WEBVTT

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Hello and welcome to the traumatic

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brain injury program . I'm dr Reynolds

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and I'm dr hempstead every year ,

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millions of americans experienced

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traumatic brain injury or TBI , which

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can be mild , moderate or severe while

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falls , motor vehicle accidents and

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sports are common causes of TB . It's

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no surprise that military personnel in

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combat and training environments face

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an increased risk of head injury that

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can result in T . V . I . In this

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program . We'll explain what A T . B .

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I . Is and how it can affect the brain .

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We'll talk about the differences

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between mild TBI I . Or concussion and

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moderate to severe TBI and how to

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diagnose each . We'll also describe the

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causes and symptoms of TB as well as

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some of the potential short and long

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term effects . We'll explore how to

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treat TB and its symptoms . In the

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personal journey section will introduce

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you to several patients who share their

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stories . You can also visit the

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caregivers Journey for comprehensive

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information on supporting a loved one

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with T . B . I keep in mind there maybe

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terms that you're not familiar with ,

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so please visit our glossary at any

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time . You can also take a look at the

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F . A . Q . S . And other resources

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included in this program . For related

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information . Thank you for joining us .

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Mhm .

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A

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traumatic brain injury , or TBI . I ,

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occurs when an external force such as a

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bump blow or jolt causes structural

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damage to the brain or disruption of

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brain function injuries can be focal or

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diffuse when the damage occurs in a

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specific area of the brain , it's

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called a focal injury . A diffused

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injury means more than one area of the

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brain is damaged or that the damage is

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widespread . T . B . Can be caused by a

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number of external forces , including

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the head being struck by a falling or

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flying object that had striking an

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object such as the windshield of a car

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or the ground . And I'm just going

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through the skull and entering the

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brain tissue , which is called a

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penetrating head injury . The forces

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generated by a blast or explosion often

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called a blast injury and the sudden

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acceleration deceleration movement of

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the brain without a direct blow to the

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head . As in severe cases of whiplash .

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These forces can cause nerve cells in

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the brain to stretch , tear or pull

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apart , making it difficult or

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impossible for the cells to send

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messages from one part of the brain to

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another or to other parts of the body .

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T . B . I can interfere with certain

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brain functions including thinking ,

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memory , vision and controlling the

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body's movements . Often called motor

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skills . You can find more information

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about how the brain works If you visit

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the interactive brain , the anatomy of

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the brain and Loeb functions .

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Traumatic brain injury can range from

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mild to severe depending on several

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factors . To learn more about how A . T .

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B . I . Is classified as mild ,

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moderate or severe visit

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classifications of T . B . I .

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The brain is an incredibly complex

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organ and what the brain does is truly

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amazing . The brain is the body's

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computer . It stores memories and

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controls thoughts , emotions and all of

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the body's movements dr green . Can you

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tell us more about how the brain does

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these remarkable things ? Certainly dr

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Reynolds everything we know and

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everything we do is filtered , analyzed

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and organized by the brain . The brain

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controls our personalities , our

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attitudes or feelings and attractions .

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Pretty much all the things that make us

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who we are . The brain also

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communicates with all the organs and

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muscles in the body . From telling the

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heart to be a function of the brain

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stem to making our legs move when we

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want to run a function of the motor

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cortex . Different parts of the brain

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are responsible for different things .

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Healthy adult brain weighs about 2.5 to

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£3 and is located inside the skull ,

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which protects the brain from injury

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inside the skull . Three thin

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protective layers called the meninges

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cover the brain . The space between the

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meninges and the brain is filled with a

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clear liquid called cerebral spinal

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fluid . This fluid works to keep the

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central nervous system healthy . The

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brain constantly sends and receives

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signals from all over the body . The

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body then uses these signals to do

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things like think , move , talk , see

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and understand these signals also

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control personality , mood and behavior .

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Each part of the brain has a specific

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job in links with other parts of the

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brain to do more difficult tasks . The

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most basic functions of the brain ,

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such as the ones that control your

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heartbeat and breathing are governed by

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the brain stem , which is the innermost

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part of the brain further outward .

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More complicated functions such as

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emotions and memories , are controlled

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by the limbic system . Autonomic nerves ,

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which regulate internal organs such as

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the stomach and intestines , and the

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endocrine system , which includes all

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the body's hormone producing glands ,

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are also controlled by the limbic

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system . The most complex functions ,

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such as reasoning and decision making

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are controlled at the outermost level

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in the cerebral , the cerebrum is the

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largest part of the brain . It has a

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wrinkled surface of alternating hills

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known as gyro and valleys known as soul

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side . The cerebral is divided into two

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halves known as the left and right

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hemispheres . Each hemisphere of the

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cerebral is divided into four sections

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called lobes . These lobes are known as

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the frontal lobe , the parietal lobe ,

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the occipital lobe and the temporal

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lobe at the back of the brain . Beneath

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the occipital lobes is the cerebellum .

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Like the cerebral . The cerebellum is

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divided into two halves called

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hemispheres . The main job of the

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cerebellum is to control , regulate and

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coordinate movement , posture and

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balance .

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Mhm . Yeah .

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The outermost and largest part of the

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brain called the cerebrum is divided

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into halves called hemispheres . Each

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hemisphere has four sections called

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lobes . These lobes the frontal lobe ,

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the parietal lobe , the occipital lobe

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and the temporal lobe each have a

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different function . Doctor Freeman .

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Can you tell us more about lobe

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functions absolutely ? Doctor hempstead .

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The frontal lobes are the largest of

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the four lobes and deal with reasoning ,

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planning , self control , some speech

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and emotion functions and problem

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solving . The frontal lobes also play

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an important part in memory ,

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intelligence and concentration and are

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responsible for executive functions .

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There are many executive functions of

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the brain , such as the ability to plan ,

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set goals and organize . These

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functions include being able to

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determine right from wrong and being

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able to monitor and change , behavior

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is needed . Executive functions also

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allow people to adapt to new situations

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and to override or control reactions

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when appropriate . The abilities to

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think abstractly form concepts and

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socialist are often considered

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executive functions . The parietal

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lobes are involved with movement and

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the sense of touch . They also

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integrate the signals received from

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other areas of the brain , such as

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vision , hearing and memory to make

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sense of the people , places and

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objects around us . The parietal lobes

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pull all the sensory information

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together to help determine spatial

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awareness and navigation . The

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occipital lobes are found at the back

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of the brain . These lobes receive and

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process signals from the eyes to allow

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people to understand what they're

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seeing . The occipital lobes influence

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how people process colors and shapes .

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The temporal lobes are located at about

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ear level and are the main memory

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center of the brain , contributing to

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both long term and short term memories .

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The temporal lobe is also involved with

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speech and interpreting sounds . An

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area on the right side is involved in

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visual memory and helps people

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recognize objects and faces . An area

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on the left side is involved in verbal

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memory and helps people remember and

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understand language . The back area of

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the temporal lobes helps people

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interpret the emotions and reactions of

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others .

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Traumatic brain injury can be broadly

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categorized as penetrating or non

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penetrating and as focal or diffuse

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penetrating injuries occur when an

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object pierces the skull and enters the

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brain tissue . Non penetrating injuries ,

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sometimes called blunt or closed head

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injuries cause the brain to move within

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the skull and collide with the bone .

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Sometimes the brain hits at the site of

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the injury , but more often it hits the

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skull at a point directly opposite of

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the injury site . In some cases , the

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force is so great that it causes the

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brain to go back and forth and hit on

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both sides . Focal injuries are located

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in a small specific area , whereas

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diffused injuries occur over a large

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area of the brain . These categories

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have to do with what's called the

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mechanism of injury , but they

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generally don't affect how TBS

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diagnosed or treated . The severity of

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TB , however , is paramount in

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diagnosing and treating the injury .

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TBI I can be classified as mild ,

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moderate or severe . The criteria for

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classification include loss of

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consciousness alteration of

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consciousness or mental state ,

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temporary loss of memory , also known

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as post traumatic amnesia or pita and

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in some cases structural imaging as

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seen on a CT scan or MRI alteration of

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consciousness or mental status refers

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to looking and feeling dazed ,

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experiencing confusion , difficulty

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thinking clearly or being unable to

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describe what happened before or after

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the event that caused the trauma

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mm . Mhm .

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A brain injury is classified as a mild

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TBI I . Or concussion when the patient

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experiences any of the following a loss

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of consciousness or loc lasting for up

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to 30 minutes . Loc with a mild TBI I .

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Is uncommon alteration of consciousness

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or AOC for up to 24 hours . Or post

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traumatic amnesia or P . T . A . For up

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to 24 hours structural imaging tests

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such as a C . T . Scan or MRI are not

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usually conducted for mild TBI patients .

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If an imaging test is done , the

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results will be normal . A brain injury

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is classified as a moderate TBI when

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the patient experiences loc that lasts

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more than 30 minutes but less than 24

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hours . AOC that lasts more than 24

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hours , or P . T . A . That lasts 1 to

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7 days . Structural imaging tests will

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be done for a patient with a moderate

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TBI . The results may be normal or

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abnormal . A brain injury is classified

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as a severe TBI . When the patient

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experiences loc that lasts more than 24

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hours AOC . That lasts more than 24

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hours or P . T . A . That lasts longer

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than seven days . As with moderate TBI .

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I , structural imaging tests will be

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done for severe TBI patients and the

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results may be normal or abnormal . The

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structural imaging of a moderate to

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severe TBI I like a mild TBI . I can be

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normal . However , if structural

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imaging is abnormal , the T . B . I .

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Is classified as being at least

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moderate in severity . If a patient

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meets criteria in more than one

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severity category , they will be

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classified at the higher level of

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severity . For instance , if a person

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loses consciousness for two hours as is

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typical with a moderate T . B . I , but

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only experiences three hours of post

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traumatic amnesia as with a mild TBI .

