Traumatic brain injury

1. TRAUMATIC BRAIN INJURY
SWAYAM ACADEMIC WRITING
SWAYAM APPLICATION NUMBER:-
0B3C0030EFDF11E9BD4805FECE566FB4
EMAIL I’D – GUPTASHREYA055@GMAIL.COM
SHREYA
M.A. 2ND YEAR, 3RD SEMESTER

3. WHAT IS HEAD INJURY?
• A HEAD INJURY IS ANY SORT OF INJURY TO YOUR BRAIN, SKULL, OR SCALP. THIS
CAN RANGE FROM A MILD BUMP OR BRUISE TO A TRAUMATIC BRAIN INJURY.
COMMON HEAD INJURIES INCLUDE CONCUSSIONS, SKULL FRACTURES, AND
SCALP WOUNDS. THE CONSEQUENCES AND TREATMENTS VARY GREATLY,
DEPENDING ON WHAT CAUSED YOUR HEAD INJURY AND HOW SEVERE IT IS.
• HEAD INJURIES MAY BE EITHER CLOSED OR OPEN. A CLOSED HEAD INJURY IS
ANY INJURY THAT DOESN’T BREAK YOUR SKULL. AN OPEN (PENETRATING) HEAD
INJURY IS ONE IN WHICH SOMETHING BREAKS YOUR SCALP AND SKULL AND
ENTERS YOUR BRAIN.
• SOME MINOR HEAD INJURIES BLEED A LOT, WHILE SOME MAJOR INJURIES
DON’T BLEED AT ALL. IT’S IMPORTANT TO TREAT ALL HEAD INJURIES SERIOUSLY
AND GET THEM ASSESSED BY A DOCTOR.

4. INCIDENCE OF TBI
• WORLDWIDE, AN ESTIMATED 10 MILLION
PEOPLE INCUR A TBI SERIOUS ENOUGH TO
RESULT IN DEATH OR HOSPITALIZATION
EACH YEAR

5. IN FACT…
INDIA
•60 PERCENT OF ALL TBI CAUSED BY RTA
•FATALITY RATE: 70 PER 10,000 VEHICLES
•25 TIMES HIGHER THAN IN DEVELOPED COUNTRIES
•ALCOHOL INVOLVEMENT: 15-20 PERCENT OF TBI
•A 38 TO 43 PERCENT MORTALITY RATE IN SEVERE TBI
•ONE PERSON DIES IN INDIA EVERY 6 TO 10 MINUTES; WILL BE
EVERY 3 MINUTES BY 2020
•ASIA IS THE LOCATION OF THE HIGHEST RATE OF INJURY FOR
PEDESTRIANS AND MOTORCYCLE OPERATORS
•MOST OF THOSE WHO ARE INJURED IN RTA ARE CONSIDERED
“VULNERABLE ROAD USERS”: PEDESTRIANS (25 PERCENT OF
THOSE INJURED), MOTORCYCLISTS (17 PERCENT),
FOUR-WHEEL VEHICLE OPERATORS (15 PERCENT), AND PEDAL
CYCLISTS (10 PERCENT).

6. • WHAT ARE THE SEVERITY LEVELS OF TBI?
• MILD – AWAKE; EYES OPEN. ALSO CALLED A CONCUSSION.
SYMPTOMS CAN INCLUDE CONFUSION, MEMORY, AND
ATTENTION DIFFICULTIES, HEADACHE, AND BEHAVIORAL
PROBLEMS.
• MODERATE – LETHARGIC; EYES OPEN TO STIMULATION.
SOME BRAIN SWELLING OR BLEEDING CAUSING SLEEPINESS,
BUT STILL AROUSAL.
• SEVERE – COMA; EYES DO NOT OPEN, EVEN WITH
STIMULATION. ASSOCIATED WITH 20-50% DEATH RATE OR
SEVERE DISABILITIES. IT IS IN THIS CATEGORY THAT MANY
LIVES CAN BE SAVED BY APPLICATION OF BTF’S TBI
GUIDELINES.

