Traumatic Brain Injury

What is traumatic brain injury (TBI)?

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. This is a closed head injury. A TBI can also happen when an object penetrates the skull. This is a penetrating injury.

Symptoms of a TBI can be mild, moderate, or severe. Concussions are a type of mild TBI. The effects of a concussion can sometimes be serious, but most people completely recover in time. More severe TBI can lead to serious physical and psychological symptoms, coma, and even death.

What causes traumatic brain injury (TBI)?

The main causes of TBI depend on the type of head injury:

• Some of the common causes of a closed head injury include
  • Falls. This is the most common cause in adults age 65 and older.
  • Motor vehicle crashes. This is the most common cause in young adults.
  • Sports injuries
  • Being struck by an object
  • Child abuse. This is the most common cause in children under age 4.
  • Blast injuries due to explosions
• Some of the common causes of a penetrating injury include
  • Being hit by a bullet or shrapnel
  • Being hit by a weapon such as a hammer, knife, or baseball bat
  • A head injury that causes a bone fragment to penetrate the skull

Some accidents such as explosions, natural disasters, or other extreme events can cause both closed and penetrating TBI in the same person.

Who is at risk for traumatic brain injury (TBI)?

Certain groups are at higher risk of TBI:

• Men are more likely to get a TBI than women. They are also more likely to have serious TBI.
• Adults aged 65 and older are at the greatest risk for being hospitalized and dying from a TBI

What are the symptoms of traumatic brain injury (TBI)?

The symptoms of TBI depend on the type of injury and how serious the brain damage is.

The symptoms of mild TBI can include:

• A brief loss of consciousness in some cases. However, many people with mild TBI remain conscious after the injury.
• Headache
• Confusion
• Lightheadedness
• Dizziness
• Blurred vision or tired eyes
• Ringing in the ears
• Bad taste in the mouth
• Fatigue or lethargy
• A change in sleep patterns
• Behavioral or mood changes
• Trouble with memory, concentration, attention, or thinking

If you have a moderate or severe TBI, you may have those same symptoms. You may also have other symptoms such as:

• A headache that gets worse or does not go away
• Repeated vomiting or nausea
• Convulsions or seizures
• Not being able to wake up from sleep
• Larger than normal pupil (dark center) of one or both eyes. This is called dilation of the pupil.
• Slurred speech
• Weakness or numbness in the arms and legs
• Loss of coordination
• Increased confusion, restlessness, or agitation

How is traumatic brain injury (TBI) diagnosed?

If you have a head injury or other trauma that may have caused a TBI, you need to get medical care as soon as possible. To make a diagnosis, your health care provider:

• Will ask about your symptoms and the details of your injury
• Will do a neurologic exam
• May do imaging tests, such as a CT scan or MRI
• May use a tool such as the Glasgow coma scale to determine how severe the TBI is. This scale measures your ability to open your eyes, speak, and move.
• May do neuropsychological tests to check how your brain is functioning

What are the treatments for traumatic brain injury (TBI)?

The treatments for TBI depend on many factors, including the size, severity, and location of the brain injury.

For mild TBI, the main treatment is rest. If you have a headache, you can try taking over-the-counter pain relievers. It is important to follow your health care provider's instructions for complete rest and a gradual return to your normal activities. If you start doing too much too soon, it may take longer to recover. Contact your provider if your symptoms are not getting better or if you have new symptoms.

For moderate to severe TBI, the first thing health care providers will do is stabilize you to prevent further injury. They will manage your blood pressure, check the pressure inside your skull, and make sure that there is enough blood and oxygen getting to your brain.

Once you are stable, the treatments may include:

• Surgery to reduce additional damage to your brain, for example to
  • Remove hematomas (clotted blood)
  • Get rid of damaged or dead brain tissue
  • Repair skull fractures
  • Relieve pressure in the skull
• Medicines to treat the symptoms of TBI and to lower some of the risks associated with it, such as
  • Anti-anxiety medication to lessen feelings of nervousness and fear
  • Anticoagulants to prevent blood clots
  • Anticonvulsants to prevent seizures
  • Antidepressants to treat symptoms of depression and mood instability
  • Muscle relaxants to reduce muscle spasms
  • Stimulants to increase alertness and attention
• Rehabilitation therapies, which can include therapies for physical, emotional, and cognitive difficulties:
  • Physical therapy, to build physical strength, coordination, and flexibility
  • Occupational therapy, to help you learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing
  • Speech therapy, to help you to with speech and other communication skills and treat swallowing disorders
  • Psychological counseling, to help you learn coping skills, work on relationships, and improve your emotional well-being
  • Vocational counseling, which focuses on your ability to return to work and deal with workplace challenges
  • Cognitive therapy, to improve your memory, attention, perception, learning, planning, and judgment

Some people with TBI may have permanent disabilities. A TBI can also put you at risk for other health problems such as anxiety, depression, and post-traumatic stress disorder. Treating these problems can improve your quality of life.