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I . Their injury will be classified as

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moderate the Glasgow coma scale , or

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GCS is a test used by many health care

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providers to determine the level of

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consciousness and classify the severity

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of injury . It measures a person's

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ability to open their eyes and respond

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to spoken questions and physical

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problems for movements . While the test

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is easy to administer , reliable and

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serves as a good indicator or prognosis

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for recovery following T . B . I , the

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Department of Defense has recommended

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against using GCS scores in diagnosing

12:27.031 --> 12:28.050
T . B . I ,

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traumatic

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brain injury can be classified as mild ,

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moderate or severe , mild TBI I is

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often referred to as MTB or concussion .

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When a person experiences a mild TBI ,

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the connections between nerve cells in

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the brain are disrupted brain functions ,

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such as memory alertness and awareness

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of surroundings can be affected by this

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disruption . When a mild TBI affects

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brain center is responsible for

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maintaining consciousness , it causes a

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loss of consciousness , sometimes

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called blacking out or being knocked

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out , but a mild TBI I may simply cause

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a dazed or confused feeling without

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loss of consciousness . It's important

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to note that not everyone who sustains

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a mild TBI experiences a loss of

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consciousness . In fact , it is more

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common to experience that dazed or

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confused sensation than being knocked

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out . When a mild traumatic brain

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injury does cause a loss of

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consciousness , it's brief lasting 30

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minutes or less . Mild TBI . I . Or

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concussion can also cause post

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traumatic amnesia . Often referred to

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as Pieta P . T . A . Is characterized

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by memory loss of the events

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immediately before or after the injury .

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This memory loss can last for up to a

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day . A person with mild TBI might feel

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confused or have trouble thinking

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clearly immediately following the head

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trauma , but this feeling shouldn't

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last more than 24 hours . It's

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important to remember that in most mild

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TBI cases the patient recovers

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completely . Recovery typically occurs

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in 1 to 2 weeks , although in some

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cases it can take several weeks to

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fully recover . There are a small

14:07.027 --> 14:08.971
number of cases where the physical

14:08.971 --> 14:11.027
cognitive and emotional symptoms can

14:11.027 --> 14:12.971
last for months or years and cause

14:12.971 --> 14:15.304
permanent changes to the patient's life .

14:15.304 --> 14:17.360
In this section , you can learn more

14:17.360 --> 14:19.416
about the most common causes of mild

14:19.416 --> 14:22.260
TBI and explore what are referred to as

14:22.260 --> 14:24.640
mechanisms of injury . You can also

14:24.640 --> 14:26.807
find information about the symptoms of

14:26.807 --> 14:28.807
concussion and how it's diagnosed .

14:28.807 --> 14:30.696
We'll discuss potential long term

14:30.696 --> 14:32.862
effects treatment and follow up care ,

14:40.740 --> 14:42.907
traumatic brain injuries can be caused

14:42.907 --> 14:45.073
by a number of events . Dr Green . Can

14:45.073 --> 14:47.018
you tell us about some of the most

14:47.018 --> 14:49.184
common events causing TB ? Of course ,

14:49.184 --> 14:51.407
doctor instead , one of the most common

14:51.407 --> 14:54.470
causes of TB is falling TBS resulting

14:54.470 --> 14:56.526
from falls affect young Children and

14:56.526 --> 14:58.748
the elderly . More often than other age

14:58.748 --> 15:00.914
groups , falling out of bed , slipping

15:00.914 --> 15:02.970
in the shower or bath , falling down

15:02.970 --> 15:05.192
steps or falling off ladders are common

15:05.192 --> 15:07.414
ways people injure their heads and when

15:07.414 --> 15:09.637
the force of the fall is great enough ,

15:09.637 --> 15:11.748
they can result in A . T . B . In the

15:11.748 --> 15:13.526
military false can occur during

15:13.526 --> 15:15.137
training activities or while

15:15.137 --> 15:16.970
participating in sports or other

15:16.970 --> 15:18.859
recreational activities . Another

15:18.859 --> 15:20.970
common cause of TB I is motor vehicle

15:20.970 --> 15:23.026
collisions , People in car accidents

15:23.026 --> 15:24.692
often bump their heads on the

15:24.692 --> 15:26.692
windshield , steering wheel or side

15:26.692 --> 15:28.692
window . The risk of head injury is

15:28.692 --> 15:30.803
especially high for motorcyclists who

15:30.803 --> 15:32.914
could hit their head on the ground or

15:32.914 --> 15:35.081
other vehicles if they are thrown from

15:35.081 --> 15:36.970
the motorcycle , wearing a helmet

15:36.970 --> 15:39.192
reduces the risk of skull fractures and

15:39.192 --> 15:41.359
penetrating injuries , but A T . B . I

15:41.359 --> 15:43.248
can still result from the violent

15:43.248 --> 15:45.414
motion of the brain inside the skull .

15:45.414 --> 15:47.581
Other common causes of traumatic brain

15:47.581 --> 15:49.359
injury include assaults such as

15:49.359 --> 15:51.526
domestic violence or child abuse , and

15:51.526 --> 15:53.692
sports injuries . Sports injuries that

15:53.692 --> 15:55.803
may result in T . B . I can be caused

15:55.803 --> 15:57.581
by colliding with other players

15:57.581 --> 15:59.581
striking your head on the ground or

15:59.581 --> 16:01.692
goalpost or being hit by a ball stick

16:01.692 --> 16:03.859
or punk . Of course , all these causes

16:03.859 --> 16:05.637
are things that could happen in

16:05.637 --> 16:07.692
everyday life . Military personnel ,

16:07.692 --> 16:09.748
however , often have extra risk from

16:09.748 --> 16:11.692
participating in military training

16:11.692 --> 16:14.026
exercises and being in combat zones , T .

16:14.026 --> 16:15.970
B . I . And combat can result from

16:15.970 --> 16:18.081
motor vehicle collisions and rollover

16:18.081 --> 16:20.303
accidents , penetrating injuries , from

16:20.303 --> 16:22.414
a bullet shrapnel or other debris and

16:22.414 --> 16:24.581
from blast injuries where the force of

16:24.581 --> 16:26.803
the pressure wave can cause significant

16:26.803 --> 16:26.450
damage to the brain .

16:32.940 --> 16:36.320
Mm When we talk about mechanisms of

16:36.320 --> 16:38.542
traumatic brain injury , were referring

16:38.542 --> 16:40.264
to the cause of injury and the

16:40.264 --> 16:42.376
resulting physiological or structural

16:42.376 --> 16:44.153
damage , There are four primary

16:44.153 --> 16:47.290
mechanisms of TB direct impact , sudden

16:47.290 --> 16:49.568
or rapid acceleration and deceleration ,

16:49.740 --> 16:52.070
penetrating injury and blast injury .

16:52.540 --> 16:54.373
Doctor Freeman . Can you help us

16:54.373 --> 16:56.540
understand a little bit more about the

16:56.540 --> 16:58.873
mechanisms of brain injury ? Sure thing .

16:58.873 --> 17:01.110
Dr Reynolds direct impact means the

17:01.110 --> 17:03.054
head has struck something like the

17:03.054 --> 17:05.900
ground or a windshield or an object has

17:05.900 --> 17:08.380
struck the head like a baseball or a

17:08.380 --> 17:11.760
fist , sudden or rapid acceleration .

17:11.760 --> 17:14.410
And deceleration happens when nothing

17:14.410 --> 17:16.410
has come in direct contact with the

17:16.410 --> 17:18.620
head , but the brain inside the skull

17:18.620 --> 17:22.380
still experiences violent motion . This

17:22.380 --> 17:24.213
is what happens in the case of a

17:24.213 --> 17:26.520
whiplash injury when the head moves

17:26.520 --> 17:30.020
rapidly forward and backward , whiplash

17:30.020 --> 17:32.460
that causes a rapid turning motion of

17:32.460 --> 17:35.360
the head results in a rotational injury .

17:36.240 --> 17:38.880
A penetrating injury is caused by high

17:38.880 --> 17:41.900
velocity projectiles such as bullets or

17:41.900 --> 17:45.170
shrapnel or objects of lower velocity

17:45.180 --> 17:47.700
such as knives or bone fragments from a

17:47.700 --> 17:50.280
skull fracture being driven into the

17:50.280 --> 17:54.060
brain . A blast injury is caused by the

17:54.070 --> 17:56.440
impact from a pressure wave generated

17:56.440 --> 17:59.300
by an explosion or direct trauma to the

17:59.300 --> 18:01.940
head resulting from a blast . Yeah ,

18:02.340 --> 18:04.790
there are three primary types of damage

18:04.790 --> 18:06.790
that can result from these external

18:06.790 --> 18:10.030
forces , including diffuse external

18:10.030 --> 18:13.440
injury , focal contusions and

18:13.440 --> 18:16.370
hematomas or bleeding in or around the

18:16.370 --> 18:20.260
brain . Diffuse axonal injury or D . A .

18:20.260 --> 18:23.130
I . Refers to the widespread damage to

18:23.130 --> 18:25.600
the brains . White matter . White

18:25.600 --> 18:28.430
matter is composed of bundles of axons

18:28.440 --> 18:30.860
which , like the wires in a computer ,

18:30.880 --> 18:33.320
connect different areas of the brain to

18:33.320 --> 18:37.060
one another . D . A . I . Is the result

18:37.070 --> 18:39.770
of shearing forces which stretch ,

18:39.780 --> 18:43.050
twist or tear these axon bundles .

18:43.940 --> 18:46.660
D . A . I . Is often microscopic ,

18:46.670 --> 18:48.780
meaning it cannot be detected using

18:48.780 --> 18:52.460
standard neuro imaging techniques when

18:52.460 --> 18:55.050
D . A . I . Is severe . However , it

18:55.050 --> 18:58.970
can be seen on an MRI D . A . I .

