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Physical Medicine and Rehabilitation - January '08
Traumatic Brain Injury: Diagnosis and Treatment
John Kane, MD
According to the Centers for Disease Control and Prevention, more than one million people in the United States endure a Traumatic Brain Injury (TBI) each year. At The University of Toledo Medical Center, specialists team up to provide TBI patients with better acute treatment and early rehabilitation. TBIs may occur when trauma causes damage to the brain. John Kane, MD, associate professor of orthopaedic surgery at the UT Medical Center, says they are most commonly caused by at-home injuries, motor vehicle accidents and industrial accidents.
Although TBIs can affect anyone, the youth and elderly are more susceptible. “Younger people seem to be involved with risk, such as sports, high-speed motor vehicle accidents, industrial accidents and personal injuries,” Dr. Kane adds. “The elderly have more injuries around the home, such as falling.” UT Medical Center’s Level I Trauma Center is dedicated to improving the outcome of TBIs for patients of any age.
Minor and major injuries
TBIs are divided into two categories: major and minor. Minor injuries are subtle but can have long-term health complications. “These are persisting problems that occur after a head injury that may or may not be associated with loss of consciousness,” explains Dr. Kane. In addition, minor injuries may not be apparent after the injury but symptoms could be discovered in the future. Not seeking help can result in isolated findings of memory loss, an inability to comprehend things, loss of coordination and sometimes psychological loss. According to Dr. Kane, minor injuries tend to be ignored. “A head injury might be subtle, like briefly being stunned or knocked out for a short period of time, and although the scalp and skin may heal up pretty quickly, six months from now you might find that you don’t feel and ’compute’ quite right,” he says.
Unlike minor injuries, most major TBIs are profoundly impairing. “These are people that may be coming out of a coma and have developed major cognitive, motor or functional deficits following the injury,” Dr. Kane says. With either severity, early detection and treatment are key.
Damage
TBIs can injure brain tissue directly through impact, shear nerves from the forces involved or create circulation loss. By treating circulation complications and maintaining oxygenation of the brain, doctors can prevent the progression of TBIs if they treat patients acutely and intensively. “We can protect what’s left of the brain and provide supportive care; that makes a big difference in their outcome,” Dr. Kane stresses. The brain has an ability, called plasticity, not only to recover after the initial effects, but a long-term potential for mechanisms allowing restoration and function beyond a simple recovery. “We’re still somewhat in the dark, but many people with head injuries recover above and beyond what you would expect, much due to these mechanisms of plasticity,” he says.
Treatment
There are three ways to determine the extent of a TBI: neurological assessments, functional assessments and neuropsychological examinations. Specialists at UT Medical Center work together to facilitate the process into all three exams. “We work with other therapists that look for specific components of the deficits to evaluate the patients, then the neurophysiologist helps assess their cognitive and behavioral deficits,” says Dr. Kane.
Once assessed, patients with minor TBIs receive physical rehab and neuropsychological exams if cognitive deficits are expected. Once the deficit is discovered, a patient can do specific exercises or restorative therapies. For example, adaptive techniques teach patients with memory loss how to compensate. Major TBI treatments are more comprehensive. “We’ll look at deficits and severe disorders of cognition,” Dr. Kane says. “They’ll be involved in comprehensive therapies which include physical, speech and neuropsychology treatments. The whole rehab team will be involved.” However, the prognosis depends on the patient and the severity of the injury.
Brain cell recovery: neuroplasticity
Through a mechanism called neuroplasticity, the brain has some ability to form new connections. Recovery also occurs when some formerly suppressed or inactive areas of the brain become active or compensate for parts of the brain that have been lost. Dr. Kane says, “We can’t tell how far someone will progress, but at least we can say the brain has much more potential to recover and compensate for injuries than we once thought it did.”
To schedule an appointment with one of UT Medical Center’s rehabilitation specialists, call 877-451-2299.
