrhages, hematomas, contusions, brain tissue swelling, and tumors, and can help determine the prognosis of TBI patients.\n
  • stupor, coma, persistent vegetative state, locked-in syndrome, and brain death.\nstupor- patient is unresponsive but can be aroused for a short time by a strong stimulus, such as sharp pain\nComa-unconscious, unresponsive, unaware, and unarousable. They respond to nothing. even pain or light, and do not have sleep-wake cycles\nPersistent Vegetative state-are unconscious and unaware of their surroundings, but they continue to have a sleep-wake cycle and can have periods of alertness. often open their eyes and may move, groan, or show reflex responses\nlocked-in syndrome-is a condition in which a patient is aware and awake, but cannot move or communicate due to complete paralysis of the body.Most locked-in syndrome patients can communicate through movements and blinking of their eyes, which are not affected by the paralysis. Some patients may have the ability to move certain facial muscles as well. The majority of locked-in syndrome patients do not regain motor control, but several devices are available to help patients communicate.\nBrain death-is the lack of measurable brain function due to diffuse damage to the cerebral hemispheres and the brainstem, with loss of any integrated activity among distinct areas of the brain. Brain death is irreversible. Removal of assistive devices will result in immediate cardiac arrest and cessation of breathing.\n\n,r:2,s:0&biw=1140&bih=633\n\n
  • If someone is showing signs of having a TBI, they should get help as soon as possible. There is not much a doctor can do, once someone has received a TBI. In the hospital, they do not focus on treating the head trauma, they work on stabilizing the patient, and working to prevent farther injury. Three of the most important thing’s once in the hospital is making sure the patient is getting the right amount of oxygen to their brain, and body. That they have a adequate blood flow, and that they have controlled blood pressure. After the hospital they will receive physical therapy, occupational therapy, speech/language therapy, physical medicine, psychology/psychiatry, and social support. \n
  • Could be one of the most famous TBI patient in the history of medicine. It was in 1848 and gage was a 25-year old railroad construction foreman Rutland and Burlington Railroad in Vermont. During the time Phineas was alive, not much was known about the brain. Doctors did not have much knowledge about head injures, and how to treat it. Most head injuries ended in death due to bleeding or infection. At work, Gage was working with explosion powder, and a tamping iron. There was a spark that lit the explosion powder, and it launched the three-foot-long rod into his skull. Soon after he was conscious and able to walk around. The workers also found the rod a couple feet back, covered in blood and brains. He was then put int the care of John Harlow who was his physician for 73 days Gage’s wounds were not treated surgically, but were instead left open to drain into the dressings. Gages exposed brain became infected with a fungus, and was thought to die. He survived but since they knew very little about brain injuries, when Gage survived they thought it was a miracle, and that he was fine. They were wrong, Gage survived but there was a huge impact on his brain, and how it would effect him for the rest of his life. Before the accident he was quite, well mannered man, after he was obscene, obstinate, self-absorbed man he stayed that way until he died in 1861. \n\n\n\n,r:10,s:168&biw=1140&bih=603\n\n\n\n\n
  • TBI is a leading cause of death and disability among children and young adults in the united states. \nThe risk is highest among adolescents, young adults, and people over the age of 75.\n
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  • When I heard about Floods incident I wanted immediately to help, her family. I joined a group on facebook, made just for idea’s on how to raise money for the Flood family. I had written on the wall, that I wanted to do anything, and I would help anyone that needed it. Mrs. Satterfield, messaged me that night, and said she had a bunch of purses, that she would donate to me. She donated them, so I could sell them, and give the money to the Flood’s. Mrs. Rieger then heard about my fundraiser, and donated a HUGE amount of Vera Bradley. I have been selling them all year long, and I made $ \n
  • Christina Flood was a former water polo player. When we received the new’s about her accident, I was informing people of what I heard when I heard it, and about my up coming fundraiser to raise money for the flood’s by selling purses. My team was extremely concerned about her, and wanted to also help in any way they could. So one of the other caption, and I starting forming ideas for a fundraiser. We decided on a car wash. \n