18:58.970 --> 19:01.150
Can occur throughout the brain and is

19:01.150 --> 19:04.010
typically associated with mild TBI I .

19:04.030 --> 19:07.090
But it can also occur with more severe

19:07.090 --> 19:10.690
tbs focal contusions are

19:10.690 --> 19:13.980
bruises or swelling in small specific

19:13.990 --> 19:17.100
areas of the brain . These are commonly

19:17.100 --> 19:19.970
referred to as coo injuries which is

19:19.970 --> 19:22.310
when the bruising is directly under the

19:22.310 --> 19:24.750
sight of impact and contre coup

19:24.750 --> 19:27.000
injuries . When the bruising happens on

19:27.000 --> 19:29.222
the side of the brain opposite the site

19:29.222 --> 19:32.740
of impact , coup contre coup injuries

19:32.750 --> 19:34.990
are also possible where the brain

19:34.990 --> 19:37.210
bounces back and forth , causing

19:37.210 --> 19:39.450
bruises on both sides of the brain ,

19:40.240 --> 19:43.240
hematomas . Or bleeding in or around

19:43.240 --> 19:45.330
the brain is another type of damage

19:45.330 --> 19:48.510
that can happen in T . B . I . An

19:48.510 --> 19:51.490
epidural hematoma or E . D . H .

19:51.500 --> 19:54.010
Involves bleeding into the area between

19:54.010 --> 19:56.490
the skull and the dura matter , which

19:56.490 --> 19:58.712
is the tough outer layer of the brain's

19:58.712 --> 20:01.800
protective covering . A subdural

20:01.800 --> 20:05.210
hematoma or sth involves bleeding

20:05.210 --> 20:07.370
between the dura matter and the next

20:07.370 --> 20:10.050
protective layer the Iraq Noid matter .

20:10.740 --> 20:13.390
Sub Iraq noid hemorrhage means there is

20:13.390 --> 20:15.780
bleeding beneath the Iraq no matter

20:16.740 --> 20:19.090
bleeding into the brain itself is

20:19.090 --> 20:21.530
called an interest , cerebral hematoma

20:21.540 --> 20:25.080
or I . C . H . Any bleeding surrounding

20:25.080 --> 20:27.530
or within the brain is a serious

20:27.530 --> 20:28.641
medical condition .

20:31.640 --> 20:37.490
There

20:37.490 --> 20:39.546
are a variety of symptoms associated

20:39.546 --> 20:42.190
with concussion or mild TBI , but not

20:42.190 --> 20:44.079
all patients will have all of the

20:44.079 --> 20:45.890
symptoms symptoms are generally

20:45.890 --> 20:48.480
categorized as physical , cognitive ,

20:48.490 --> 20:51.300
behavioral or emotional . Some health

20:51.300 --> 20:53.411
care providers include sleep symptoms

20:53.411 --> 20:56.140
as a separate category as well . Dr

20:56.140 --> 20:58.140
Greene . Will you tell us about the

20:58.140 --> 21:00.473
symptoms of mild traumatic brain injury ?

21:00.473 --> 21:02.720
Absolutely . Doctor instead , patients

21:02.720 --> 21:04.887
may have any combination of any number

21:04.887 --> 21:06.942
of these symptoms . Not all patients

21:06.942 --> 21:09.109
will experience these symptoms and the

21:09.109 --> 21:10.942
duration and severity can differ

21:10.942 --> 21:13.053
significantly among individuals . The

21:13.053 --> 21:15.109
physical symptoms of mild TBI I . Or

21:15.109 --> 21:17.380
concussion may include headache , which

21:17.380 --> 21:19.547
is the most common physical symptom of

21:19.547 --> 21:21.510
mild TBI , I dizziness or balance

21:21.510 --> 21:24.620
problems , nausea , fatigue or sleep

21:24.620 --> 21:27.060
disturbance such as insomnia , blurred

21:27.060 --> 21:29.540
vision or sensitivity to light hearing

21:29.540 --> 21:31.890
loss or hearing difficulties . Tinnitus

21:31.890 --> 21:34.570
or a ringing in the ear , sensitivity

21:34.570 --> 21:37.960
to noise , seizure numbness or tingling ,

21:40.440 --> 21:42.162
cognitive symptoms or symptoms

21:42.162 --> 21:44.384
affecting thought processes may include

21:44.440 --> 21:46.410
problems with attention , focus or

21:46.410 --> 21:48.670
concentration , memory problems ,

21:48.770 --> 21:50.520
slower speed of processing ,

21:50.730 --> 21:53.350
difficulties with judgment and problems

21:53.350 --> 21:55.572
with executive control , which includes

21:55.572 --> 21:57.572
the ability to determine right from

21:57.572 --> 21:59.406
wrong and to override or control

21:59.406 --> 22:02.040
reactions . When appropriate behavioral

22:02.040 --> 22:04.310
and emotional symptoms of mild TBI . I

22:04.320 --> 22:07.170
may include depression , anxiety ,

22:07.180 --> 22:10.020
agitation , irritability , impulsivity

22:10.020 --> 22:13.190
and aggression . For most people who

22:13.190 --> 22:14.968
experience a concussion , these

22:14.968 --> 22:17.023
symptoms will fully resolve within a

22:17.023 --> 22:18.912
few days or weeks . However , the

22:18.912 --> 22:21.023
chances of having ongoing problems is

22:21.023 --> 22:23.079
the same . Whether a patient is only

22:23.079 --> 22:25.190
dazed or actually loses consciousness

22:25.190 --> 22:27.301
after the traumatic event . It's also

22:27.301 --> 22:29.468
important to know that after one brain

22:29.468 --> 22:31.690
injury , the risk of a second injury is

22:31.690 --> 22:33.690
three times greater . And after the

22:33.690 --> 22:35.690
second injury , the risk of a third

22:35.690 --> 22:37.857
brain injury is 6-8 times greater than

22:37.857 --> 22:40.023
average . The more brain injuries that

22:40.023 --> 22:42.190
a person experiences , the more likely

22:42.190 --> 22:44.301
they are to have long term problems ,

22:44.301 --> 22:50.610
diagnosis

22:50.610 --> 22:52.610
of a mild traumatic brain injury or

22:52.610 --> 22:54.666
concussion is based primarily on the

22:54.666 --> 22:56.832
classification criteria that determine

22:56.832 --> 22:58.777
the severity of the injury . These

22:58.777 --> 23:01.450
criteria include loss of consciousness ,

23:01.940 --> 23:04.051
alteration of consciousness or mental

23:04.051 --> 23:06.530
state , and post traumatic amnesia or

23:06.530 --> 23:08.697
loss of memory surrounding the event .

23:09.140 --> 23:11.196
Doctor Freeman , can you tell us how

23:11.196 --> 23:13.196
these criteria are used to diagnose

23:13.196 --> 23:15.830
mild TBI ? Yes , I can dr Reynolds , a

23:15.830 --> 23:18.170
person who has experienced trauma to

23:18.170 --> 23:20.470
the head will be diagnosed with mild

23:20.480 --> 23:23.070
TBI or concussion . If any of the

23:23.070 --> 23:25.810
following are true , The trauma caused

23:25.810 --> 23:28.032
them to lose consciousness for up to 30

23:28.032 --> 23:30.580
minutes . The trauma didn't cause them

23:30.580 --> 23:32.540
to lose consciousness , but it did

23:32.540 --> 23:35.140
cause them to feel dazed and confused

23:35.150 --> 23:38.550
for up to 24 hours . This is also known

23:38.550 --> 23:41.560
as an alteration of consciousness or

23:41.940 --> 23:44.810
They experience post traumatic amnesia

23:44.820 --> 23:48.180
for less than 24 hours . It's important

23:48.180 --> 23:50.380
to note that although the Glasgow coma

23:50.380 --> 23:53.880
scale , or GCS , is widely used in

23:53.880 --> 23:56.080
clinical practice to help classify the

23:56.080 --> 23:58.920
severity of Tv by the Department of

23:58.920 --> 24:00.864
Defense , has recently recommended

24:00.864 --> 24:03.550
against using GCS scores for the

24:03.550 --> 24:05.850
purposes of diagnosing T . B . I .

24:06.740 --> 24:09.550
Because the GCS is so widely used .

24:09.550 --> 24:11.720
However , it's useful to know what it

24:11.720 --> 24:14.480
is and what score indicates . A mild

24:14.480 --> 24:18.290
TBI . The Glasgow coma scale measures a

24:18.290 --> 24:21.050
person's ability to open their eyes as

24:21.050 --> 24:23.060
well as their ability to respond to

24:23.060 --> 24:25.620
spoken questions and physical prompts

24:25.620 --> 24:29.360
for movements . AGCS score between

24:29.360 --> 24:33.270
13 and 15 indicates concussion or mild

24:33.270 --> 24:36.670
TBI . A provider may order imaging

24:36.670 --> 24:38.760
tests if they have reason to believe

24:38.760 --> 24:40.982
that other damage to the skull or brain

24:40.982 --> 24:44.690
has occurred . Even a diagnosis of mild

24:44.690 --> 24:47.600
TBI I can turn into a serious problem

24:47.600 --> 24:49.656
if there are conditions that haven't

24:49.656 --> 24:51.760
yet presented symptoms such as a

24:51.760 --> 24:54.530
hematoma or bleeding in or around the

24:54.530 --> 24:55.060
brain .

