Traumatic brain injury (TBI) is a type of brain injury that occurs when the head is suddenly and violently struck by an object or penetrates the skull, damaging brain tissue. TBI is often associated with road traffic accidents, falls, sports injuries, work accidents and violent incidents. It can occur when objects outside the skull damage brain tissue (penetration) or when the brain is shaken inside the skull (non-penetration). The severity of the damage is classified as mild, moderate or severe, depending on the degree of involvement of brain tissue. Treatment may vary depending on the patient's symptoms and the type of damage.
What are the Types of Traumatic Brain Injury?
According to the condition of the skull, it can be divided into two as closed and open head injuries. In open head injuries, a skull fracture occurs, while in closed traumas, no fracture occurs.
How does the severity of traumatic brain injury affect individuals?
TBI is graded as mild, moderate and severe in terms of the symptoms that occur according to the extent of damage to the brain. In mild damage, there may be no loss of consciousness or a brief loss of consciousness of a few seconds/minutes. There may be headache, confusion, dizziness, blurred vision or eye strain, tinnitus, bad taste in the mouth, fatigue, disturbed sleep patterns, changes in behavior or mood, and minor problems with memory, concentration, attention and thinking. Most people with mild head injuries recover well.
Moderate or severe injuries may also have these symptoms, but may also include worsening or persistent headaches, recurrent vomiting or nausea, convulsions or seizures, inability to wake from sleep, dilated pupils, slurred speech, weakness or numbness in the limbs, loss of coordination and increased confusion, restlessness, agitation, anxiety, worry, nervousness, and some injuries can be fatal.
What are the Common Causes of Traumatic Brain Injury?
The most common cause of TBI is traffic accidents (often car and motorcycle accidents). Other causes include falls, sports injuries, work accidents, violence and child abuse.
Are Traumatic Brain Injuries Related to Age?
Males aged 15-24 are more likely to suffer from traumatic brain injuries due to their supposedly risky lifestyles. Individuals over 75 years of age are more exposed to fall-related traumas. For adolescents and adults, the most common causes are automobile and motorcycle accidents and violent crimes. Depending on the profession, bullet injuries are common in professions such as military and police.
In infants under one year of age, the most common cause may be physical abuse. In particular, very violent shaking for play or harm can cause brain damage. In slightly older preschool children, injuries from falls are common. After the age of five, pedestrian or bicycle injuries may increase.
What changes occur in people with traumatic brain injury?
Depending on the areas of the brain that are damaged, physical, behavioral or mental changes may occur. Most injuries can be limited to a small area of the brain. This small damage is often located where the head strikes the object or where the object enters the brain.
Especially in closed head injuries, widespread damage can also occur in which several areas of the brain are affected. These diffuse injuries are caused by the brain moving back and forth inside the skull. The frontal and temporal lobes, and thus the speech and language areas, are often affected in this way. Since the speech and language areas are often damaged, communication difficulties often arise. Other problems can be listed as follows voice disorders, swallowing difficulties, inability to walk, balance, coordination, smell, memory and cognitive skills.
What are the linguistic and cognitive problems resulting from traumatic brain injury?
These problems vary from person to person. Individual differences are seen according to personality, pre-injury skills and severity of brain injury. The impact of brain injury is greatest immediately after the injury. Nevertheless, some effects of TBI can be misunderstood. Newly damaged brain tissue is often swollen (edema), bruised and scarred. This type of damage is usually not permanent; the function of these areas can be restored once the swelling and scarring have gone. Therefore, it is difficult to accurately predict long-term problems in the first weeks after TBI. However, even a minor injury can cause permanent, long-term problems. Development can be observed as the undamaged areas of the brain learn and begin to perform the functions of the damaged areas. Children's brains are more prone to this plasticity than those of adults. For this reason, children with the same damage may progress better than adults.
Cognitive Problems
Possible cognitive problems in conscious patients can be listed as follows: Decreased attention span, difficulty organizing thoughts, forgetfulness, confusion,
sometimes difficulties in learning new information, inability to interpret other people's actions, inappropriate behavior in social situations, difficulties in problem solving, decision making and planning.
Language Problems
Language problems, like cognitive problems, show individual differences. Some of the language-related problems include: Difficulty in finding words; inability to form proper sentences; long and often inaccurate narratives or explanations; difficulty in understanding words; inability to understand different usages, idioms, innuendos in jokes or jokes; sometimes not being aware of one's own mistakes and thus getting angry easily; decline in reading and writing skills; deterioration in math skills.
Problems with Speech
There are also problems with speech intelligibility that can occur in people with TBI. Slower than normal, unintelligible, slurred speech may be heard. This is due to damage to the areas of the brain that control the muscles in the speech organs. This type of speech disorder is called dysarthria. More detailed information about dysarthria is given in the section "Motor Speech Disorders".
What kind of interventions are performed in traumatic brain injury?
People with TBI require medical intervention first. The priority is to provide oxygen support and adequate blood flow to the brain and the rest of the body, and to control blood pressure. Imaging techniques such as X-rays, tomography and MRI are very important in determining the diagnosis and treatment of TBI. After imaging and diagnosis of the damage, necessary medical and surgical interventions are performed.
In the following periods, individual therapy programs suitable for the patient are organized. These programs may include physiotherapy, occupational therapy, speech and language therapy, psychological and social solidarity.
What is the role of a speech and language therapist in traumatic brain injuries?
The speech and language therapist primarily performs a speech and language assessment to determine the areas where the current situation is sufficient and insufficient and to plan appropriate therapy programs. If necessary, a cognitive assessment may also be carried out.
If there is a speech and language therapist working in the hospital, therapies can be started while the person is hospitalized. In early therapies, work on alertness and attention is included. Skills that are essential for communication, such as noticing and recognizing people, place and time, and understanding what is said to them, can be practiced. If the person has problems with speech intelligibility or swallowing, oral-motor exercises can be performed.
The main goal of rehabilitation in the period after leaving the hospital is to enable the person to continue living as independently as possible. With regard to language skills, the speech and language therapist determines and elaborates on goals such as expressing requests appropriately (through speech, gestures or pictures), understanding what is said, remembering and using appropriate words in speech, reading and writing as much as necessary.
The speech and language therapist also deals with cognitive problems. The most common problem with people with TBI is memory problems called "forgetfulness". The problems with forgetfulness and how long it takes to recover depend on the degree of brain damage. Memory-related activities include remembering people's names (such as spouse's name, parents' names, names of famous people), remembering the names of frequently used objects (such as cups, beds, phones, money), remembering the sequence of events (such as first I got up, then I washed my face, then I had breakfast), remembering general information (such as what is the capital of Turkey, who is the President of the Republic, what is the holiday of April 23rd), remembering personal information (such as address, telephone, occupation).