Traumatic brain injury (TBI) is an injury to the brain as a result of accident or injury. It may be focal (confined to a small area) or diffuse (affecting a large area of the brain).

Generally, when patients suffer a TBI, they are brought to an emergency room for evaluation and treatment. They may be suffering such signs and symptoms as:

• Nausea
• Confusion
• Problems concentrating and remembering
• Irritability
• Seizures
• Unconsciousness

Traumatic brain injuries may be classified as closed head injuries or penetrating head injuries. Closed head injuries usually occur as a result of a blow to the head, or from being struck in the head by an object. A closed head injury may result from a motor vehicle accident when you strike your head on the windshield. A penetrating head injury occurs when an object penetrates the skull, which may drive small bits of bone or tissue into the brain. A gunshot wound is a good example of a penetrating head trauma.

The following terms help to illustrate the different areas of the brain and the effect that suffering a traumatic brain injury to these areas may have on the patient.

Brainstem- This area is where the brain connects to the spinal cord. Damage to this area of the brain may result in death as this area controls critical functions such as heart rate, blood pressure, and breathing. This center is also responsible for arousal, or the state of being awake and alert.

Any TBI that requires brain surgery can cause further damage to the brain if left untreated. Pressure on the brain is harmful because the skull is fixed and cannot expand; therefore, when the brain swells, it can be compressed up against the hard bony structure of the skull. This can lead to irreparable damage if this pressure is not relieved.

Recovery from TBI depends on whether the injury sustained is mild, moderate, or severe.

Traumatic brain injury commonly affects people of younger age and can cause life-long disability in physical, cognitive, behavioural, and social function. Even more so than physical deficits, behaviour and personality deficits may be even more disabling. Recovery from TBI can take up to several years from the time of the initial injury.

As with rehabilitation from any illness or injury, the goal of rehabilitation following TBI is to return the patient to the maximum degree of function possible. There are two phases of rehabilitation: inpatient rehabilitation and community management.

Patients who suffer a moderate to severe TBI should have their nutritional needs met as soon as possible after the injury. New studies have indicated that the body heals better when proper nutrition is provided, above the minimum once thought to be adequate.

Depending on the severity of TBI, there may be a need for a wide range of medical supplies for the patient’s home. Some equipment may be needed for a short time until the patient regains function. In severe TBI, equipment may be needed on a permanent basis.

It is difficult to predict with any accuracy what long-term effects TBI will have on the patient. Effects may not become evident until well after the initial injury. This is due to the fact that, initially, the brain swells. It takes time for this swelling to subside, so that it becomes difficult for medical personnel to determine if damage is due to the initial assault or is a permanent, lingering effect.

Care must be taken in prescribing medications for patients with TBI, as they may be overly sensitive to medications and side effects may be more pronounced, due to changes in the blood-brain barrier that may occur as a result of TBI.

Self-medicating should be discouraged. Over-the-counter medications and herbal remedies should be cleared with the patient’s physician, as some of these medications may be harmful for the patient with TBI, or may react adversely with medications the patient is already taking and that has been prescribed.