Traumatic Brain Injury (TBI) refers to disruption of normal brain function caused by an external mechanical force. This may result in temporary or permanent cognitive, physical, emotional, and behavioural impairments.
Common Causes of TBI #
- Falls (especially in children & older adults)
- Vehicular accidents (road traffic collisions)
- Assaults (e.g., blows to head)
- Sports injuries (contact sports)
- Blast injuries (military context)
TBI Classification by Severity (Glasgow Coma Scale) #
- Mild: GCS 13–15 (e.g., concussion)
- Moderate: GCS 9–12
- Severe: GCS ≤8
TBI Classification by Severity (Westmead PTA Scale) #
More reliable than GCS:
- Mild: PTA < 24 hours
- Severe: PTA 1-7 days
- Very Severe: PTA 1-4 weeks
- Extremely Severe: PTA > 4 weeks
Types of TBI #
- Closed (Non‑penetrating): head struck but skull intact — e.g., diffuse axonal injury
- Open (Penetrating): foreign object penetrates skull — often focal
- Primary injury: damage occurring at moment of impact (contusion, haemorrhage)
- Secondary injury: delayed cascade of metabolic, vascular, inflammatory processes that worsen outcome
Common TBI Neuropathology #
- Diffuse axonal injury (DAI)
- Contusions (coup-contrecoup)
- Intracranial haemorrhages (subdural, epidural, subarachnoid)
Neuropsychological Sequelae of TBI #
- Cognitive: slowed processing speed, impaired attention/working memory, executive dysfunction, memory deficits
- Emotional/Behavioural: irritability, depression, anxiety, apathy, disinhibition
- Physical: headaches, sleep disruption, dizziness, fatigue, motor dysfunction
Assessment Considerations #
- Premorbid functioning estimation
- Stage (acute vs post‑acute vs chronic)
- Use standardised batteries (e.g., WAIS, D‑KEFS, RBANS)
- Assess emotional/behavioural changes (e.g., HADS, BDI‑II)
- Collateral history from family/rehab team
Rehabilitation & Management Strategies #
- Cognitive rehabilitation (attention, memory, executive function)
- Psychotherapy/behavioural interventions
- Multidisciplinary approach (OT, PT, speech therapy)
- Education of patient & family re: expectations and strategies
- See also Stages and Recovery Timelines After Traumatic Brain Injury
Prognostic Factors #
- Injury severity and localisation
- Age at injury
- Time to treatment
- Socio‑environmental support
Key Role of Clinical Neuropsychologists #
- Detailed cognitive & behavioural assessment
- Differential diagnosis & tracking recovery
- Planning rehabilitation and compensatory strategies
- Guiding return‑to‑work/school decisions
