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What is it? These are some of the many causes of traumatic brain injury. Each year in the United States, about 1.5 million people sustain a brain injury. Brain injury is a major cause of death and disability for children and adults. More US children die of brain injury than of any other cause.

A blow or jolt to the head can cause traumatic brain injury. The blow causes damage to the brain. Some injuries are focal, or in one area of the brain. Others are diffuse, or in more than one area of the brain.

Injuries can range from a mild concussion to severe injury, coma, and death. If you have a mild concussion, you may have no long-term side effects. If you have a moderate to severe brain injury, side effects can range from headache and confusion to personality changes and seizures.

Fortunately, brain injury is one of the most preventable brain disorders. Improved use of car safety belts and child car seats has helped reduce the number of brain injuries. So has greater use of helmets in biking and other sports. Efforts to reduce drinking and driving have also helped.

There have been considerable efforts to recognize and prevent brain injuries in sports. Coaches and parents have learned the signs of concussion. They have also learned that student athletes must get quick medical care.

Severe brain injuries affect both the injured people and their families. It is a period of great trauma and change. Over time, often with the help of counseling, you begin to develop a new sense of self. Then you make decisions based on that new reality.

Types of traumatic brain injury. There are several types of brain injuries, depending on the type of force and amount of force that impacts the head.

In open head injury the skull is fractured or displaced.

In closed head injury there is no skull fracture.

Concussion is the mildest and the most common type of brain injury. Trauma from an impact or a sudden momentum or movement change can cause a concussion.

A contusion is a bruise on the brain caused by a skull fracture.

In a coup-contrecoup injury, bruises are both at the site of impact and on the opposite side of the brain. This occurs when the impact forces the brain to hit the opposite side of the skull. This can happen in car accidents after high-speed stops. It also happens in Shaken Baby Syndrome.

Shaken Baby Syndrome occurs when a baby is shaken forcefully. Different parts of the brain can be injured in this way. Shaking is so dangerous for babies due to their small size, large relative head size, and undeveloped necks, skulls, and brains.

Second Impact Syndrome can occur when a person sustains a second brain injury before the symptoms of the first injury have healed. The second injury can happen from days to weeks after the first one. It is also called recurrent traumatic brain injury.

What is the cause? Half of all brain injuries are due to transportation-related accidents. These can include car, motorcycle, and bicycle accidents, as well as injuries to pedestrians. About 20 percent of brain injuries are due to violence. This can include firearm use and child abuse. For people age 75 and older, brain injuries are most often caused by falls.

What are the symptoms? Symptoms of a brain injury can be mild to severe, depending on the amount of damage. Some symptoms show up right away. Others may not appear until several days or weeks after the injury.

Immediate Signs of Concussion (Seen within seconds/minutes):

· Any loss of consciousness

· Impaired attention: vacant stare, delayed responses, inability to focus

· Slurred or incoherent speech

· Lack of coordination

· Disorientation

· Emotional reactions out of proportion

· Memory problems

· Later Signs of Concussion

If the following symptoms occur, hours or even days or weeks later, consult a neurologist:

· Persistent headache

· Dizziness / vertigo

· Poor attention and concentration

· Memory problems

· Nausea or vomiting

· Fatigue easily

· Irritability

· Intolerant of bright lights and / or loud noises

· Anxiety and / or depression

· Disturbed sleep

People with moderate to severe brain injury may have these same symptoms, as well as:

· Seizures

· Physical, cognitive or behavioral impairments that last for months or are permanent

· Prolonged unconscious state

· Coma

How is it diagnosed? People with head injuries must get emergency medical treatment in the first few hours. This can make the difference between recovery and disability or death. It is helpful to have a neurologist involved early in the diagnosis and treatment. It is even more vital if symptoms continue for more than a few days or weeks.

After an injury, the patient is stabilized. Then doctors can assess the severity of the brain injury. They check the person’s level of consciousness and neurological functioning. They use the Glasgow Coma Scale. This measures eye opening, verbal response, and motor response. The test has 15 points. A score of zero is consistent with brain death. A total score of 3 to 8 is a severe brain injury. From 9 to 12 is a moderate injury. And 13 or 14 is a mild injury, with 15 being normal.