7. MAJOR TYPE OF HEAD INJURY
• HEMATOMA
• A HEMATOMA IS A COLLECTION, OR CLOTTING, OF BLOOD OUTSIDE THE BLOOD VESSELS. IT CAN BE VERY
SERIOUS IF A HEMATOMA OCCURS IN THE BRAIN. THE CLOTTING CAN LEAD TO PRESSURE BUILDING UP INSIDE
YOUR SKULL. THIS CAN CAUSE YOU TO LOSE CONSCIOUSNESS OR RESULT IN PERMANENT BRAIN DAMAGE.
• HEMORRHAGE
• A HEMORRHAGE IS UNCONTROLLED BLEEDING. THERE CAN BE BLEEDING IN THE SPACE AROUND YOUR BRAIN,
CALLED SUBARACHNOID HEMORRHAGE, OR BLEEDING WITHIN YOUR BRAIN TISSUE, CALLED INTRACEREBRAL
HEMORRHAGE.
• SUBARACHNOID HEMORRHAGES OFTEN CAUSE HEADACHES AND VOMITING. THE SEVERITY OF INTRACEREBRAL
HEMORRHAGES DEPENDS ON HOW MUCH BLEEDING THERE IS, BUT OVER TIME ANY AMOUNT OF BLOOD CAN
CAUSE PRESSURE BUILDUP.
• CONCUSSION
• A CONCUSSION OCCURS WHEN THE IMPACT ON THE HEAD IS SEVERE ENOUGH TO CAUSE BRAIN INJURY. IT’S
THOUGHT TO BE THE RESULT OF THE BRAIN HITTING AGAINST THE HARD WALLS OF YOUR SKULL OR THE FORCES
OF SUDDEN ACCELERATION AND DECELERATION. GENERALLY SPEAKING, THE LOSS OF FUNCTION ASSOCIATED
WITH A CONCUSSION IS TEMPORARY. HOWEVER, REPEATED CONCUSSIONS CAN EVENTUALLY LEAD TO
PERMANENT DAMAGE.

8. MAJOR TYPE OF HEAD INJURY, CONTI….
• EDEMA
• ANY BRAIN INJURY CAN LEAD TO EDEMA, OR SWELLING. MANY INJURIES CAUSE SWELLING OF THE SURROUNDING
TISSUES, BUT IT’S MORE SERIOUS WHEN IT OCCURS IN YOUR BRAIN. YOUR SKULL CAN’T STRETCH TO
ACCOMMODATE THE SWELLING. THIS LEADS TO PRESSURE BUILDUP IN YOUR BRAIN, CAUSING YOUR BRAIN TO
PRESS AGAINST YOUR SKULL.
• SKULL FRACTURE
• UNLIKE MOST BONES IN YOUR BODY, YOUR SKULL DOESN’T HAVE BONE MARROW. THIS MAKES THE SKULL VERY
STRONG AND DIFFICULT TO BREAK. A BROKEN SKULL IS UNABLE TO ABSORB THE IMPACT OF A BLOW, MAKING IT
MORE LIKELY THAT THERE’LL ALSO BE DAMAGE TO YOUR BRAIN. LEARN MORE ABOUT SKULL FRACTURES.
• DIFFUSE AXONAL INJURY
• A DIFFUSE AXONAL INJURY (SHEER INJURY) IS AN INJURY TO THE BRAIN THAT DOESN’T CAUSE BLEEDING BUT
DOES DAMAGE THE BRAIN CELLS. THE DAMAGE TO THE BRAIN CELLS RESULTS IN THEM NOT BEING ABLE TO
FUNCTION. IT CAN ALSO RESULT IN SWELLING, CAUSING MORE DAMAGE. THOUGH IT ISN’T AS OUTWARDLY VISIBLE
AS OTHER FORMS OF BRAIN INJURY, A DIFFUSE AXONAL INJURY IS ONE OF THE MOST DANGEROUS TYPES OF
HEAD INJURIES. IT CAN LEAD TO PERMANENT BRAIN DAMAGE AND EVEN DEATH.

