Traumatic Brain Injury (TBI)-Long-Term Care
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- Traumatic brain injury (TBI) is caused by external trauma to the brain and may result in chronic impairment of physical, cognitive, and psychosocial function. The management of acute TBI is not covered here.
- Mild TBI (mTBI) is synonymous with concussion.
- Predominant age: highest incidence in the very young (0 to 4 years), from 15 to 24 years of age, and after age 75 years
- Predominant sex: male > female (2:1)
- ~2 million in the United States sustain a TBI per year.
- 50,000 deaths per year
- 80,000 to 90,000 sustain long-term disabilities.
5.3 million in United States have TBI-related disabilities.
Interactions of physical, cognitive, and behavioral sequelae interfere with new learning. Effects of early TBI may not become apparent until later.
Etiology and Pathophysiology
- Falls and motor vehicle accidents are the most common causes.
- Violence-related TBI is increasing (10% of all cases).
- Sports and recreation injuries (especially in teenagers and young adults)
- Cortical contusions due to coup-contrecoup injuries. Although axonal rupture from shear and tensile forces can occur at the time of severe head injury, milder degrees of axonal damage play a role in mTBI.
- Disruption of axonal neurofilament organization impairs axonal transport, leading to axonal swelling, wallerian degeneration, and transection.
- Release of excitatory neurotransmitters acetylcholine, glutamate, and aspartate and generation of free radicals may contribute to secondary injury.
- High risk: male, age 15 to 34 years
- Moderate risk <5 years and >60 years
- Lower socioeconomic status (head injury)
- Improved safety standards and programs to minimize injury from vehicular-related events (motor vehicle, motorcycle, bicycle, pedestrian), falls, violence, sports, and recreation provide best prevention against TBI.
- This includes car seat safety, seatbelt use, helmet use, trip hazards (senior living), balance activities (seniors), safety gates, sport-specific training, and playground safety regulations.
Commonly Associated Conditions
- Chronic headaches
- Suicide attempts
- Substance abuse
- Attention deficit disorder