25:02.740 --> 25:04.780
Over 80% of patients with mild

25:04.780 --> 25:06.850
traumatic brain injury will recover

25:06.850 --> 25:09.010
quickly and fully , with no long-term

25:09.010 --> 25:12.210
effects . Less than 20% of patients may

25:12.210 --> 25:14.110
have some longer lasting or even

25:14.110 --> 25:16.220
permanent symptoms , persistent

25:16.220 --> 25:18.940
headaches , memory loss , anxiety and

25:18.940 --> 25:21.280
depression are the most common lasting

25:21.280 --> 25:23.540
problems challenges relating to

25:23.540 --> 25:25.820
movement , balance , attention span ,

25:25.830 --> 25:28.620
concentration , judgment and reaction

25:28.620 --> 25:30.920
time can also be persistent . In some

25:30.920 --> 25:33.450
patients in combat , the effects of a

25:33.450 --> 25:35.783
concussion can be potentially dangerous ,

25:35.783 --> 25:37.728
putting others at risk . Even mild

25:37.728 --> 25:39.728
traumatic brain injury can affect a

25:39.728 --> 25:41.617
service member's ability to drive

25:41.617 --> 25:43.228
handle weapons . Established

25:43.228 --> 25:45.450
situational awareness , follow rules of

25:45.450 --> 25:47.660
engagement or control aggression .

25:47.910 --> 25:50.021
These factors must be considered when

25:50.021 --> 25:51.910
making return to duty decisions .

25:59.440 --> 26:01.650
Because mild TBI I has become known as

26:01.650 --> 26:03.761
one of the signature wounds of recent

26:03.761 --> 26:05.928
overseas conflicts . Medical personnel

26:05.928 --> 26:07.983
at field hospitals are more aware of

26:07.983 --> 26:10.150
the symptoms of traumatic brain injury

26:10.150 --> 26:12.094
and the value of early battlefield

26:12.094 --> 26:13.983
assessment and treatment . If the

26:13.983 --> 26:16.261
injury is recognized and treated early ,

26:16.261 --> 26:18.261
most patients can recover normal or

26:18.261 --> 26:20.094
near normal brain function . The

26:20.094 --> 26:22.317
earlier and mild TBI is diagnosed , the

26:22.317 --> 26:24.317
sooner proper medical treatment can

26:24.317 --> 26:26.539
begin . DR Green . Can you tell us more

26:26.539 --> 26:28.761
about the treatment plan for a mild TBI

26:28.761 --> 26:30.872
I of course , Dr Reynolds . Treatment

26:30.872 --> 26:32.706
of mild TBI I . Or concussion is

26:32.706 --> 26:34.928
symptom based , meaning that a provider

26:34.928 --> 26:37.150
will recommend a treatment solution for

26:37.150 --> 26:39.039
each T . B . I , symptoms such as

26:39.039 --> 26:41.206
headaches or sleep disturbance . Other

26:41.206 --> 26:43.372
aspects of treatment include providing

26:43.372 --> 26:45.261
the patient and their family with

26:45.261 --> 26:47.206
information about the symptoms and

26:47.206 --> 26:49.428
expectations of recovery , education on

26:49.428 --> 26:51.206
preventing further injuries and

26:51.206 --> 26:52.928
guidance about sleep hygiene ,

26:52.928 --> 26:54.872
relaxation techniques , monitoring

26:54.872 --> 26:56.770
progress and returning to duty

26:57.140 --> 26:59.307
providers may prescribe medications to

26:59.307 --> 27:01.360
address some symptoms of mild TBI .

27:01.840 --> 27:03.784
They might also make the following

27:03.784 --> 27:05.840
suggestions . Get plenty of downtime

27:05.840 --> 27:07.980
and rest , including a mandatory 24

27:07.980 --> 27:10.147
hour rest period immediately following

27:10.147 --> 27:12.202
the injury . Get sufficient sleep at

27:12.202 --> 27:14.258
night , which for most people is 6-8

27:14.258 --> 27:16.520
hours . Stay well hydrated by drinking

27:16.520 --> 27:18.770
plenty of water , avoid alcohol ,

27:18.780 --> 27:21.360
tobacco and caffeine . Talk to a

27:21.360 --> 27:23.527
provider before taking any medications

27:23.527 --> 27:25.670
or sleep aids , avoid activities that

27:25.670 --> 27:27.837
increase risk for another concussion ,

27:27.837 --> 27:29.780
including contact sports and some

27:29.780 --> 27:31.724
military training activities until

27:31.724 --> 27:33.502
symptoms are controlled , limit

27:33.502 --> 27:35.280
activities that require intense

27:35.280 --> 27:37.550
concentration and stretch to keep the

27:37.550 --> 27:39.772
body moving , but avoid physical work ,

27:39.772 --> 27:42.190
such as heavy lifting or exercise until

27:42.190 --> 27:44.940
cleared by a provider . In many cases ,

27:44.940 --> 27:46.940
due to the importance of the unit's

27:46.940 --> 27:48.996
mission , cutting back on duties and

27:48.996 --> 27:51.051
taking it easy are not possible in a

27:51.051 --> 27:53.107
combat setting . However , steps are

27:53.107 --> 27:54.940
being taken to make certain that

27:54.940 --> 27:57.051
service members get the best possible

27:57.051 --> 27:59.218
treatment . In theater . This includes

27:59.218 --> 28:01.329
medical supervision and monitoring of

28:01.329 --> 28:03.551
the patient's symptoms and reducing the

28:03.551 --> 28:05.496
risk for additional head injury by

28:05.496 --> 28:07.607
limiting exposure to common causes of

28:07.607 --> 28:09.607
brain injury . Patients who have no

28:09.607 --> 28:11.662
symptoms should be physically tested

28:11.662 --> 28:13.884
before returning to duty . This testing

28:13.884 --> 28:15.773
may include sit ups , push ups or

28:15.773 --> 28:17.940
running in place for five minutes . If

28:17.940 --> 28:20.107
the TB symptoms return after testing ,

28:20.107 --> 28:21.829
then continued observation and

28:21.829 --> 28:24.670
retesting in 24-48 hours is suggested .

28:25.040 --> 28:27.140
A patient with mild TBI I should not

28:27.150 --> 28:29.340
return to full duty until all symptoms

28:29.340 --> 28:32.040
of the injury are resolved . Yeah . In

28:32.040 --> 28:33.929
most cases , the brain will fully

28:33.929 --> 28:35.818
recover from mild traumatic brain

28:35.818 --> 28:38.151
injury in a relatively short time frame ,

28:38.151 --> 28:40.096
typically within 7 to 10 days . In

28:40.096 --> 28:42.318
other cases , full recovery can take up

28:42.318 --> 28:44.770
to 30 to 90 days a second T . B . I .

28:44.770 --> 28:46.492
Before the brain has recovered

28:46.492 --> 28:48.770
completely can cause a snowball effect ,

28:48.770 --> 28:50.659
making the symptoms worse and the

28:50.659 --> 28:52.820
recovery more difficult For patients

28:52.820 --> 28:55.098
whose symptoms persist . After 90 days ,

28:55.240 --> 28:57.462
providers may collaborate with the TB .

28:57.462 --> 28:59.410
Specialist and case manager for

28:59.410 --> 29:00.688
continuing treatment .

29:06.240 --> 29:07.240
Mhm

29:09.540 --> 29:11.790
traumatic brain injuries classified as

29:11.790 --> 29:14.530
mild , moderate or severe when a person

29:14.530 --> 29:16.474
receives a trauma to the head that

29:16.474 --> 29:18.419
results in more than 30 minutes of

29:18.419 --> 29:20.830
unconsciousness but less than 24 hours .

29:20.900 --> 29:23.830
They have a moderate TBI I . When loss

29:23.830 --> 29:25.800
of consciousness last more than 24

29:25.810 --> 29:28.260
hours , a person has a severe T . B . I .

29:28.640 --> 29:30.862
People with moderate and severe T . B .

29:30.862 --> 29:32.973
I . S . Also experience an alteration

29:32.973 --> 29:35.084
of consciousness for at least today ,

29:35.084 --> 29:37.196
meaning they look and feel , days are

29:37.196 --> 29:39.307
confused and have difficulty thinking

29:39.307 --> 29:41.362
clearly are describing what happened

29:41.362 --> 29:43.529
before and after the traumatic event .

29:43.529 --> 29:45.640
Post traumatic amnesia or P . T . A .

29:45.640 --> 29:47.640
Will also last more than 24 hours .

29:47.740 --> 29:49.700
Pita may include loss of memory of

29:49.700 --> 29:51.900
events prior to and immediately after

29:51.910 --> 29:54.077
the injury . There are several factors

29:54.077 --> 29:56.077
that will help predict the level of

29:56.077 --> 29:58.021
recovery from a moderate to severe

29:58.021 --> 30:00.077
brain injury . Those factors include

30:00.077 --> 30:02.299
force of the trauma and the severity of

30:02.299 --> 30:04.620
the injury . Brain functions affected

30:04.620 --> 30:07.690
by the injury , areas of brain function

30:07.700 --> 30:09.700
that are not affected by the injury

30:10.140 --> 30:12.362
patient's age at the time of the injury

30:12.560 --> 30:14.950
and other injuries to the body from the

30:14.950 --> 30:17.580
same traumatic events now keep in mind

30:17.580 --> 30:19.636
that every traumatic brain injury is

30:19.636 --> 30:21.636
different and every person responds

30:21.636 --> 30:23.858
differently . In this section , you can

30:23.858 --> 30:25.913
find information about common causes

30:25.913 --> 30:28.024
and mechanisms of injury , as well as

30:28.024 --> 30:30.358
the symptoms of moderate and severe TBI .

