U of O
The Center on Brain Injury
Research & Training

General Information About TBI



There may or may not be long-lasting consequences when a child has a brain injury. Most children who have mild brain injuries (such as a concussion) recover fully with no long-term effects. Children who have more severe injuries may have more serious and long-lasting consequences. In others, the full effect of the brain injury may be revealed as the brain matures and the child grows up. Consequently, it is important to pay attention to changes in a child's behavior, communication, emotions, memory, and ability to think or learn after either a concussion or a more intrusive injury.

Your child's educational needs may change because of the brain injury. The need for assistance may be greatest as your child transitions back into school and decline over the next months. For others, the need for support may become more evident over time – perhaps not until years after the injury. Some children may need no accommodations or specially designed instruction as a result of the injury. Other students are able to do well academically with support from home. Some students may have serious social and physical challenges to work around. In other words, every brain injury is different, and every student with a brain injury has different needs.

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About the Brain

Weighing about 3.5 pounds, a human brain is roughly the consistency of 3 day-old gelatin. Held in the skull and surrounded by less than ¼ cup of cerebral spinal fluid, brains have approximately 10 billion neurons that connect with other neurons with an average of 10,000 synapses (spaces between neurons where chemical messages are sent). Brains grow from a single cell into a complex structure that controls every movement, thought, and system that make the human body function.

The human brain continues to develop from conception into the early 20s. An injury during childhood or adolescence can alter brain development and create changes that last a lifetime. Brain injury can be caused by birth damage, degenerative disorders, tumors, illness, toxins, or loss of oxygen, in addition to trauma.

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Types of Brain Injuries

The term "brain injury" includes both traumatic and acquired brain injuries.

A traumatic brain injury (TBI) is caused by an external physical force that results in total or partial functional disability, psychosocial impairment. or both. Causes include shaking, striking against an object, a fall, or a collision with speed and force. In an open head injury, the skull is penetrated or opened in some way. In a closed head injury, the skull remains intact. A concussion is a closed injury.

An acquired brain injury (ABI) is an injury from an internal event, such as a stroke or tumor. It can also be caused by lack of oxygen to the brain, such as a choking or near drowning. Other sources of acquired brain injuries include poisoning (ingesting lead or other chemicals) and illnesses (viral meningitis, etc.).

Primary injuries occur directly as a result of a traumatic event. These involve:

Secondary injuries happen within the brain after the primary injury. These involve:

The type of injury can make a difference in a person's recovery. For instance, focal and penetrating injuries tend to damage specific portions of the brain. A child with this type of injury may have relatively little overall damage as a result, depending on where the injury occurs and the cognitive processes involved in the damaged area of the brain. In contrast, a student whose head hits the pavement after a fall may injure both the area of the brain at the point of impact and the opposite side of the brain as well. This type of injury may become diffuse because of the shearing and tearing that can occur as the brain moves back and forth within the skull. Rotation injuries also involve shearing and tearing of brain tissue. In diffuse injuries, the blood vessels tear, causing internal hemorrhaging in addition to the direct damage to the brain tissue.

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Severity of TBI

Mild brain injury or post-concussive syndrome may not result in a loss of consciousness, and damage often does not appear on brain imaging tests. For 90% of such cases, symptoms resolve within a few weeks. However, about 10% of people with post-concussive syndrome continue to demonstrate symptoms such as confusion, headaches, or nausea for months after the injury. Although this is referred to as a "mild" injury, it should be noted that the consequences can be quite debilitating.

Moderate brain injury is a term used when the patient was unconscious for more than 20–30 minutes but less than 24 hours. There may or may not have been skull fractures, contusions, or bleeding. This type of brain injury is likely to show on a brain scan or imaging device. In children, a moderate brain injury may result in physical weakness, cognitive or communication impairments, difficulty learning new information, and psychosocial challenges.

Severe brain injury is a term used when a patient is in a coma for more than 24 hours. About 80% of children who sustain a severe brain injury will have multiple physical, cognitive, cognitive-communicative, social, emotional, and behavioral problems that are long lasting. Some difficulties may not appear until later in the child's development, when greater levels of planning and abstract thinking are required for successful functioning in school and at home.

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Incidence of TBI

Brain injuries are a leading cause of death and disability in children. Annually, almost half a million children visit emergency departments for injuries related to TBI. During childhood, children aged 0 to 4 years and older adolescents aged 15 to 19 years are most at risk.

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Causes of TBI

The causes of TBI vary by age. For infants, physical abuse is the leading cause. For toddlers, falls and motor vehicle crashes are the leading causes. Motor vehicle crashes, ATVs, motorcycle or passenger-related injuries are common causes of brain injury in children and adolescents. Injuries to pedestrians or bicyclists are also quite common among children.

(Source: CDC, http://www.cdc.gov/traumaticbraininjury/causes.html)

Any contact sport has the potential to cause a TBI. These injuries can occur at home, during practice, or in the community. It is estimated that 20% of all high school football players sustain a brain injury each season. About 5% of soccer players are injured annually. Skiing and horseback riding are also leading causes of sports-related brain injury

(Source: BIA USA, http://www.biausa.org/BIAUSA.ORG/word.files.to.pdf/good.pdfs/factsheets/SportsAndRec.pdf)

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Medical Complications from TBI

Medical complications resulting from brain injury may be the main focus immediately after the injury. Some complications can last after the immediate crisis. These complications may require surgery or ongoing medication. Side effects of medication may affect a student's stamina, attention, and ability to perform well in the classroom.

Seizures, hydrocephalus, deep vein thrombosis (blood clot), and ossification (a buildup of bone that can cause pain and decreased range of motion) are most common in students who have had open brain injuries, comas, or injuries that result in decreased mobility. Spasticity or decreased range of motion, paralysis, stress ulcers, dysphasia (swallowing problems), bowel and bladder incontinence, and elevated liver function are also possible side effects following a brain injury.

Decreased levels of consciousness may persist long after the injury and hospital release and may be permanent for a student. About 1/3 of patients experience excesses of behavior, including combinations of aggression, disinhibition and/or emotional swings.

Source: Pangilinan, P. H., Kelly, B. M., Hornyak, J.E. IV, Smith, D. E. (2008, April 2).Classification and Complications of Traumatic Brain Injury. eMedicine. Retrieved July 15, 2010, from http://emedicine.medscape.com/article/326643-overview

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