Imaging tests may also be used to help in the diagnosis. These may include X-rays and CT (computerized tomography) scans.

What are the treatments? It’s important to remember that the treatment and recovery process is different for everyone. No two brain injuries are alike.

Treatment begins at the time of the accident or incident. A brain injury is an emergency. Medical personnel try to stabilize the person. They also work to prevent further injury. They make sure oxygen gets to the brain. They also make sure there is enough blood flow. Blood pressure must be controlled.

About half of all severely injured people will need surgery. This may be to remove or repair a hematoma. A hematoma is bleeding in or around the brain. Some people may need a ventriculostomy. This procedure drains fluid from the brain.

After the emergency treatment, people may receive care in an intensive care unit in a hospital. Once they are stable, they may move to the subacute unit of the hospital or to a rehabilitation hospital.

At this point, people follow many paths toward recovery. There are many options for rehabilitation. These can include:

· Day treatment

· Outpatient therapy

· Home health services

· Independent living programs

The goal of rehabilitation is to help people regain the most independent level of functioning possible.

The rehabilitation team may include:

· Neurologist

· Physiatrist (physical medicine specialist)

· Physical therapist

· Occupational therapist

· Rehabilitation nurse

· Speech/language pathologist

· Neuropsychologist

· Social worker/case manager

Medication is needed for some people. People with brain injuries can be at more risk for side effects. So doctors are careful in choosing and monitoring their patients’ drugs.

Rehabilitation should be tailored to each person. It should be based on the individual’s strengths and capacities.

There is much that is still unknown about the brain and how it heals and relearns tasks. As we learn, new treatment methods are being developed.

Prevention. Fortunately, brain injury is one of the most preventable brain disorders. In many cases, taking simple steps can prevent injury.

Falls. For children under age five, falls are the number one cause of brain injury. To help prevent falls:

· Never leave infants unattended on changing tables or other furniture where there is danger of falling.

· Never use baby walkers on wheels.

· Use safety gates at the top and bottom of stairs.

· Lock all unopened windows. Open windows from the top, not the bottom. Move chairs and other furniture away from windows. Consider installing window guards.

Motor vehicle crashes. Motor vehicle crashes are the number one cause of brain injury among children ages 4 to 14. To help prevent injury:

· Always place infants and children under 12 in the back seat of the car.

· Infants age one and under or children weighing less than 20 pounds should ride in a rear facing child safety seat.

· Children weighing 20 to 40 pounds should ride in approved car seats, facing forward.

· Children weighing 40 to 80 pounds should ride in approved car booster seats.

Pedestrian injuries. Each year, about 50, 000 children are hit by motor vehicles. Many receive serious brain injuries. To help prevent injury:

· Children should hold an adult’s hand when crossing the street. They should cross only at designated crossing areas.

· Children should never cross between parked cars.

· Children should be taught to look left-right-left when crossing. They should also learn to watch for turning cars.

Sports and recreation injuries. There are an estimated 300, 000 sports-related concussions in the US each year. To help prevent injury, wear a helmet, and make sure children wear helmets when:

· Riding a bicycle

· Playing contact sports such as football and hockey

· Using in-line skates or skateboards

· Batting and running bases in baseball or softball

· Riding a horse

· Skiing or snowboarding

Firearms injuries. Firearms are the number one cause of brain injury deaths in the US. Nearly all unintentional shootings occur in or around the home. To help prevent injury:

· Always keep guns unloaded and locked up. Make sure children do not have access to guns.

· Explain to children that guns are dangerous. Tell them never to touch guns. Tell them never to stay in a home where a gun is accessible.

Living With. The effects of a brain injury can last for months or even years. They can include:

· Problems with cognition, such as memory problems and difficulty concentratingCommunication problems, such as difficulty expressing yourself and understanding others

· Behavior or mental health problems, such as depression and personality changes

Treatments and help are available for many of these problems. For others, the goal may be to minimize the impact they have on your life.Many people find that support groups for people with brain injuries are a source of help, comfort, and information. They learn about coping skills and resources that can help.Over time, often with the help of counseling, people adjust to their new strengths and weaknesses and develop a new sense of self.