30:30.358 --> 30:32.580
We also talk about diagnosing traumatic

30:32.580 --> 30:34.580
brain injury and other injuries and

30:34.580 --> 30:36.610
conditions commonly associated with

30:36.610 --> 30:39.090
moderate to severe TBI . You can find

30:39.090 --> 30:41.257
information on secondary complications

30:41.257 --> 30:43.201
and potential long term effects of

30:43.201 --> 30:45.470
moderate to severe TBI as well as the

30:45.470 --> 30:47.637
different stages of treatment settings

30:47.637 --> 30:49.748
of care and providers and specialists

30:49.748 --> 30:51.803
who make up the Tv . I . Health care

30:51.803 --> 30:55.270
team mm

30:59.540 --> 31:01.707
traumatic brain injuries can be caused

31:01.707 --> 31:03.800
by a number of events dr green . Can

31:03.800 --> 31:05.744
you tell us about some of the most

31:05.744 --> 31:07.856
common events causing to be of course

31:07.856 --> 31:10.078
doctor instead . One of the most common

31:10.078 --> 31:13.280
causes of TB is falling Tbs resulting

31:13.280 --> 31:15.336
from falls affect young Children and

31:15.336 --> 31:17.447
the elderly more often than other age

31:17.447 --> 31:19.669
groups falling out of bed , slipping in

31:19.669 --> 31:21.891
the shower or bath , falling down steps

31:21.891 --> 31:24.058
or falling off ladders are common ways

31:24.058 --> 31:26.224
people injure their heads and when the

31:26.224 --> 31:28.391
force of the fall is great enough that

31:28.391 --> 31:30.613
can result in a T . B . In the military

31:30.613 --> 31:32.391
false can occur during training

31:32.391 --> 31:34.447
activities or while participating in

31:34.447 --> 31:36.780
sports or other recreational activities .

31:36.780 --> 31:38.780
Another common cause of TB is motor

31:38.780 --> 31:40.810
vehicle collisions . People in car

31:40.810 --> 31:43.032
accidents often bump their heads on the

31:43.032 --> 31:45.032
windshield , steering wheel or side

31:45.032 --> 31:47.032
window . The risk of head injury is

31:47.032 --> 31:49.330
especially high from motorcyclists who

31:49.330 --> 31:51.441
could hit their head on the ground or

31:51.441 --> 31:53.663
other vehicles if they were thrown from

31:53.663 --> 31:55.663
the motorcycle , wearing a helmet ,

31:55.663 --> 31:57.886
reduces the risk of skull fractures and

31:57.886 --> 31:59.997
penetrating injuries , but a Tv I can

31:59.997 --> 32:02.219
still result from the violent motion of

32:02.219 --> 32:04.163
the brain inside the skull . Other

32:04.163 --> 32:06.386
common causes of traumatic brain injury

32:06.386 --> 32:08.386
include assaults , such as domestic

32:08.386 --> 32:10.441
violence or child abuse , and sports

32:10.441 --> 32:12.441
injuries . Sports injuries that may

32:12.441 --> 32:14.497
result in T . B . I can be caused by

32:14.497 --> 32:16.719
colliding with other players , striking

32:16.719 --> 32:18.886
your head on the ground or goalpost or

32:18.886 --> 32:20.997
being hit by a ball stick or pug . Of

32:20.997 --> 32:23.219
course all these causes are things that

32:23.219 --> 32:24.997
could happen in everyday life .

32:24.997 --> 32:27.052
Military personnel , however , often

32:27.052 --> 32:29.163
have extra risk from participating in

32:29.163 --> 32:31.108
military training exercises , hint

32:31.108 --> 32:33.219
being in combat zones T . B . I . And

32:33.219 --> 32:35.274
combat can result from motor vehicle

32:35.274 --> 32:37.274
collisions and rollover accidents ,

32:37.274 --> 32:39.219
penetrating injuries from a bullet

32:39.219 --> 32:41.441
shrapnel or other debris and from blast

32:41.441 --> 32:43.219
injuries where the force of the

32:43.219 --> 32:45.219
pressure wave can cause significant

32:45.219 --> 32:46.441
damage to the brain .

32:52.340 --> 32:54.720
When we talk about mechanisms of

32:54.720 --> 32:56.942
traumatic brain injury , were referring

32:56.942 --> 32:58.664
to the cause of injury and the

32:58.664 --> 33:00.776
resulting physiological or structural

33:00.776 --> 33:02.553
damage . There are four primary

33:02.553 --> 33:04.887
mechanisms of T . B . I . Direct impact ,

33:05.310 --> 33:07.143
sudden or rapid acceleration and

33:07.143 --> 33:09.690
deceleration , penetrating injury and

33:09.690 --> 33:12.110
blast injury ? Doctor Freeman . Can you

33:12.110 --> 33:14.166
help us understand a little bit more

33:14.166 --> 33:16.332
about the mechanisms of brain injury ?

33:16.332 --> 33:18.700
Sure thing . Dr Reynolds direct impact

33:18.700 --> 33:20.710
means the head has struck something

33:20.720 --> 33:23.300
like the ground or a windshield or an

33:23.310 --> 33:25.450
object has struck the head like a

33:25.450 --> 33:28.950
baseball or a fist , sudden or rapid

33:28.950 --> 33:31.860
acceleration . And deceleration happens

33:31.860 --> 33:34.082
when nothing has come in direct contact

33:34.082 --> 33:36.140
with the head , but the brain inside

33:36.140 --> 33:38.650
the skull still experiences violent

33:38.650 --> 33:41.440
motion . This is what happens in the

33:41.440 --> 33:44.080
case of a whiplash injury when the head

33:44.080 --> 33:46.560
moves rapidly forward and backward ,

33:47.440 --> 33:49.930
whiplash that causes a rapid turning

33:49.930 --> 33:52.010
motion of the head results in a

33:52.010 --> 33:55.320
rotational injury . A penetrating

33:55.320 --> 33:57.590
injury is caused by high velocity

33:57.590 --> 34:00.770
projectiles such as bullets or shrapnel

34:00.780 --> 34:03.700
or objects of lower velocity such as

34:03.700 --> 34:06.130
knives or bone fragments from a skull

34:06.130 --> 34:08.860
fracture being driven into the brain .

34:09.940 --> 34:12.670
A blast injury is caused by the impact

34:12.670 --> 34:14.820
from a pressure wave generated by an

34:14.820 --> 34:17.800
explosion or direct trauma to the head

34:17.810 --> 34:20.790
resulting from a blast . There are

34:20.790 --> 34:23.200
three primary types of damage that can

34:23.200 --> 34:25.340
result from these external forces ,

34:25.620 --> 34:28.820
including diffuse external injury ,

34:28.830 --> 34:32.460
focal contusions and hematomas

34:32.470 --> 34:34.960
or bleeding in or around the brain .

34:35.340 --> 34:38.970
Okay , diffuse axonal injury , or D . A .

34:38.970 --> 34:41.820
I . Refers to the widespread damage to

34:41.820 --> 34:44.550
the brains . White matter . White

34:44.550 --> 34:47.290
matter is composed of bundles of axons

34:47.300 --> 34:49.960
which , like the wires in a computer ,

34:49.970 --> 34:52.330
connect different areas of the brain to

34:52.330 --> 34:55.820
one another . D . A . I . Is the result

34:55.830 --> 34:58.640
of shearing forces which stretch ,

34:58.650 --> 35:01.960
twist or tear these Exxon bundles .

35:02.950 --> 35:05.600
D . A . I . Is often microscopic ,

35:05.730 --> 35:07.730
meaning it cannot be detected using

35:07.730 --> 35:10.090
standard neuro imaging techniques .

35:10.940 --> 35:13.750
When diarrhea is severe , however , it

35:13.750 --> 35:17.650
can be seen on an MRI . D . A .

35:17.650 --> 35:19.940
I . Can occur throughout the brain and

35:19.940 --> 35:22.350
is typically associated with mild TBI .

35:22.350 --> 35:25.120
I . But it can also occur with more

35:25.120 --> 35:29.120
severe T . B . I . S focal contusions

35:29.130 --> 35:31.770
are bruises or swelling in small

35:31.780 --> 35:34.890
specific areas of the brain . These are

35:34.890 --> 35:37.620
commonly referred to as coo injuries

35:37.840 --> 35:40.140
which is when the bruising is directly

35:40.150 --> 35:42.850
under the sight of impact and contra

35:42.850 --> 35:44.739
coup injuries . When the bruising

35:44.739 --> 35:46.572
happens on the side of the brain

35:46.572 --> 35:49.970
opposite the site of impact coup contre

35:49.970 --> 35:52.560
coup injuries are also possible where

35:52.560 --> 35:54.770
the brain bounces back and forth ,

35:54.780 --> 35:57.040
causing bruises on both sides of the

35:57.040 --> 36:00.730
brain . He hematomas were bleeding in

36:00.730 --> 36:02.950
or around the brain is another type of

36:02.950 --> 36:05.250
damage that can happen in T . B . I .

36:05.630 --> 36:08.930
An epidural hematoma or E . D . H .

36:08.940 --> 36:11.430
Involves bleeding into the area between

36:11.430 --> 36:13.980
the skull and the dura matter which is

36:13.980 --> 36:16.040
the tough outer layer of the brain's

36:16.040 --> 36:19.380
protective covering . A subdural

36:19.380 --> 36:22.770
hematoma or S . D . H . Involves

36:22.770 --> 36:24.880
bleeding between the dura matter and

36:24.880 --> 36:27.580
the next protective layer the Iraq Noid

36:27.580 --> 36:31.230
matter . Sub Iraq noid hemorrhage means

36:31.230 --> 36:33.290
there is bleeding beneath the Iraq .

36:33.290 --> 36:36.240
Noid matter , bleeding into the brain

36:36.240 --> 36:38.840
itself is called an interest cerebral

36:38.840 --> 36:42.670
hematoma or I . C . H . Any

36:42.670 --> 36:44.660
bleeding surrounding or within the

36:44.660 --> 36:47.300
brain is a serious medical concern .