Can traumatic brain injury (TBI) be prevented?

There are steps you can take to prevent head injuries and TBIs:

• Always wear your seatbelt and use car seats and booster seats for children
• Never drive under the influence of drugs or alcohol
• Wear a properly fitting helmet when riding a bicycle, skateboarding, and playing sports like hockey and football
• Prevent falls by
  • Making your house safer. For example, you can install railings on the stairs and grab bars in the tub, get rid of tripping hazards, and use window guards and stair safety gates for young children.
  • Improving your balance and strength with regular physical activity

Aphasia

What is aphasia?

Aphasia is a language disorder that makes it hard for you to read, write, and say what you mean to say. Sometimes it makes it hard to understand what other people are saying, too. Aphasia is not a disease. It's a symptom of damage to the parts of the brain that control language.

The signs of aphasia depend on which part of the brain is damaged. There are four main types of aphasia:

• Expressive aphasia is when you know what you want to say, but you have trouble saying or writing your thoughts.
• Receptive aphasia affects your ability to read and understand speech. You can hear what people say or see words on a page, but you have trouble making sense of what they mean.
• Global aphasia is the loss of almost all language ability. You can't speak, understand speech, read, or write.
• Anomic or amnesia aphasia is when you have trouble using the right words for certain things, people, places or events.

In some cases, aphasia may get better on its own. But it can be a long-term condition. There's no cure, but treatment may help improve language skills.

What causes aphasia?

Aphasia happens from damage to one or more parts of the brain involved with language. The damage may be from:

• Stroke, which is the most common cause of aphasia
• Brain tumor
• Brain infection or inflammation
• Brain injury
• Other brain disorders or neurologic diseases that affect the brain and get worse over time, such as dementia

Who is more likely to develop aphasia?

Anyone can have aphasia at any age, but most people with aphasia are middle-aged or older. Most aphasia happens suddenly from a stroke or brain injury. Aphasia from a brain tumor or other brain disorder may develop slowly over time.

How is aphasia diagnosed?

If a health care provider sees signs of aphasia, the provider will usually:

• Test the person's ability to understand language and speech. This includes asking questions and checking to see if the person can follow simple commands.
• Order an imaging scan to see if there's a brain injury and what part of the brain is damaged. Possible tests include:
  • MRI
  • CT scan

If imaging shows signs of aphasia, more tests may be needed. These tests measure how much the brain damage has affected the ability to talk, read, write, and understand. In most cases, the tests are done by a speech-language pathologist or speech therapist (a specialist who treats speech and communication disorders).

What are the treatments for aphasia?

Some people fully recover from aphasia without treatment. But most people should begin speech-language therapy to treat aphasia as soon as possible.

Treatment may be one-on-one with a speech therapist or in a group. Therapy using a computer may also be helpful.

The specific therapy depends on the type of language loss that a person has. It may include exercises in reading, writing, following directions, and repeating what the therapist says. Therapy may also include learning how to communicate with gestures, pictures, smartphones, or other electronic devices.

Family participation may be an important part of speech therapy. Family members can learn to help with recovery in many ways, such as:

• Using simpler language
• Including the person with aphasia in conversations
• Repeating or writing down key words to help communicate more clearly

How much a person recovers depends on many things, including:

• What caused the brain injury
• What part of the brain was hurt
• How badly and how much of the brain was hurt
• The age and health of the person

Can aphasia be prevented?

You can help prevent aphasia by:

• Making heart-healthy lifestyle changes to lower your chance of having:
  • A stroke
  • Heart disease
  • Vascular disease (problems with your blood vessels)
• Protecting your brain from injury:
  • Wearing the right helmet for sports safety, such as when riding a bike
  • Taking action to prevent falls
  • Always wearing your seatbelt and driving safely

NIH: National Institute on Deafness and Other Communication Disorders

Arm Injuries and Disorders

Of the 206 bones in your body, three of them are in your arm: the humerus, radius, and ulna. Your arms are also made up of muscles, joints, tendons, and other connective tissue. Injuries to any of these parts of the arm can occur during sports, a fall, or an accident.

