Traumatic brain injury.

Traumatic brain injury, caused by motor vehicle accidents, falls, assaults, or sports injuries affects approximately 7 million people each year. Early and rapid management of the initial brain injury and reduction in secondary insults can lead to improved outcomes. Nursing has an integral role in the care of the patient with traumatic brain injury and can have a positive impact on the outcome for the patient and the family. Types of injuries, treatment modalities, interdisciplinary management, and expected outcomes are discussed.     

Traumatic brain injury

Purpose : Traumatic brain injury (TBI) leading to severe disability is fortunately rare, but when it occurs, the effect on patients and their families can be devastating.

Issue : In the UK at the current time, there are insufficient specialist rehabilitation services to cater for the case-load and many patients receive their care in general wards.

Conclusion : This educational article outlines the principles of management of severe TBI from a practical clinical viewpoint, reviews briefly the evidence for effectiveness of rehabilitation and offers an approach to consistent outcome measurement.     

Traumatic brain injury

Purpose : Traumatic brain injury (TBI) leading to severe disability is fortunately rare, but when it occurs, the effect on patients and their families can be devastating. Issue : In the UK at the current time, there are insufficient specialist rehabilitation services to cater for the case-load and many patients receive their care in general wards. Conclusion : This educational article outlines the principles of management of severe TBI from a practical clinical viewpoint, reviews briefly the evidence for effectiveness of rehabilitation and offers an approach to consistent outcome measurement.     

Traumatic brain injury

Traumatic brain injury (TBI) is a significant source of morbidity and mortality throughout the world. This article discusses the epidemiology, pathophysiology, and clinical presentations of minor, moderate, and severe TBI. Controversial topics, such as hypertonic saline for increased intracranial pressure, prehospital intubation of patients who have experienced TBI, and the use of recombinant factor VIIa, are addressed.     

Traumatic brain injury: a family experience.

Traumatic brain injury (TBI), sometimes referred to as a silent epidemic, affects thousands of people each year. A head injury not only affects the patient, but the entire family system as well. Families experience a myriad of needs during this time of crisis. With the immediate focus on the patient's physical or cognitive state, the family's needs may go unnoticed or unrecognized. It is imperative health care professionals understand the emotional impact on family needs, and the unique grieving patterns which influence their ability to cope with this situation. Caregivers are advised to assess, formulate and implement a plan of care for the family as well as the patient. Since families play such an integral role in the patient's recovery process, it is crucial to recognize the scope of the TBI experience and provide care within the context of the individual family system.     

Traumatic brain injury: the silent epidemic.

It is difficult to accurately determine the number of people affected annually by the devastating effects of traumatic brain injury. It is clear, however, that the impact of traumatic brain injury exceeds the financial cost of acute health care. The long-term outcome of patients with traumatic brain injury has been targeted specifically for improvement during this decade. The initial brain injury--known as the primary injury--may occur in one area of the brain (focal injury) or may affect the entire brain (diffuse injury). The outcome depends on many factors, including the severity of the brain injury and the effectiveness of the interventions received. Accurate assessment of the scope of the problem would be improved by the development of a national database and the standardization of assessment practices. Critical care nurses can contribute skill and knowledge in the care of patients with traumatic brain injury and in efforts to prevent the accidents and violence that cause traumatic brain injury.     

Traumatic brain injury and pain

The co-occurrence of traumatic brain injury (TBI) and pain is quite frequent and presents a number of challenges to the medical practitioner. The distinct nature and extent of these challenges calls for considering the co-existence of TBI and pain a unique medical entity. Clearly, from a research standpoint, the area is in its infancy. The clinician is often left with adapting standard techniques effective for evaluating and treating pain in patients without TBI. Such adaptations require a readiness to recognize how pain affects the presence and course of TBI-related symptoms and, in turn, how TBI symptoms affect the presence and course of pain. Given the myriad factors that can affect outcome, effective evaluation and treatment of this co-occurring problem need to rely on a biopsychosocial model, which encourages consideration of a broad perspective of possible causes and care approaches as well as use of multiple disciplines.     

Traumatic brain injury: family response and outcome.