36:55.330 --> 36:57.552
One of the most common and severe types

36:57.552 --> 36:59.663
of brain injury is known as a diffuse

36:59.663 --> 37:02.430
axonal injury or D . A . I . With D . A .

37:02.430 --> 37:04.652
I . The damage to the brain occurs over

37:04.652 --> 37:06.708
a large area and is one of the major

37:06.708 --> 37:08.930
causes of unconsciousness and long term

37:08.930 --> 37:10.930
coma after traumatic brain injury .

37:10.930 --> 37:13.041
Doctor Green , what else can you tell

37:13.041 --> 37:15.374
us about ? D . A . I . Well dr Reynolds .

37:15.374 --> 37:17.541
Dhe refers to the widespread damage to

37:17.541 --> 37:19.430
the brains . White matter . White

37:19.430 --> 37:21.263
matter is composed of bundles of

37:21.263 --> 37:23.263
Exxon's which like the wires in the

37:23.263 --> 37:25.486
computer connect different areas of the

37:25.486 --> 37:27.652
brain to one another day is the result

37:27.652 --> 37:29.597
of shearing forces which stretch ,

37:29.597 --> 37:32.140
twist or tear these Exxon bundles .

37:32.300 --> 37:34.300
This type of injury usually results

37:34.300 --> 37:36.189
from rotational forces or violent

37:36.189 --> 37:38.411
stopping , such as an auto collisions ,

37:38.411 --> 37:41.070
falls and assaults . Vehicle collisions

37:41.080 --> 37:43.630
are the most frequent causes of T AI ,

37:43.640 --> 37:46.280
Another common causes child abuse , for

37:46.280 --> 37:48.210
example , shaken baby syndrome .

37:48.220 --> 37:50.840
Although diffuse axonal injury seldom

37:50.840 --> 37:52.690
kills , The outcome is often not

37:52.690 --> 37:55.340
predictable . In severe D . AI patients

37:55.340 --> 37:57.507
are frequently in a coma and many will

37:57.507 --> 37:59.118
never regain consciousness ,

38:06.620 --> 38:09.130
focal contusions or bruises or swelling

38:09.130 --> 38:11.297
in small specific areas of the brain .

38:11.610 --> 38:13.740
This type of injury can be coup or

38:13.740 --> 38:16.790
contre coup or both . Doctor Freeman ,

38:16.800 --> 38:19.230
can you tell us about focal contusions ?

38:19.330 --> 38:22.620
Absolutely . Doctor Halmstad , focal

38:22.620 --> 38:24.790
contusions can be caused by direct

38:24.790 --> 38:27.290
impact or rapid acceleration and

38:27.290 --> 38:30.570
deceleration a coup injury occurs when

38:30.570 --> 38:32.610
the bruising is directly under the

38:32.610 --> 38:35.830
sight of impact . A contre coup injury

38:35.840 --> 38:37.784
happens when the side of the brain

38:37.784 --> 38:40.007
opposite the site of impact , bruises ,

38:40.920 --> 38:43.170
Contra coup injuries are actually more

38:43.170 --> 38:45.280
common than cu injuries when the

38:45.280 --> 38:48.440
mechanism is direct impact . When the

38:48.440 --> 38:50.660
mechanism is rapid or sudden

38:50.660 --> 38:53.290
acceleration and deceleration , a

38:53.290 --> 38:56.040
person is likely to have a coup contre

38:56.040 --> 38:59.670
coup injury . Rapid acceleration and

38:59.670 --> 39:02.510
deceleration means the brain inside the

39:02.510 --> 39:05.240
skull is being thrown back and forth .

39:06.400 --> 39:08.880
The result is bruising on both sides of

39:08.880 --> 39:12.530
the brain . Coup contre coup is also

39:12.530 --> 39:14.810
possible with direct impact injuries

39:14.960 --> 39:17.300
that create enough force to cause this

39:17.300 --> 39:19.410
violent back and forth motion of the

39:19.410 --> 39:21.340
brain inside the skull .

39:27.120 --> 39:31.110
Mm A hematoma is bleeding in

39:31.110 --> 39:33.332
or around the brain . There are several

39:33.332 --> 39:35.554
different types of hematoma is that can

39:35.554 --> 39:37.610
happen in T . V . Dr green . Can you

39:37.610 --> 39:39.499
tell us more about hematomas ? Of

39:39.499 --> 39:41.666
course , Dr Reynolds a pocket of blood

39:41.666 --> 39:43.721
that forms between the skull and the

39:43.721 --> 39:45.554
tough outer layer of the brain's

39:45.554 --> 39:47.499
protective cover called the dura .

39:47.499 --> 39:49.832
Matter is known as an epidural hematoma .

39:49.832 --> 39:51.999
Or E . D . H . And E . D . H . Is most

39:51.999 --> 39:53.888
often the result of bleeding from

39:53.888 --> 39:56.110
higher pressure arteries . The bleeding

39:56.110 --> 39:58.277
forms a pocket of blood that increases

39:58.277 --> 40:00.443
the pressure inside the skull . As the

40:00.443 --> 40:02.790
hematoma grows , the pressure pushes on

40:02.790 --> 40:05.420
the brain . This pressure can damage

40:05.420 --> 40:07.531
the brain and in some cases even push

40:07.531 --> 40:09.642
part of the brain through the hole in

40:09.642 --> 40:11.531
the bottom of the skull where the

40:11.531 --> 40:13.698
spinal column passes through . This is

40:13.698 --> 40:15.920
called herniation which is likely to be

40:15.920 --> 40:18.087
fatal if the bleeding occurs one layer

40:18.087 --> 40:20.142
down between the dura matter and the

40:20.142 --> 40:22.142
next protective layer the arachnoid

40:22.142 --> 40:23.920
matter . It's called a subdural

40:23.920 --> 40:26.910
hematoma or sth a slight impact to the

40:26.910 --> 40:28.799
head or even a fall to the ground

40:28.799 --> 40:30.966
without hitting the head may be enough

40:30.966 --> 40:33.510
to cause an sth subdural hematomas may

40:33.510 --> 40:36.170
cause no obvious symptoms at all or can

40:36.170 --> 40:38.310
be life threatening . Small subdural

40:38.310 --> 40:40.430
hematomas may not be very serious and

40:40.440 --> 40:42.840
the blood can be slowly absorbed over

40:42.840 --> 40:45.340
several weeks . In other cases , small

40:45.340 --> 40:47.960
or medium subdural hematomas may slowly

40:47.960 --> 40:50.140
grow in size over weeks to months .

40:51.030 --> 40:53.086
This growth can compress the brain ,

40:53.086 --> 40:55.030
possibly leading to death . If the

40:55.030 --> 40:57.252
blood is not drained , larger hematomas

40:57.252 --> 40:59.790
may require immediate surgery to reduce

40:59.790 --> 41:02.130
the pressure on the brain based on when

41:02.130 --> 41:03.910
the symptoms appear . Subdural

41:03.910 --> 41:06.450
hematomas can be divided into acute or

41:06.450 --> 41:09.180
chronic . Acute subdural hematomas are

41:09.180 --> 41:11.402
those with symptoms that appear quickly

41:11.402 --> 41:13.480
after the injury . If weeks passed

41:13.480 --> 41:15.600
before symptoms appear , the hematoma

41:15.600 --> 41:17.711
is called a chronic subdural hematoma

41:17.711 --> 41:19.880
and is often the result of a slow

41:19.880 --> 41:22.213
bleeding , small tear of a blood vessel .

41:22.610 --> 41:25.000
Children and the elderly are most

41:25.000 --> 41:27.222
likely to experience a chronic subdural

41:27.222 --> 41:29.520
hematoma . This chronic form is less

41:29.520 --> 41:31.830
risky because it happens slowly and the

41:31.830 --> 41:33.960
brain is often able to adjust to the

41:33.960 --> 41:36.016
bleeding . However , if the bleeding

41:36.016 --> 41:38.160
continues and the hematoma is not

41:38.160 --> 41:40.382
treated , the condition can become very

41:40.382 --> 41:42.710
serious bleeding in the next layer

41:42.710 --> 41:44.766
between the Iraqi annoyed matter and

41:44.766 --> 41:46.488
the p . A matter is called sub

41:46.488 --> 41:49.200
arachnoid hemorrhage or shh . Some

41:49.200 --> 41:51.380
people with S . H . Recover fully but

41:51.390 --> 41:53.668
it can be a life threatening condition .

41:53.668 --> 41:55.834
Even with treatment , the outcome of a

41:55.834 --> 41:58.001
sub Iraq noid hemorrhage varies widely

41:58.001 --> 42:00.223
depending on the location and amount of

42:00.223 --> 42:02.650
bleeding surgery may be done to relieve

42:02.650 --> 42:05.010
pressure on the brain . Finally ,

42:05.020 --> 42:06.909
bleeding into the brain itself is

42:06.909 --> 42:09.450
called an intra cerebral hematoma or I

42:09.450 --> 42:11.770
ch . These injuries occur after a

42:11.770 --> 42:14.190
trauma , literally tears Exxon's in the

42:14.190 --> 42:16.440
brain's white matter . Axons are the

42:16.440 --> 42:18.329
connections that carry electrical

42:18.329 --> 42:20.690
impulses or messages from one part of

42:20.690 --> 42:22.690
the brain to another . When this

42:22.690 --> 42:24.801
connection is sheared , serious brain

42:24.801 --> 42:26.912
damage can result because the neurons

42:26.912 --> 42:28.820
can no longer communicate .

42:36.200 --> 42:38.720
Military personnel in combat zones are

42:38.720 --> 42:41.580
at increased risk for TB resulting from

42:41.590 --> 42:44.360
blast injuries . Doctor Freeman . What

42:44.360 --> 42:46.527
can you tell us about blast injuries ?