9. CAUSES OF TBI
• TRAUMATIC BRAIN INJURY IS USUALLY CAUSED BY A BLOW OR OTHER TRAUMATIC INJURY TO THE HEAD OR BODY.
THE DEGREE OF DAMAGE CAN DEPEND ON SEVERAL FACTORS, INCLUDING THE NATURE OF THE INJURY AND THE
FORCE OF IMPACT.
• COMMON EVENTS CAUSING TRAUMATIC BRAIN INJURY INCLUDE THE FOLLOWING:
• FALLS. FALLS FROM BED OR A LADDER, DOWN STAIRS, IN THE BATH AND OTHER FALLS ARE THE MOST COMMON
CAUSE OF TRAUMATIC BRAIN INJURY OVERALL, PARTICULARLY IN OLDER ADULTS AND YOUNG CHILDREN.
• VEHICLE-RELATED COLLISIONS. COLLISIONS INVOLVING CARS, MOTORCYCLES OR BICYCLES — AND
PEDESTRIANS INVOLVED IN SUCH ACCIDENTS — ARE A COMMON CAUSE OF TRAUMATIC BRAIN INJURY.
• VIOLENCE. GUNSHOT WOUNDS, DOMESTIC VIOLENCE, CHILD ABUSE AND OTHER ASSAULTS ARE COMMON
CAUSES. SHAKEN BABY SYNDROME IS A TRAUMATIC BRAIN INJURY IN INFANTS CAUSED BY VIOLENT SHAKING.
• SPORTS INJURIES. TRAUMATIC BRAIN INJURIES MAY BE CAUSED BY INJURIES FROM A NUMBER OF SPORTS,
INCLUDING SOCCER, BOXING, FOOTBALL, BASEBALL, LACROSSE, SKATEBOARDING, HOCKEY, AND OTHER HIGH-
IMPACT OR EXTREME SPORTS. THESE ARE PARTICULARLY COMMON IN YOUTH.
• EXPLOSIVE BLASTS AND OTHER COMBAT INJURIES. EXPLOSIVE BLASTS ARE A COMMON CAUSE OF TRAUMATIC
BRAIN INJURY IN ACTIVE-DUTY MILITARY PERSONNEL. ALTHOUGH HOW THE DAMAGE OCCURS ISN'T YET WELL-
UNDERSTOOD, MANY RESEARCHERS BELIEVE THAT THE PRESSURE WAVE PASSING THROUGH THE BRAIN
SIGNIFICANTLY DISRUPTS BRAIN FUNCTION.
• TRAUMATIC BRAIN INJURY ALSO RESULTS FROM PENETRATING WOUNDS, SEVERE BLOWS TO THE HEAD WITH
SHRAPNEL OR DEBRIS, AND FALLS OR BODILY COLLISIONS WITH OBJECTS FOLLOWING A BLAST.

11. SYMPTOMS
• TRAUMATIC BRAIN INJURY CAN HAVE WIDE-RANGING PHYSICAL AND PSYCHOLOGICAL EFFECTS. SOME SIGNS OR
SYMPTOMS MAY APPEAR IMMEDIATELY AFTER THE TRAUMATIC EVENT, WHILE OTHERS MAY APPEAR DAYS OR
WEEKS LATER.
• MILD TRAUMATIC BRAIN INJURY
• THE SIGNS AND SYMPTOMS OF MILD TRAUMATIC BRAIN INJURY MAY INCLUDE:
PHYSICAL SYMPTOMS
• LOSS OF CONSCIOUSNESS FOR A FEW SECONDS TO A FEW MINUTES
• NO LOSS OF CONSCIOUSNESS, BUT A STATE OF BEING DAZED, CONFUSED OR DISORIENTED
• HEADACHE
• NAUSEA OR VOMITING
• FATIGUE OR DROWSINESS
• PROBLEMS WITH SPEECH
• DIFFICULTY SLEEPING
• SLEEPING MORE THAN USUAL
• DIZZINESS OR LOSS OF BALANCE