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  • I went to IhI for one of my applications. I was shadowing/interacting when I was there. IHI Is an after care program for people who have suffered from a traumatic brain injury. They have inpatient, and out patients. The in-patience either live in their own apartments provided by the company, or in a home. The apartments are for the more independent patients who are well off, and able to live without much care/ check ups. The patients that live in the home, are the ones that need constant care, and check ins. For four to five hours of the day they go to the center where they work. They are not real jobs, they take blots off of screws, and stick pins in cartons to be painted. They are paid to do this, and it helps them with cognitive skills, and just feeling like they are living normal lives. They get breaks, and have meetings. On Wednesdays they have music day. Twice a week a personal trainer also comes to help them with their balance. The trainer puts them in fallen positions, and help to strengthen their cores so they can get themselves out of the position. \n
  • One of the ladies I met, was in her middle to late twenties, but had the mind set of a child. When she was two or three years old, her head was caught in a car window, and she lost oxygen to her brain. Enough to cause brain trauma. She is wheel chair confined, and has a problem speaking. She is such a happy person though, and they first time I met her, she kept repeating my name, and then asked me for a pickle. \n
  • I met a women at IHI, in 1992 She was beaten, and left for dead. She was working the night shift, when two men she worked with had come back, to steal money. They shot the manager, and beat her until they thought she was dead. In reality she had suffered from multiple blows to the head, and had a brain injury. She has never been the same, and now 19 years later, she is still in the need off one on one. Which is where there is someone that has to be with, or checking on her constantly. \n
  • He was a state trooper, and head on the radio that there was a high speed chase, close by. Since he was close by he decided to join in, maybe to catch them by surprise. There were two adult women, and two children in the car. The two women were on drugs. His car was smashed, and the firefighters had to use the jaws of life to get him out of the car. He is now an in-patient at IHI, and he lives in the apartments. Almost self reliant. \n
  • This is a case you won’t hear of to often. He was drunk, and actually trying to do the responsible thing. He was trying to get on the bus, instead of driving home. While crossing the street to the bus he was hit by a car. Now the guy who hit him with the car, would have gotten away if he wasn’t dragging him along for 200 feet. That night it had been raining, and his long rain coat, had gotten stuck in the car when he was hit, and he was dragged. He now Is confined to a wheel chair, has a very hard time speaking, and when he does it is raspy and gargled. \n
  • \n\n\n\n\n\nIn the 1950’s there were not many cures. He was diagnosed with one illness, and the doctors told him there was nothing to be done. His mother believed strongly in natural cures, and vitamins. Since the doctors told him there was no hope, he started looking somewhere else. He found a “doctor” who was later marked as a qwack. The doctor put him on a diet, that was just liquids, and it was supposed to cleanse his body. He was outside on a extremely hot day, when he had a heat stroke. It caused trauma to his head. He now has to be on one and one. Constantly being watched over, and taken care off. He has limited mobility in his limbs. His neck gives him no support, and he need’s to have a neck brace, and wear a helmet. he is now also confined to a wheel chair. \n\n\n\n\n,r:1,s:0\n\n\n
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  • I learn so much about the brain. I learned about people who have suffered from a brain injury, and what they have to deal with after the accident. I’ve raised money to help a family in our community, and raised awareness about how serious head trauma is, and the effects of it. \n
  • Bspence, head trauma. sgp

    1. 1. Head Trauma“where there is life, there is hope.”
    2. 2. THESIS Has someone you know been effected by a brain injury? Well I have had two people in my live effected by them. That is why I am going to research traumatic brain injuries (TBI). I want to know more about brain injuries because it effect’s my life, and touches close to home. The brain is an amazing thing, and also one of the most complex organ in the human body. I think everyone takes interest in the brain but knows very little about what goes on in it, and the kinds of injury’s that can effect it. During the project I hope to educate myself on brain injuries, and raise money for The Flood family. http://
    3. 3. Personal relevanceCh!"ina Flood
    4. 4. What is a traumatic brain injury? • Happens when a sudden physical assault on the head causes damage to the brain.