42:46.527 --> 42:48.620
Blast injuries are caused by the

42:48.630 --> 42:50.930
indirect impact from a pressure wave

42:50.940 --> 42:54.790
generated by an explosion . The

42:54.800 --> 42:57.600
explosion causes an instant rise in

42:57.600 --> 43:00.230
pressure , which creates a blast wave .

43:00.800 --> 43:02.860
This wave starts at the site of the

43:02.860 --> 43:05.940
explosion and travels outward . The

43:05.940 --> 43:08.180
effects of the blast on a person depend

43:08.180 --> 43:11.480
on several factors , including the type

43:11.480 --> 43:13.900
and strength of the blast , the

43:13.900 --> 43:16.730
person's distance from the blast and

43:17.100 --> 43:18.990
whether exposure is in an open

43:18.990 --> 43:22.500
environment or in an enclosed structure ,

43:22.510 --> 43:25.190
injuries caused by these pressure or

43:25.190 --> 43:28.150
blast waves are described as primary ,

43:28.160 --> 43:31.730
secondary , tertiary and quaternary .

43:32.600 --> 43:34.760
Primary blast injury occurs when the

43:34.760 --> 43:38.190
blast wave hits the body . Air filled

43:38.200 --> 43:41.080
organs such as the ears , lungs ,

43:41.090 --> 43:44.310
stomach and intestines are particularly

43:44.310 --> 43:47.250
at risk for blast injuries . This is

43:47.250 --> 43:48.917
also true for organs that are

43:48.917 --> 43:51.540
surrounded by fluid such as the brain

43:51.540 --> 43:55.000
and the spine . As the wave passes

43:55.000 --> 43:57.130
through these organs , it can cause

43:57.130 --> 43:59.870
fragmenting and shearing of tissues .

43:59.880 --> 44:03.060
Secondary blast injury includes being

44:03.060 --> 44:05.860
hit by flying debris , which can cause

44:05.860 --> 44:08.400
both penetrating and direct impact

44:08.400 --> 44:12.050
trauma . Tertiary blast injury

44:12.050 --> 44:13.994
occurs when a person is physically

44:13.994 --> 44:16.320
thrown by the blast , which usually

44:16.320 --> 44:19.190
causes direct impact trauma . For

44:19.190 --> 44:21.650
example , being thrown by the blast

44:21.650 --> 44:23.594
might cause the head to strike the

44:23.594 --> 44:26.700
ground or a wall . And lastly

44:26.710 --> 44:29.640
quaternary blast injuries include burns ,

44:29.650 --> 44:32.470
chemical exposure and breathing toxic

44:32.470 --> 44:34.110
gases or vapors .

44:36.590 --> 44:42.440
The

44:42.450 --> 44:44.617
symptoms of moderate to severe TBI are

44:44.617 --> 44:46.783
very serious and can have an effect on

44:46.783 --> 44:48.839
many aspects of the patient's life .

44:48.839 --> 44:50.672
With moderate injuries , loss of

44:50.672 --> 44:52.940
consciousness may last up to 24 hours

44:52.950 --> 44:55.390
with severe T . B . I . A . Coma is not

44:55.390 --> 44:57.550
uncommon . As the patient regains

44:57.550 --> 44:59.828
consciousness or emerges from the coma .

44:59.828 --> 45:01.828
They may have a range of physical ,

45:01.828 --> 45:03.840
cognitive behavioral or emotional

45:03.840 --> 45:06.080
symptoms . Doctor Freeman , can you

45:06.080 --> 45:08.024
tell us about some of the possible

45:08.024 --> 45:10.191
symptoms of a moderate to severe TBI ?

45:10.191 --> 45:13.240
Certainly dr Reynolds the symptoms of

45:13.240 --> 45:15.410
moderate and severe TBI . I can be

45:15.410 --> 45:18.310
categorized as physical , cognitive

45:18.320 --> 45:21.550
behavioral or emotional patients may

45:21.550 --> 45:23.730
experience any combination of any

45:23.730 --> 45:26.200
number of these symptoms . Physical

45:26.200 --> 45:28.820
symptoms of moderate to severe TBI can

45:28.820 --> 45:31.740
include a headache that gets worse or

45:31.740 --> 45:35.580
does not go away , dizziness , pain ,

45:35.590 --> 45:38.660
fatigue or drowsiness , repeated

45:38.660 --> 45:41.490
vomiting or nausea , convulsions or

45:41.490 --> 45:44.430
seizures , difficulty waking up from

45:44.430 --> 45:46.940
sleep problems , falling asleep or

45:46.940 --> 45:49.850
staying asleep , dilation of one or

45:49.850 --> 45:52.420
both pupils of the eyes , blurred

45:52.420 --> 45:55.200
vision or double vision , sensitivity

45:55.200 --> 45:58.140
to light or sound ringing in the ears ,

45:58.150 --> 46:00.950
clear fluid draining from the nose or

46:00.950 --> 46:04.000
ears . Slurred speech , bad taste in

46:04.000 --> 46:06.450
the mouth , weakness or numbness of the

46:06.450 --> 46:10.380
arms , legs or face and loss of

46:10.380 --> 46:13.690
balance or coordination , cognitive

46:13.690 --> 46:15.950
symptoms , which are symptoms affecting

46:15.950 --> 46:18.210
the way a person thinks or processes

46:18.210 --> 46:21.590
information can include confusion or

46:21.590 --> 46:23.790
disorientation , problems with

46:23.790 --> 46:26.670
attention , concentration and focus ,

46:26.680 --> 46:29.460
difficulty thinking , clearly , slow

46:29.460 --> 46:32.270
speed of processing , difficulty with

46:32.270 --> 46:35.000
judgment and decision making . Problems

46:35.000 --> 46:37.650
with executive control , which includes

46:37.650 --> 46:39.650
the ability to determine right from

46:39.650 --> 46:41.790
wrong and to override or control

46:41.790 --> 46:44.440
reactions when appropriate and memory

46:44.440 --> 46:46.770
problems including post traumatic

46:46.770 --> 46:50.700
amnesia , post traumatic amnesia or

46:50.700 --> 46:53.420
P . T . A . Is memory loss related to

46:53.420 --> 46:56.610
the trauma . How long amnesia lasts

46:56.620 --> 46:58.920
helps determine how badly the brain is

46:58.920 --> 47:01.980
injured if P . T . A . Lasts more than

47:01.980 --> 47:04.310
one week . Long term problems with

47:04.310 --> 47:07.270
thinking , planning behavior and

47:07.270 --> 47:10.690
personality are more likely behavioral

47:10.690 --> 47:12.860
and emotional symptoms of moderate to

47:12.860 --> 47:16.170
severe TBI . I can include restlessness ,

47:16.180 --> 47:19.550
agitation , mood swings or changes

47:19.560 --> 47:23.080
combativeness , depression , anxiety

47:23.090 --> 47:26.000
and a lack of energy or motivation .

47:26.660 --> 47:28.840
Some symptoms are immediately apparent

47:28.850 --> 47:30.683
at the time of injury or shortly

47:30.683 --> 47:33.090
thereafter and resolve over time .

47:33.880 --> 47:36.400
Others develop more slowly and appear

47:36.400 --> 47:39.130
later . Many can leave a patient with

47:39.130 --> 47:42.360
severe and permanent disability but

47:42.360 --> 47:44.750
keep in mind that symptoms vary greatly

47:44.750 --> 47:47.040
from one patient to another , depending

47:47.040 --> 47:48.830
on the severity of the T . B .

47:57.280 --> 47:59.670
Post traumatic amnesia or P . T . A .

47:59.680 --> 48:02.380
Is memory loss related to a trauma . A

48:02.380 --> 48:04.700
person who experiences a moderate TBI .

48:04.700 --> 48:08.560
I may have P . T . A . From 1 to 7 days

48:08.560 --> 48:10.670
following the traumatic event . A

48:10.670 --> 48:12.850
person with a severe T . B . I . Is

48:12.850 --> 48:14.850
likely to have P . T . A . For more

48:14.850 --> 48:17.570
than seven days dr . Green . Can you

48:17.570 --> 48:19.990
tell us more about to and what it means

48:19.990 --> 48:22.540
for TB patients ? Sure thing . Doctor

48:22.540 --> 48:24.640
Instead patients with a moderate to

48:24.640 --> 48:26.862
severe TBI . I will experience a period

48:26.862 --> 48:29.090
of P . T . A . Which can be difficult

48:29.100 --> 48:31.156
for both the patient and their loved

48:31.156 --> 48:33.378
ones . Pita includes memory loss of the

48:33.378 --> 48:35.544
present time , meaning the patient has

48:35.544 --> 48:37.489
no continuous memory of day to day

48:37.489 --> 48:39.711
events . They may be unable to remember

48:39.711 --> 48:41.933
what happened within the past few hours

48:41.933 --> 48:44.180
or even the past few minutes . A person

48:44.180 --> 48:46.124
with Peta may recognize family and

48:46.124 --> 48:48.180
friends but they may have difficulty

48:48.180 --> 48:50.236
understanding where they are or that

48:50.236 --> 48:52.458
they've had an injury of some kind . In

48:52.458 --> 48:54.569
other cases of to patients are unable

48:54.569 --> 48:56.680
to recognize familiar people at all .

48:56.770 --> 48:58.980
Pita can also cause other symptoms or

48:58.990 --> 49:01.830
changes in behavior including confusion ,

49:01.840 --> 49:04.690
agitation , distress and anxiety ,

49:05.070 --> 49:07.410
uncharacteristic aggression , violence ,

49:07.420 --> 49:09.830
swearing or shouting inappropriate

49:09.830 --> 49:13.630
behaviors and a tendency to wander . In

49:13.630 --> 49:15.980
some cases people maybe unusually quiet

49:15.980 --> 49:18.570
and docile or overly affectionate and

49:18.570 --> 49:20.403
friendly in a childlike manner .