12. CONTINUE….
SENSORY SYMPTOMS
• SENSORY PROBLEMS, SUCH AS BLURRED VISION, RINGING IN THE EARS, A BAD
TASTE IN THE MOUTH OR CHANGES IN THE ABILITY TO SMELL
• SENSITIVITY TO LIGHT OR SOUND
COGNITIVE OR MENTAL SYMPTOMS
• MEMORY OR CONCENTRATION PROBLEMS
• MOOD CHANGES OR MOOD SWINGS
• FEELING DEPRESSED OR ANXIOUS

13. • MODERATE TO SEVERE TRAUMATIC BRAIN INJURIES
• MODERATE TO SEVERE TRAUMATIC BRAIN INJURIES CAN INCLUDE ANY OF THE SIGNS AND SYMPTOMS OF MILD INJURY, AS WELL AS THESE
SYMPTOMS THAT MAY APPEAR WITHIN THE FIRST HOURS TO DAYS AFTER A HEAD INJURY:
PHYSICAL SYMPTOMS
• LOSS OF CONSCIOUSNESS FROM SEVERAL MINUTES TO HOURS
• PERSISTENT HEADACHE OR HEADACHE THAT WORSENS
• REPEATED VOMITING OR NAUSEA
• CONVULSIONS OR SEIZURES
• DILATION OF ONE OR BOTH PUPILS OF THE EYES
• CLEAR FLUIDS DRAINING FROM THE NOSE OR EARS
• INABILITY TO AWAKEN FROM SLEEP
• WEAKNESS OR NUMBNESS IN FINGERS AND TOES
• LOSS OF COORDINATION
COGNITIVE OR MENTAL SYMPTOMS
• PROFOUND CONFUSION
• AGITATION, COMBATIVENESS OR OTHER UNUSUAL BEHAVIOR
• SLURRED SPEECH
• COMA AND OTHER DISORDERS OF CONSCIOUSNESS

14. • RISK FACTORS
• THE PEOPLE MOST AT RISK OF TRAUMATIC BRAIN INJURY INCLUDE:
• CHILDREN, ESPECIALLY NEWBORNS TO 4-YEAR-OLDS
• YOUNG ADULTS, ESPECIALLY THOSE BETWEEN AGES 15 AND 24
• ADULTS AGE 60 AND OLDER
• MALES IN ANY AGE GROUP

15. • WHAT ARE THE CAUSES OF TRAUMATIC BRAIN INJURY
(TBI)?
• WE’VE SPENT A BIT OF TIME TALKING ABOUT THE
DIFFERENT SEVERITY LEVELS. NOW WE’RE GOING TO
PROVIDE AN OVERVIEW OF THE TWO COMMON CAUSES
OF TBI.
• THERE ARE TWO TYPES OF TBIS:
• ACCELERATION AND DECELERATION INJURIES
• CRUSH INJURIES

16. • WHAT IS AN ACCELERATION AND DECELERATION INJURY?
• THE MOST COMMON CAUSE OF AN ACCELERATION AND
DECELERATION INJURY IS THE QUICK SLOWING THAT
OCCURS IN A CAR ACCIDENT.
• FOR EXAMPLE, IN A CAR ACCIDENT, THE SUDDEN SLOWING
OFTEN CAUSES INDIVIDUALS TO HIT THEIR HEADS ON THEIR
STEERING, DASHBOARD, OR SIDE WINDOW.
• IN THESE CASES, THE INDIVIDUAL’S HEAD IS PROPELLED IN
ONE DIRECTION, THEN IN THE OPPOSITE DIRECTION, AND
THEN COMES TO A SUDDEN STOP.

17. • ACCELERATION/ DECELERATION CAUSES DAMAGE
THROUGH THREE DIFFERENT MECHANISMS:
• COUP-CONTRECOUP INJURY
• ROTATIONAL FORCES
• SUDDEN ACCELERATION

19. • ROTATIONAL FORCES
• ROTATIONAL FORCES ARE CREATED WHEN THE HEAD IS
STRUCK AT AN ANGLE CAUSING THE BRAIN TO TWIST
AWAY FROM THE POINT OF IMPACT.
• THE ROTATIONAL FORCES CAUSE THE FIBERS AND
BLOOD VESSELS IN THE BRAIN TO ROTATE AND TWIST
RESULTING IN DAMAGE.

20. SUDDEN ACCELERATION
WHEN THE BRAIN IS SET INTO SUDDEN AND VIOLENT MOTION , IT CAN BE
DAMAGED BY THE SHARP AND BONY PROTUBERANCE THAT ARE INSIDE OF THE
SKULL.
THIS PROTUBERANCES ARE LOCATED IN THE REGION OF THE SKULL THAT HOUSES
THE INTERIOR FRONTAL LOBE AND ANTERIOR TEMPORAL LOBES.

21. WHAT IS A CRUSH INJURY?
• CRUSH INJURIES ARE ANOTHER FORM OF BLUNT FORCE
TRAUMA. IN A CRUSH INJURY, THE HEAD ISN’T
PROPELLED INTO MOTION. IT STAYS STATIONARY AND IS
STRUCK WITH A MOVING OBJECT.
• EXAMPLES OF CRUSH INJURIES INCLUDE BEING HIT BY A
FALLING OBJECT (E.G. A TREE BRANCH OR OBJECT AT A
CONSTRUCTION SITE) OR BEING KICKED IN THE HEAD
DURING AN ASSAULT.

23. ASSESSMENTS OFF TBI…
• THE GLASGOW COMA SCALE (GCS), WHICH IS DETERMINED
WHEN THE PERSON FIRST ARRIVES AT THE HOSPITAL.
• LOSS OF CONSCIOUSNESS (LOC)
• POST-TRAUMATIC AMNESIA (PTA), WHICH IS A STATE OF
CONFUSION AND MEMORY LOSS RIGHT AFTER A TBI. PTA
OCCURS BECAUSE THERE IS AN IMPAIRMENT IN ATTENTION
AND CONCENTRATION, WHICH ARE REQUIRED TO PLACE
NEW INFORMATION INTO MEMORY STORAGE.

25. • WHAT IS POST-TRAUMATIC AMNESIA (PTA)?
• POST-TRAUMATIC AMNESIA (PTA) IS A STATE OF
CONFUSION AND MEMORY LOSS RIGHT AFTER A
TRAUMATIC BRAIN INJURY. PTA OCCURS BECAUSE
THERE ARE IMPAIRMENTS IN ATTENTION AND
CONCENTRATION, WHICH ARE REQUIRED TO PLACE NEW
INFORMATION INTO MEMORY STORAGE.
HERE ARE SOME OF THE COMMON SIGNS OF PTA:
• DISORIENTATION AND CONFUSION
• ANTEROGRADE AMNESIA (DIFFICULTY FORMING NEW
MEMORIES)
• RETROGRADE AMNESIA (DIFFICULTY RECALLING OLD
MEMORIES)
• DISTRACTIBILITY
• DIFFICULTIES WITH ALERTNESS

26. • GLASGOW COMA SCALE
• THE GLASGOW COMA SCALE (GCS) DEFINES THE SEVERITY OF A TBI WITHIN 48 HOURS OF INJURY.
EYE OPENING
• SEE THE LIST BELOW:
• SPONTANEOUS = 4
• TO SPEECH = 3
• TO PAINFUL STIMULATION = 2
• NO RESPONSE = 1
MOTOR RESPONSE
• SEE THE LIST BELOW:
• FOLLOWS COMMANDS = 6
• MAKES LOCALIZING MOVEMENTS TO PAIN = 5
• MAKES WITHDRAWAL MOVEMENTS TO PAIN = 4
• FLEXOR (DECORTICATE) POSTURING TO PAIN = 3
• EXTENSOR (DECEREBRATE) POSTURING TO PAIN = 2
• NO RESPONSE = 1

27. VERBAL RESPONSE
• SEE THE LIST BELOW:
• ORIENTED TO PERSON, PLACE, AND DATE = 5
• CONVERSES BUT IS DISORIENTED = 4
• SAYS INAPPROPRIATE WORDS = 3
• SAYS INCOMPREHENSIBLE SOUNDS = 2
• NO RESPONSE = 1
THE SEVERITY OF TBI ACCORDING TO THE GCS SCORE (WITHIN 48 H) IS AS
FOLLOWS:
1. SEVERE TBI = 3-8
2. MODERATE TBI = 9-12
3. MILD TBI = 13-15

28. • PREVENTION
• FOLLOW THESE TIPS TO REDUCE THE RISK OF BRAIN INJURY:
• SEAT BELTS AND AIRBAGS. ALWAYS WEAR A SEAT BELT IN A MOTOR VEHICLE. A
SMALL CHILD SHOULD ALWAYS SIT IN THE BACK SEAT OF A CAR SECURED IN A
CHILD SAFETY SEAT OR BOOSTER SEAT THAT IS APPROPRIATE FOR HIS OR HER
SIZE AND WEIGHT.
• ALCOHOL AND DRUG USE. DON'T DRIVE UNDER THE INFLUENCE OF ALCOHOL
OR DRUGS, INCLUDING PRESCRIPTION MEDICATIONS THAT CAN IMPAIR THE
ABILITY TO DRIVE.
• HELMETS. WEAR A HELMET WHILE RIDING A BICYCLE, SKATEBOARD,
MOTORCYCLE, SNOWMOBILE OR ALL-TERRAIN VEHICLE. ALSO WEAR
APPROPRIATE HEAD PROTECTION WHEN PLAYING BASEBALL OR CONTACT
SPORTS, SKIING, SKATING, SNOWBOARDING OR RIDING A HORSE

29. • PREVENTING FALLS
• THE FOLLOWING TIPS CAN HELP OLDER ADULTS AVOID FALLS AROUND THE
HOUSE:
• INSTALL HANDRAILS IN BATHROOMS
• PUT A NONSLIP MAT IN THE BATHTUB OR SHOWER
• REMOVE AREA RUGS
• INSTALL HANDRAILS ON BOTH SIDES OF STAIRCASES
• IMPROVE LIGHTING IN THE HOME
• KEEP STAIRS AND FLOORS CLEAR OF CLUTTER
• GET REGULAR VISION CHECKUPS
• GET REGULAR EXERCISE

30. • PREVENTING HEAD INJURIES IN CHILDREN
• THE FOLLOWING TIPS CAN HELP CHILDREN AVOID HEAD INJURIES:
• INSTALL SAFETY GATES AT THE TOP OF A STAIRWAY
• KEEP STAIRS CLEAR OF CLUTTER
• INSTALL WINDOW GUARDS TO PREVENT FALLS
• PUT A NONSLIP MAT IN THE BATHTUB OR SHOWER
• USE PLAYGROUNDS THAT HAVE SHOCK-ABSORBING MATERIALS ON THE
GROUND
• MAKE SURE AREA RUGS ARE SECURE
• DON'T LET CHILDREN PLAY ON FIRE ESCAPES OR BALCONIES

31. ACKNOWLEDGEMENT
I WOULD LIKE TO EXPRESS MY SPECIAL THANKS OF THE TEACHERS DR. AJAY
SEMALTY, DR MONA SEMALTY AND ALL THE TEAM MEMBER OF THIS ACADEMIC
WRITING COURSE AND AS WELL AS SWAYAM ONLINE ACADEMIC COURSE WHICH
GIVE ME THE GOLDEN OPPORTUNITY TO PUBLISHED MY PRESENTATION.
THANKING YOU