    5. 5. Our emotional control center, and home to ourpersonality.
    6. 6. OPEN HEAD INJURY %20ap_jpg.jpg
    7. 7. %200004%20closed%20head%20injury%20ap_jpg.jpg
    8. 8. Glasgow Coma Scale Eye Opening Response• Spontaneous Score• To speech 4 3• To pain 2• None 1
    9. 9. Glasgow Coma Scale Best Motor Response• Obeys command localizes pain Score• Flexor withdrawal to pain 6• Abnormal spastic stereotypes 5 4• Flexion posture 3• Extensor response at elbow 2• No movement 1
    10. 10. Glasgow coma scale Verbal Response Oriented conversation Confused conversation Inappropriate words Score Incomprehensible sounds 5 4 No vocalization 3 2 1 Total score possible 3 to 15
    11. 11. Childrens GCS,
    13. 13. Moderate brain injury
    14. 14. SEVERE BRAIN INJURY %2Bbrain%2Binjury%26hl%3Den%26safe%3Dactive%26sa%3DX%26gbv%3D2%26biw%3D1140%26bih%3D603%26tbs%3Disch: 10%2C751&itbs=1&iact=hc&vpx=893&vpy=137&dur=2050&hovh=194&hovw=208&tx=151&ty=121&oei=be5rTdTfOcT58AbI7aiSCw&page=2&ndsp=18&ved=1t:429,r:17,s:18&biw=1140&bih=603 gclid=CNSX44Cii6cCFZ065Qod4Ev0hA
    15. 15. symptoms of a TBI Headaches Depression Nausea irritabilityConfusing-cognitive may have seizures problems. Emotional and change in behavioral personality problems
    16. 16. Disabilities resulting from a traumatic brain injury.
    17. 17. Specific Problems After Head Injury
    18. 18. IMPACTS OF A TBI Aphasia Global aphasia Broca’s aphasia Wernicke’s Aphasia Anomic Aphasia
    19. 19. Impact’s of a TBIApraxiaDysarthriaSwallowing DisordersParalysisSpasticitymemoryExecutive function
    20. 20. Causes of a Traumatic Brain Injury.
    21. 21. Questions • _ _,_ _ _die each year from a TBI • _ _ _,_ _ _ people are hospitalized annually and survive. • _ _,_ _ _ to _ _,_ _ _ people experience the onset of long term disability each year.
    22. 22. Answer • 50,000 people die a year • 230,000 people are hospitalized • 80,000 to 90,000 experience onset of long-term disability.
    23. 23. Question • _._ million people, _% of the U.S population- are living with a permeant TBI disability. • TBIs requiring hospitalization cost the nation about $_ _._ billion each year.
    24. 24. answer • 5.3 million people, 2% of the U.S pop. • $56.3 billion dollars each year.
    25. 25. Normal steps after aTraumatic Brain Injury Emergency room ICU-intensive care unit Neuro ICU Neuro floor Rehab unit Home
    27. 27. FIVE ABNORMAL STATESOF CONSCIOUSNESS.StuporComaPersistent vegetative statelocked-in syndromebrain death
    28. 28. Treatments?
    29. 29. Phineas Gage
    30. 30. Statistics Each year an estimated 1.5 million Americans sustain a TBI. That is 8 times the number of people diagnosed with breast cancer, and 34 times the number of cases of HIV/ AIDS each year.
    31. 31. FLOODS OF LOVE
    32. 32. CAR WASH FOR FLOOD
    35. 35. %3D1%26hl%3Den%26safe%3Dactive%26sa%3DX%26biw%3D1140%26bih%3D631%26tbm%3Disch0%2C1542&um=1&itbs=1&iact=rc&dur=391&oei=7a2lTfGmMabm0QGKwJzSCA&page=4&ndsp=15&ved=1t:429,r:4,s:43&tx=90&ty=52&biw=1140&bih=631
    36. 36. %3D1%26hl%3Den%26safe%3Dactive%26biw%3D1140%26bih%3D633%26tbm%3Disch&um=1&itbs=1&iact=hc&vpx=396&vpy=110&dur=241&hovh=185&hovw=272&tx=156&ty=82&oei=i9KlTbj3JZS5tgep4YnGAg&page=1&ndsp=15&ved=1t:429,r:2,s:0
    37. 37. Class room activity!