Family outcome following traumatic brain injury has been the subject of investigation for nearly two decades. Researchers have reported on samples from Israel, Scotland, Denmark, England, and the United States. Cultural diversity as well as differences in design, assessment methods, injury characteristics, and definitions have contributed to difficulties establishing definitive conclusions. Findings indicate that patients' levels of emotional and personality disturbances are associated with levels of family disturbance, and are relatively more significant than physical disability. Undeniably, the long-term sequelae of injury have a long-term negative impact on families. Unfortunately, little has been done to establish the nature of family outcomes for patients younger than age 17, siblings, and less than severe injuries. Recent advances including development of valid measurement tools, definitions established through consensus, and multi-center collaborative research networks are promising and contribute to the likelihood of imminent progress.     

Traumatic brain injury: a review

Traumatic brain injury (TBI) is defined as "a blow or jolt to the head ...which can disrupt the function of the brain" (CDC. Traumatic brain injury [TBI]: Topic Home. 2004 [http://www.cdc.gov]). TBI changes the lives of approximately 2 million persons each year in the United States. Rapid diagnosis and treatment are imperative to promote optimum outcomes. The critical care clinician who is able to identify and treat appropriately utilizing best practice guidelines may significantly reduce the morbidity and mortality of TBI. This article describes the classification, mechanism of injury, pathophysiology, and clinical therapeutic management strategies identified as best practice for TBI.     

Traumatic brain injury is under-diagnosed in patients with spinal cord injury.

OBJECTIVE: To investigate the occurrence and severity of traumatic brain injury in patients with traumatic spinal cord injury. DESIGN: Cross-sectional study with prospective neurological, neuropsychological and neuroradiological examinations and retrospective medical record review. PATIENTS: Thirty-one consecutive, traumatic spinal cord injury patients on their first post-acute rehabilitation period in a national rehabilitation centre. METHODS: The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury were applied. Assessments were performed with neurological and neuropsychological examinations and magnetic resonance imaging 1.5T. RESULTS: Twenty-three of the 31 patients with spinal cord injury (74%) met the diagnostic criteria for traumatic brain injury. Nineteen patients had sustained a loss of consciousness or post-traumatic amnesia. Four patients had a focal neurological finding and 21 had neuropsychological findings apparently due to traumatic brain injury. Trauma-related magnetic resonance imaging abnormalities were detected in 10 patients. Traumatic brain injury was classified as moderate or severe in 17 patients and mild in 6 patients. CONCLUSION: The results suggest a high frequency of traumatic brain injury in patients with traumatic spinal cord injury, and stress a special diagnostic issue to be considered in this patient group.     

Traumatic brain injury: A case-based review

BACKGROUND:

Traumatic brain injuries are common and costly to hospital systems. Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines. This is a review of the current literature discussing the evolving practice of traumatic brain injury.

DATA SOURCES:

A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses, systematic reviews, and randomized controlled trials.

RESULTS:

The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas, maintain systolic blood pressure above 90 mmHg, oxygen saturations above 93%, euthermia, intracranial pressures below 20 mmHg, and cerebral perfusion pressure between 60–80 mmHg.

CONCLUSION:

Much is still unknown about the management of traumatic brain injury. The current practice guidelines have not yet been sufficiently validated, however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.KEY WORDS: Traumatic brain injury, Emergency departments, Glascow Coma Scale     

Traumatic brain injury in children: issues in community function.

The pathology and sequelae of pediatric traumatic brain injury (TBI) differ from those of the adult TBI population. In childhood TBI, cognitive impairment and secondary delays are often overlooked in the referral and intervention process. Although TBI is the leading cause of acquired disability in childhood, most children with TBI are discharged from acute care to home with little or no rehabilitation. This literature review provides current information germane to the occupational therapist on sequelae and functional limitations that may exist or develop after TBI in children. Further, methods by which these deficits can be addressed within the context of Individuals With Disabilities Education Act guidelines are described. Children with a history of TBI should be screened regularly because some cognitive problems emerge years after the injury as developmental demands on the child increase. In this article, school-based therapists are urged to look beyond a child's motor limitations to address the cognitive and neuropsychological problems typical of this population.