Although it has existed seemingly forever, traumatic brain injury—commonly referred to as TBI—has become a familiar contemporary topic. One reason is the phenomenon of its impact on the military and in football.
A consequence of both military training and combat, TBI is often called the signature wound of the Iraq and Afghanistan wars. Estimates range from 360,000 to 400,000 soldiers who have suffered from minor to severe TBI in these wars.
And in football, an April 2016 study by the American Academy of Neurology (AAN) stated that “more than 40 percent of retired National Football League (NFL) players had signs of traumatic brain injury based on sensitive MRI scans called diffusion tensor imaging (DTI).”
TBI is a result of sudden trauma, which causes damage to the brain. This can occur with a blow/impact to the head or when an object penetrates the skull, impacting the brain tissue. The range of TBI can vary from mild to moderate to severe. Thus, the injured person may or may not lose consciousness for any length of time (brief to prolonged) with the greatest degree of unconsciousness equaling a coma.
Proving that TBI affects more than those in uniform, here are some enlightening statistics about TBI in the United States, according to brainline.org:
· An estimated 1.7 million people sustain a TBI annually
· Of those people, 52,000 die, 275,000 are hospitalized and 1.365 million (nearly 80 percent) are treated and released from an emergency department
· Those most likely to sustain a TBI include children aged 0 to 4 years, adolescents aged 15 to 19 years and adults aged 65 years and older
· TBI results in both direct costs (medical care) and indirect costs (such as lost productivity). In 2000, those costs totaled $60 billion
Those with severe TBI need to be hospitalized. As neurosurgeons at Advanced Neurosurgery Associates, we encounter severe TBI in emergency situations. In particular, we are called upon for specialized trauma surgery. Procedures in which surgery may be necessary include:
· To remove a hematoma
· To fix a depressed skull fracture
· To implant a shunt or drain to relieve fluid/pressure
· To do a decompressive hemicraniectomy to relieve brain pressure due to swelling/injury to the brain
· To insert an intracranial pressure monitor to measure pressure in the brain
To completely comprehend severe TBI, it is instructive to understand brain physiology and how this severe form of injury impacts the brain. Inflammation is a part of the body’s response to tissue injury. The same is true of the brain. When injured, the brain swells and fills with fluid. Unlike other parts of the body, however, the problem with an injured brain is that the skull prevents it from expanding when this swelling occurs. What results is intracranial pressure, a dangerous phenomenon that is a primary focus of controlling the damage after TBI. Without that control, the pressure can cause further brain damage or death. In fact, according to the Center for Disease Control and Prevention (CDC), TBI is a contributing factor in one-third of all injury-related deaths in the United States.
The Impact of TBI on the Brain
Approximately 5.3 million Americans are living with a TBI-related disability and the consequences of severe TBI, according to the CDC. For those suffering as the result of various levels of TBI, there is a disruption of brain function. Brain function is based on the interplay between the cells within our central nervous system, called neurons. Operating normally, these specialized cells serve to communicate information to other nerve cells within the body so the brain can perform its functions. However, the brain’s delicate chemistry is disrupted due to TBI, resulting in a disturbance of neuron function. This is why those who suffer a TBI can experience severe patterns of mental and behavioral changes.
TBI is still not completely understood, specifically in the area of expected recovery or long-term impacts. This is the source of particular concern and focus in the military and the world of sports, like football. The current dilemma is that it is difficult to predict the recovery process from TBI. While it is recognized that the greatest amount of healing progress takes place within the first six months following an injury, long-term prognosis is harder to predict.
Recovery, A Light at the End of the Tunnel
Although the brain proves to be a mystery, we can take some faith in the brain’s plasticity (technically referred to as neuroplasticity). We know that the brain has a remarkable ability to change and that this is true throughout our lives. Rehabilitation can maximize one’s potential recovery. As a testament to the brain’s adaptability, the undamaged parts may take over the function of the damaged parts.
In conclusion, the brain is the most complex, yet miraculous part of human anatomy. While it is true that it is challenging to ever expect 100 percent recovery from more serious TBI, with hard work and a determined attitude, people do experience improvements and can prevail. Hopefully, the growing discussion and research on this topic will result in even greater medical knowledge in order for us to better help those who suffer this injury.