    38. 38. work cited• The Brain Injury Recovery Network. "Injury Overview." The Brain Injury Recovery Network. The Brain Injury Recovery Network, 2003. Web. 17 Feb. 2011. <>.•••••••••••
    39. 39. work cited.••,•••• Turkington, Carol, and Joseph R. Harris. "Coma." The Encyclopedia of the Brain and Brain Disorders. 3rd ed. New York, NY: Facts on File, 2002. (page 99)• 808a-4ba1a11f7018%40sessionmgr115&bdta=JnNpdGU9Y2hjLWxpdmU%3 d#db=cmh &AN=HL22822>.• American Red Cross. "Injuries to the Head, Neck, and Back." FirstAid Responding to Emergencies. 4th ed. Yardley, Pa: Staywell, 2005. 254-57. Print.• Crippen, David W. "Head Trauma: eMedicine Trauma." Editorial. eMedicine from Web• Williams, Brenda. "Head trauma and its effects ." Head trauma and its Effects.
    40. 40. picture cites.• dontcross_370x278.jpg&imgrefurl= 8301-504083_162-20026779-504083.html&usg=__cuyOjOPgCTB1jy- wCFjGaY2MvBg=&h=278&w=370&sz=40&hl=en&start=43&sig2=ZjxbUQj_XX98UbIlg6cE_A&zoom=1&tbnid=Fs3bNRENqHB1h M:&tbnh=133&tbnw=177&ei=_K2lTdWhO4OW8QOI4NG5Dw&prev=/images%3Fq%3Dstate%2Btrooper%2Bcar%2Baccident %2Bin%2Bpennsylvania%26um%3D1%26hl%3Den%26safe%3Dactive%26sa%3DX%26biw%3D1140%26bih%3D631%26tbm %3Disch0%2C1542&um=1&itbs=1&iact=rc&dur=391&oei=7a2lTfGmMabm0QGKwJzSCA&page=4&ndsp=15&ved=1t:429,r:4,s: 43&tx=90&ty=52&biw=1140&bih=631••••••• traumatic_brain_injury.jpg&imgrefurl= injury-200149.html&usg=__nevAsW9j80tcFiVrlFUXFSwrpVg=&h=243&w=260&sz=14&hl=en&start=18&sig2=n_c9VyeW wAv-A7QUGK7vlw&zoom=1&tbnid=SOkOZccjx51HMM:&tbnh=134&tbnw=145&ei=kO5rTd-eJcGqlAf_-uX-AQ&prev=/ images%3Fq%3Dsevere%2Btraumatic%2Bbrain%2Binjury%26hl%3Den%26safe%3Dactive%26sa%3DX%26gbv %3D2%26biw%3D1140%26bih%3D603%26tbs%3Disch: 10%2C751&itbs=1&iact=hc&vpx=893&vpy=137&dur=2050&hovh=194&hovw=208&tx=151&ty=121&oei=be5rTdTfOcT5 8AbI7aiSCw&page=2&ndsp=18&ved=1t:429,r:17,s:18&biw=1140&bih=603