Types of arm injuries include :

• Tendinitis and bursitis
• Sprains
• Dislocations
• Fractures (broken bones)
• Nerve problems
• Osteoarthritis

You may also have problems or injure specific parts of your arm, such as your hand, wrist, elbow, or shoulder.

Blood Thinners

What are blood thinners?

Blood thinners are medicines that prevent blood clots from forming. They do not break up clots that you already have. But they can stop those clots from getting bigger. It's important to treat blood clots, because clots in your blood vessels and heart can cause heart attacks, strokes, and blockages.

Who needs blood thinners?

You may need a blood thinner if you have:

• Certain heart or blood vessel diseases
• An abnormal heart rhythm called atrial fibrillation
• A heart valve replacement
• A risk of blood clots after surgery
• Congenital heart defects

What are the different types of blood thinners?

There are different types of blood thinners:

• Anticoagulants, such as heparin or warfarin (also called Coumadin), slow down your body's process of making clots.
• Antiplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets from clumping together to form a clot. Antiplatelets are mainly taken by people who have had a heart attack or stroke.

How can I take blood thinners safely?

When you take a blood thinner, follow the directions carefully. Blood thinners may interact with certain foods, medicines, vitamins, and alcohol. Make sure that your health care provider knows all of the medicines and supplements you are using.

You may need regular blood tests to check how well your blood is clotting. It is important to make sure that you're taking enough medicine to prevent clots, but not so much that it causes bleeding.

What are the side effects of blood thinners?

Bleeding is the most common side effect of blood thinners. They can also cause an upset stomach, nausea, and diarrhea.

Other possible side effects can depend on which type of blood thinner that you are taking.

Call your provider if you have any sign of serious bleeding, such as:

• Menstrual bleeding that is much heavier than normal
• Red or brown urine
• Bowel movements that are red or black
• Bleeding from the gums or nose that does not stop quickly
• Vomit that is brown or bright red
• Coughing up something red
• Severe pain, such as a headache or stomachache
• Unusual bruising
• A cut that does not stop bleeding
• A serious fall or bump on the head
• Dizziness or weakness

Chest Injuries and Disorders

What is the chest?

The chest is the part of your body between your neck and your abdomen (belly). The medical term for your chest is thorax.

Your chest holds many important structures for breathing, digestion, blood circulation, and other important body functions. These structures include your:

• Ribs and breastbone
• Esophagus, the tube between your mouth and stomach
• Trachea, your windpipe
• Bronchi, the tubes that carry air from your windpipe to your lungs
• Lungs
• Pleura, a thin layer of tissue that covers the lungs and lines the inside wall of the chest space
• Heart and large blood vessels
• Thymus, a gland that's part of your immune system
• Nerves

What are chest injuries and disorders?

Chest injuries and disorders are problems that affect any of the organs or structures located in your chest.

There are many types of chest injuries and disorders, for example:

• Broken ribs
• Esophagus disorders
• Swallowing disorders, also called dysphagia
• Tracheal disorders
• Bronchial disorders
• Lung diseases and collapsed lung
• Pleural disorders
• Heart diseases
• Mediastinal diseases, which are tumors, inflammation, and other problems with the structures in the mediastinum, which is the space between your lungs, breastbone, and spine
• Thoracic aortic aneurysm
• Thoracic outlet syndrome

Chest injuries may happen from the force of car accidents, falls, or sports injuries. Or the chest may be pierced by a bullet or sharp object. Because your chest holds so many important structures, certain chest injuries may be life-threatening.

How are chest injuries and disorders diagnosed?

Diagnosis of chest injuries or disorders depends on the type of symptoms you're having and whether you've had a chest injury. Injuries are usually obvious, but in most cases, you'll need tests to know how serious an injury is.

There are many types of tests for diagnosing different types of chest injuries and disorders, for example:

• Diagnostic imaging tests
• Heart tests
• Lung function tests
• Bronchoscopy
• Pleural fluid analysis
• Dysphagia tests
• Biopsy

Treatments will depend on the type of chest injury or disorder you have.