• A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury [mTBI/concussion] to severe traumatic brain injury), mechanism (closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional and behavioural symptoms, and outcomes can range from complete recovery to permanent disability or death. • Causes include falls, vehicle collisions and violence. Brain trauma occurs as a consequence of a sudden acceleration or deceleration within the cranium or by a complex combination of both movement and sudden impact. In addition to the damage caused at the moment of injury, a variety of events following the injury may result in further injury. These processes include alterations in cerebral blood flow and pressure within the skull. Some of the imaging techniques used for diagnosis include computed tomography (CT) and magnetic resonance imaging (MRIs). • Prevention measures include use of seat belts and helmets, not drinking and driving, fall prevention efforts in older adults and safety measures for children. Depending on the injury, treatment required may be minimal or may include interventions such as medications, emergency surgery or surgery years later. Physical therapy, speech therapy, recreation therapy, occupational therapy and vision therapy may be employed for rehabilitation. Counselling, supported employment and community support services may also be useful. CLASSIFICATION: • Traumatic brain injury is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration, impact, blast waves, or penetration by a projectile. Brain function is temporarily or permanently impaired and structural damage may or may not be detectable with current technology. • TBI is one of two subsets of acquired brain injury (brain damage that occur after birth); the other subset is non-traumatic brain injury, which does not involve external mechanical force (examples include stroke and infection). All traumatic brain injuries are head injuries, but the latter term may also refer to injury to other parts of the head. However, the terms head injury and brain injury are often used interchangeably. Similarly, brain injuries fall under the classification of central nervous system injuries and neurotrauma. In neuropsychology research literature, in general the term "traumatic brain injury" is used to refer to non-penetrating traumatic brain injuries.

1. UNIT 11
TRAUMATIC BRAIN INJURY:
(Traumatic Brain Injuries, Penetrating and Non- Penetrating injuries, Secondary
consequences of TBI, Assessment of TBI patients, Rehabilitation of TBI patients, Treatment
outcome)
Submitted to Submitted by
DR. SATISH K. HIMANI BANSAL
MVSCOSH MASLP IInd year

2. • Also known as an intracranial injury, is an injury to
the brain caused by an external force
• Head injury is a broader category that may involve damage
to other structures such as the scalp and skull
• TBI can result in physical, cognitive, social, emotional and
behavioural symptoms
TBI
• Causes include falls, vehicle collisions and violence
• Brain trauma occurs as a consequence of a sudden
acceleration or deceleration within the cranium or by a
complex combination of both movement and sudden impact
CAUSES
• Prevention measures include use of seat belts and helmets,
not drinking and driving, fall prevention efforts in older
adults and safety measures for children
• Treatment may include surgery, medications, rehabilitation,
counselling & community support services
PREVENTION

3. CLASSIFICATION
Based on SEVERITY
1. Mild Brain Injury
2. Moderate Brain Injury
3. Severe Brain Injury
Based on
MECHANISM
1. Penetrating/Open Brain
Injury
2. Non- Penetrating/Closed
Brain Injury

4. PATHOLOGICAL FEATURES
Concussions
Brain
Contusions
Anoxic Brain
Injuries
Intracerebral
Haemorrhage
Subdural
Hematomas
Ischemia
Subarachnoid
Haemorrhage
Hypoxic Brain
Injuries
Second
Impact
Syndrome

5. SECONDARY CONSEQUENCES OF TBI
Cognitive deficits
Cognitive
Communication
deficits
Motor deficits
Speech deficits
Language
deficits
Functional
deficits
Social difficulties
Regulatory
disturbances
Personality or
Psychiatric
changes

6. ASSESSMENT OF TBI PATIENTS
To determine speech, language, cognitive-communication, swallowing, and audiologic
strengths and needs
Purpose
• Standardized assessment
• Non- Standardized assessment
Methods/Procedures
•Case history
•Non-speech examination & Speech production
•Language
•Cognitive- communication
•Swallowing
Comprehensive Speech &
Language Assessment
• Case history
• Behavioral hearing testing
• Auditory processing
• Vestibular testing
Comprehensive Audiologic &
Vestibular Assessment