    41. 41. Picture cites.• prognosis.html&usg=__7auXDfSFr86LDTiJPST7iRSNyKM=&h=375&w=500&sz=86&hl=en&start=35&sig2=8m7eYfPb341gvQITgBoZlA&zo om=1&tbnid=Voy59rkWVlgBNM:&tbnh=131&tbnw=162&ei=z-9rTdDZEsTflgemk9mBAg&prev=/images%3Fq%3Dsymptoms%2Bof%2Bbrain %2Btruama%26hl%3Den%26biw%3D1140%26bih%3D603%26gbv%3D2%26tbs%3Disch:• %253D8&ei=ZACeTYGAOZP2gAeXs7nnDw&zoom=1&iact=rc&dur=501&oei=WwCeTbmHMOTA0QGHiYm0BA&page=5&tbnh=137&tbnw= 183&start=66&ndsp=15&ved=1t:429,r:2,s:66&tx=80&ty=39&biw=1140&bih=631•••••• 2008/08/07/head-injury/&ei=EO- dTZr3JeyI0QGAsaTYBA&zoom=1&iact=hc&vpx=451&vpy=127&dur=35&hovh=201&hovw=251&tx=141&ty=128&oei=EO- dTZr3JeyI0QGAsaTYBA&page=1&tbnh=135&tbnw=169&start=0&ndsp=18&ved=1t:429,r:2,s:0&biw=1140&bih=633••
    42. 42. picture cites.•••• Phineas_Gage_GageMillerPhoto2010-02-17_Unretouched_Color_Cropped_compared.JPG&imgrefurl= Phineas_Gage_results.html&usg=__-CpT7GyJLFT7yLRo8hOVUzuzj60=&h=420&w=563&sz=31&hl=en&start=168&sig2=tcwl- Uap6oOtcboXJ2R0Og&zoom=1&tbnid=POJLlK4-G5vD0M:&tbnh=135&tbnw=191&ei=I2hmTeizBYqtgQeE7OnGDQ&prev=/images%3Fq%3Dphineas %2Bgage%26um%3D1%26hl%3Den%26safe%3Dactive%26sa%3DX%26biw%3D1140%26bih%3D603%26tbs%3Disch: 10%2C4367&um=1&itbs=1&iact=hc&vpx=743&vpy=172&dur=411&hovh=142&hovw=191&tx=133&ty=129&oei=pmdmTYT2GcP78Aa39_SiCw&page=10 &ndsp=18&ved=1t:429,r:10,s:168&biw=1140&bih=603•••• ru.html&usg=__VCCcQrkJ8HTd_s3YppKj0g87QH8=&h=240&w=352&sz=33&hl=en&start=0&sig2=vQyxheq3x6bFe7Ef5zABhA&zoom=1&tbnid=CtTLFY GCt6X25M:&tbnh=160&tbnw=213&ei=i9KlTbj3JZS5tgep4YnGAg&prev=/images%3Fq%3Dhit%2Band%2Brun%26um%3D1%26hl%3Den%26safe %3Dactive%26biw%3D1140%26bih%3D633%26tbm %3Disch&um=1&itbs=1&iact=hc&vpx=396&vpy=110&dur=241&hovh=185&hovw=272&tx=156&ty=82&oei=i9KlTbj3JZS5tgep4YnGAg&page=1&ndsp=15 &ved=1t:429,r:2,s:0• q-5-0dlmoIc=&h=564&w=634&sz=224&hl=en&start=0&sig2=EAwtQ_EeboU3FHREqqJUOA&zoom=1&tbnid=t_MlFPDborvBhM:&tbnh=145&tbnw=147&ei=SOWlTZGhKIi38gP7ldG5Dw&prev=/images %3Fq%3Dsun%26hl%3Den%26biw%3D1140%26bih%3D633%26gbv%3D2%26tbm %3Disch&itbs=1&iact=hc&vpx=283&vpy=125&dur=63&hovh=212&hovw=238&tx=107&ty=116&oei=OeWlTbr8BJKitgeQvcy9Ag&page=1&ndsp=18&ved=1t:429,r:1,s:0
    43. 43. conclusion• &usg=__xlv6Hr7pdkbieNObNDY7E8n_XF8=&h=895&w=811&sz=157&hl=en&start=78&sig2=aN4GHF1S17ieSUNLxK0bHg&zoom=1&tbnid=0eftLBvGIW0HYM:&tbnh=141&tbnw=128&ei=mh3ATe7OIIj50gHArL33BA&prev= /search%3Fq%3Dtraumatic%2Bbrain%2Binjuries%26hl%3Den%26safe%3Dactive%26biw%3D1140%26bih%3D635%26gbv%3D2%26tbm%3Disch0%2C2872&itbs=1&iact=rc&dur=225&page=6&ndsp=15&ved=1t:429,r:10,s: