What is a Brain Injury?
Brain injuries can range from mild to catastrophic or even fatal, have multiple causes and a host of possible outcomes, and may require specialized diagnosis and treatment. Everyone is susceptible, too, as they affect age groups from infants to the elderly. The bottom line is that brain injury is complex and its manifestations – typically not physically visible or apparent — are often unique to the individual. The encouraging news is that recent activity in scientific and medical research on brain injury has resulted in a wave of innovative and promising diagnostic, pharmaceutical, rehabilitative, and even preventive options, providing hope and optimism for survivors and their families.
Types of Brain Injury and Causes
Medical and brain injury professionals use several different terms to describe brain injuries.
While the Brain Injury Association of Michigan aims to provide information, resources, and support for all brain injury survivors and families, much of the following content is directed at audiences interested in and affected by TBI.
The broadest category, Acquired Brain Injury (ABI), includes brain damage caused by events after birth, rather than injury resulting from a genetic or congenital disorder such as fetal alcohol syndrome, pre-birth illness or hypoxia (lack of oxygen), or as part of a degenerative condition such as Alzheimer’s Disease or Parkinson’s Disease. Some causes of ABI include anoxia or hypoxia (lack of oxygen or insufficient oxygen to the brain), brain tumors, stroke, lightning strikes and other forms of electric shocks, infectious diseases, seizure disorders, and toxic exposure and substance abuse.
Traumatic Brain Injury (TBI) is a subset of Acquired Brain Injury, but is usually considered separately due to its high incidence and complexity in terms of individual diagnosis and treatment. TBI refers to blows, jolts, or injuries to the head, with the latter ranging from gunshot wounds to sudden acceleration and deceleration, strong rotational forces, and others.
Why Focus on TBI?
A number of reasons account for this focus, including the fact that many more Americans are affected by TBI, about 2.5 million annually, than by any other single cause of ABI (excluding TBI, estimates of all other forms of ABI number 1 million annually). Additionally, a significant portion of the work of the Brain Association of Michigan, as that of our national organization, the Brain Injury Association of America (www. BIAUSA.org), is focused on legislative advocacy, and the policy issues affecting TBI are often very different than those affecting ABI. Finally, and most importantly, while there are excellent online organizations and resources dealing with other kinds of Acquired Brain Injury, we believe we achieve our greatest impact through serving the historically underserved community of TBI survivors, families, and the professional brain injury community.
On-site athletic concussion assessment
Various tools and techniques have been developed and proposed for evaluating athletes immediately after receiving a blow to the head or helmet. These range from asking the athlete simple questions (“where are we?”, “who are we playing today?”, “what’s the score?”), to visual/cognitive task tests (King-Devick), balance tests, and, among others, to the significantly more complex Sports Concussion Assessment Tool III (SCAT III), whose eight elements — based on both the individual’s perceptions and task scores as well as examiner assessments– include:
- Symptom Score
- Physical Signs Score
- Glasgow Coma Scale (GCS) Score
- Sideline Assessment/Maddocks Score (e.g., “At which venue are we at today?”)
- Cognitive Assessment (Orientation and Memory Components)
- Balance Examination
- Coordination Examination
- Cognitive Assessment
Because the cognitive and physical abilities of individuals vary widely, any so-called “sideline test” will be more predictive when the athlete has taken the test prior to the injury – for example, when pre-season workouts begin — to establish a baseline measure of performance. A number of high school, collegiate, and professional teams already require baseline testing and that number is expected to grow.
CT or MRI Scan Results
The cranial tomography (CT) scan is a type of X-ray that shows problems in the brain such as bruises, blood clots, and swelling. CT scans are not painful. People with moderate to severe TBI will have several CT scans while in the hospital to keep track of lesions (damaged areas in the brain). In some cases, a magnetic resonance imaging (MRI) scan may also be performed. This creates a picture of the brain based on magnetic properties of molecules in tissue. Most people with severe TBI will have an abnormality on a CT scan or MRI scan. Because these scans cannot detect all types of brain injuries, it remains possible to have a severe TBI and be in coma even though the scan results are normal.