8. STUDIES
CITATION RESULT
Halbauer JD, Ashford JW, Zeitzer JM, Adamson MM, Lew HL,
Yesavage JA. Neuropsychiatric diagnosis and management of
chronic sequelae of war-related mild to moderate traumatic
brain injury. J Rehabil Res Dev 2009;46:757-96
Cognitive communication disorder or inappropriate communication following TBI may impair social
interacting and reintegrating which can ultimately lead to frustrating or embarrassing experiences.
Larkins B. The application of the ICF in cognitive communication
disorders following traumatic brain injury. Semin Speech Lang
2007;28:334-42
Persons with TBI can suffer from delayed word recall to reduced emotion while communicating with
others. They find difficulty specially in word finding and language processing.
Docking K, Murdoch BE, Jordan FM. Interpretation and
comprehension of linguistic humour by adolescents with head
injury: A group analysis. Brain Inj 2000;14:89-108
Brain-injured persons show impairments in self-focused conversation and in interpreting linguistic
humor.
Barwood, C. H., & Murdoch, B. E. (2013). Unravelling the
influence of mild traumatic brain injury (MTBI) on cognitive-
linguistic processing: A comparative group analysis. Brain
Injury, 27(6), 671-676.
The results demonstrated statistically significant differences between MTBI and normal control group
performance across a number of higher-level linguistic, general cognitive and general language tasks.
MTBI group performance was significantly lower than the normal control group on tasks requiring
complex lexical semantic operations and memory demands, including: Recall, organization, making
inferences, naming and perception/discrimination.
Wong, M. N., Murdoch, B., & Whelan, B. M. (2010). Language
disorders subsequent to mild traumatic brain injury (MTBI):
Evidence from four cases. Aphasiology, 24(10), 1155-1169.
high-level cognitive-linguistic deficits may occur as a consequence of MTBI and imply that MTBI
mechanisms may have the capacity to alter frontal lobe functioning. It is suggested that more sensitive
measures of cognitive and high-level language function are needed in the assessment of MTBI.

9. TREATMENT APPROACHES
RESTORATIVE
Involves direct therapy
aimed at improving or
restoring impaired
function(s) through
retraining
Hierarchical, targets
specific processes in the
the impaired domain
COMPENSATORY
Focusses on adapting
to deficits by learning
new or different ways of
of doing things to
minimize difficulties
Draws on the
individual's strengths to
maximize his or her
abilities, often through
the use of external or
internal aids

10. TREATMENT OF TBI PATIENTS
MEDICAL:
• Surgery
• Medicines
REHABILITATION THERAPIES:
• PT, OT, SLT, Cognitive therapy
• Counselling
AAC:
• Supplementing or replacing natural speech and/or writing with aided (e.g., pictures, line drawings, speech-
generating devices, and tangible objects) and/or unaided (e.g., manual signs, gestures, and finger spelling)
symbols
• May be temporary or permanent

11. TEAM APPROACH
NEUROLOGIST/
NEUROSURGEON
PHYSICAL
THERAPIST
NURSE
PSYCHIATRIST SLP
COUNSELLOR DIETICIAN
AUDIOLOGIST
OCCUPATIONAL
THERAPIST

12. 1. https://www.dolmanlaw.com/blog/4-types-brain-injuries-3-levels-severity/
2. https://en.wikipedia.org/wiki/Traumatic_brain_injury
3. https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury
4. https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/communication-problems/language-
impairment-aphasia/
5. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Traumatic-Brain-Injury
6. https://medlineplus.gov/traumaticbraininjury.html
7. https://www.asha.org/practice-portal/clinical-topics/traumatic-brain-injury-in-adults/#collapse_4
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904751/
REFERENCES

13. QUESTIONS ASKED IN PREVIOUS YEARS
1. Short note on consequences of TBI. 4 Marks (2017)
2. Short note on treatment of TBI. 4 Marks (2021)
3. Describe the cognitive- linguistic characteristics seen in TBI. 6 Marks (2013)
4. Describe the assessment, rehabilitation and treatment outcomes in traumatic brain injury
patients. 16 Marks (2011)
5. What are the cognitive- linguistic deficits seen in persons with TBI? Support your answer by
providing corroborative research findings. 16 Marks (2011)