49:20.970 --> 49:22.914
Although the period of Peta may be

49:22.914 --> 49:25.081
disturbing or uncomfortable for family

49:25.081 --> 49:26.859
and friends , it's important to

49:26.859 --> 49:28.914
remember that it is temporary . It's

49:28.914 --> 49:30.914
impossible to know exactly how long

49:30.914 --> 49:32.970
Pita will last . It could be hours ,

49:32.970 --> 49:34.970
days or weeks , but it's a phase of

49:34.970 --> 49:37.026
recovery that will eventually pass .

49:37.270 --> 49:39.492
Family and friends should try to remain

49:39.492 --> 49:41.460
as calm as possible , seeing other

49:41.460 --> 49:43.571
people's distress and being unable to

49:43.571 --> 49:45.571
understand why may make the patient

49:45.571 --> 49:47.690
more confused and agitated . It may

49:47.690 --> 49:49.579
also be necessary to have someone

49:49.579 --> 49:51.634
familiar sit with the patient at all

49:51.634 --> 49:53.579
times , especially if they tend to

49:53.579 --> 49:55.634
wander or try to get out of bed when

49:55.634 --> 49:57.857
they aren't supposed to . A patient may

49:57.857 --> 50:00.190
ask the same things over and over again ,

50:00.190 --> 50:02.190
or they may have delusions and it's

50:02.190 --> 50:04.134
best not to correct them or try to

50:04.134 --> 50:06.079
force them to remember gradually .

50:06.079 --> 50:08.301
They'll recover their ability to retain

50:08.301 --> 50:10.468
information and begin to make sense of

50:10.468 --> 50:10.390
the world around them .

50:16.160 --> 50:19.890
Mhm . Diagnosis of moderate to severe

50:19.890 --> 50:21.668
traumatic brain injury is based

50:21.668 --> 50:23.446
primarily on the classification

50:23.446 --> 50:25.668
criteria that determine the severity of

50:25.668 --> 50:27.830
the injury . These criteria include

50:27.840 --> 50:30.270
loss of consciousness , alteration of

50:30.270 --> 50:32.640
consciousness or mental state , post

50:32.640 --> 50:34.640
traumatic amnesia or loss of memory

50:34.640 --> 50:36.696
surrounding the event and structural

50:36.696 --> 50:39.280
imaging as seen with a ct scan or MRI

50:39.760 --> 50:41.982
dr Friedman . Can you tell us how these

50:41.982 --> 50:44.149
criteria are used to diagnose moderate

50:44.149 --> 50:46.520
to severe TBI ? Of course , Dr Reynolds .

50:46.530 --> 50:49.410
A person who has experienced trauma to

50:49.410 --> 50:51.330
the head will be diagnosed with a

50:51.330 --> 50:53.890
moderate TBI . If any of the following

50:53.890 --> 50:56.430
are true , The trauma caused them to

50:56.430 --> 50:59.080
lose consciousness for 30 minutes to 24

50:59.080 --> 51:01.950
hours . The trauma caused them to feel

51:01.950 --> 51:04.640
dazed and confused for more than 24

51:04.640 --> 51:08.060
hours . Or they experience post

51:08.060 --> 51:11.380
traumatic amnesia or P . T . A . For 1

51:11.380 --> 51:14.780
to 7 days . On the other hand , If a

51:14.780 --> 51:16.720
person who has experienced a head

51:16.720 --> 51:18.950
trauma loses consciousness for more

51:18.950 --> 51:22.390
than 24 hours or experiences Pita for

51:22.390 --> 51:24.550
more than seven days they'll be

51:24.550 --> 51:28.260
diagnosed with severe TBI . It's

51:28.260 --> 51:30.260
important to note that although the

51:30.260 --> 51:33.640
Glasgow coma scale or GCS , is widely

51:33.640 --> 51:35.850
used in clinical practice , the

51:35.850 --> 51:37.794
Department of Defense has recently

51:37.794 --> 51:40.650
recommended against using GCS scores

51:40.660 --> 51:44.410
for diagnosing TB . I . Because it's so

51:44.410 --> 51:47.050
widely used . However , it's useful to

51:47.050 --> 51:49.240
know what it is and what score

51:49.240 --> 51:52.100
indicates a moderate TBI and a severe

51:52.100 --> 51:55.690
TBI . The Glasgow coma scale measures a

51:55.690 --> 51:58.420
person's ability to open their eyes as

51:58.420 --> 52:00.450
well as their ability to respond to

52:00.450 --> 52:03.010
spoken questions and physical prompts

52:03.010 --> 52:06.750
for movements . AGCS score between nine

52:06.750 --> 52:09.470
and 12 indicates moderate t . v . i .

52:10.050 --> 52:12.740
Anything below a nine indicates severe

52:12.740 --> 52:16.110
TBI . A provider may order imaging

52:16.110 --> 52:18.166
tests if they have reason to believe

52:18.166 --> 52:20.400
that other damage to the skull or brain

52:20.400 --> 52:23.700
has occurred . Mhm . Serious problems

52:23.700 --> 52:25.867
can arise if there are conditions that

52:25.867 --> 52:28.520
haven't yet presented symptoms such as

52:28.520 --> 52:31.710
a hematoma or bleeding in or around the

52:31.710 --> 52:35.260
brain . Mhm mm .

52:35.650 --> 52:36.180
Yeah .

52:39.110 --> 52:42.650
External force such as a blow or jolt

52:42.650 --> 52:45.810
to the head causes TB . For this reason ,

52:45.820 --> 52:47.876
it's not uncommon for other parts of

52:47.876 --> 52:50.209
the body to be injured at the same time .

52:50.250 --> 52:52.361
Many patients with moderate to severe

52:52.361 --> 52:55.230
TBI suffer skull fractures or damage to

52:55.230 --> 52:57.286
the eyes and other parts of the face

52:57.286 --> 52:59.174
from the same external force that

52:59.174 --> 53:01.063
caused the brain injury . This is

53:01.063 --> 53:03.286
called poly trauma . Another example is

53:03.286 --> 53:05.508
a patient whose TB results from a motor

53:05.508 --> 53:08.070
vehicle accident , fall or explosion

53:08.150 --> 53:10.372
causing injuries to multiple body parts

53:10.372 --> 53:12.690
and organ systems . Some patients with

53:12.700 --> 53:15.000
mild moderate or severe TBI . I also

53:15.000 --> 53:17.000
experienced co occurring conditions

53:17.000 --> 53:18.778
such as post traumatic stress ,

53:18.778 --> 53:21.390
depression , anxiety , substance abuse

53:21.400 --> 53:23.060
or suicidal thoughts .

53:29.050 --> 53:33.040
Mhm . A skull fracture is a type

53:33.040 --> 53:35.151
of injury often seen with moderate or

53:35.151 --> 53:37.570
severe TBI , although skull fractures

53:37.570 --> 53:39.459
can occur without the brain being

53:39.459 --> 53:41.860
injured . DR Freeman . What can you

53:41.860 --> 53:44.590
tell us about skull fractures ? Well

53:44.590 --> 53:47.330
doctor Halmstad , a skull fracture is a

53:47.330 --> 53:49.410
crack or break in the bones of the

53:49.410 --> 53:52.300
skull , also called the cranial bones ,

53:52.650 --> 53:55.060
although the skull is hard and usually

53:55.060 --> 53:57.171
provides excellent protection for the

53:57.171 --> 53:59.910
brain , a severe impact or blow can

53:59.910 --> 54:02.530
cause a fracture . There are several

54:02.530 --> 54:05.140
types of skull fractures , including

54:05.320 --> 54:08.560
simple linear compound ,

54:08.940 --> 54:12.660
depressed and penetrating . A

54:12.660 --> 54:15.000
simple skull fracture is a break in the

54:15.000 --> 54:17.290
skull without damage to the surrounding

54:17.290 --> 54:20.840
skin . A linear skull fracture is a

54:20.840 --> 54:22.896
break in the skull that looks like a

54:22.896 --> 54:25.670
thin line without any additional damage

54:25.670 --> 54:28.520
to the bone . Compound . Skull

54:28.520 --> 54:30.980
fractures refer to splintering of the

54:30.980 --> 54:34.770
bone when a broken or crushed portion

54:34.780 --> 54:37.160
of the skull presses in towards the

54:37.160 --> 54:39.820
brain , it's called a depressed skull

54:39.820 --> 54:43.250
fracture . When an object , such as a

54:43.250 --> 54:45.790
bullet or debris from an explosion ,

54:45.810 --> 54:48.710
pierces the skull . A person has a

54:48.710 --> 54:52.000
penetrating skull fracture . Most

54:52.000 --> 54:54.130
simple skull fractures heal on their

54:54.130 --> 54:56.670
own and without medical intervention .

54:57.140 --> 54:59.200
However , if the fracture is

54:59.200 --> 55:02.300
accompanied by hematoma or bleeding in

55:02.300 --> 55:04.650
or around the brain , surgery may be

55:04.650 --> 55:06.760
required to relieve pressure on the

55:06.760 --> 55:10.280
brain . Additionally , if the skin is

55:10.280 --> 55:12.840
broken and the injury site contaminated ,

55:13.070 --> 55:15.570
a provider may prescribe antibiotics to

55:15.570 --> 55:17.710
prevent or fight infection .

55:21.940 --> 55:22.940
Mhm .

55:26.420 --> 55:28.642
In many cases , patients with traumatic

55:28.642 --> 55:30.698
brain injury also have problems with

55:30.698 --> 55:32.587
their vision . These problems can

55:32.587 --> 55:34.587
result from injury to the eye , the

55:34.587 --> 55:36.830
optic nerve or to the brain itself , dr

55:36.830 --> 55:38.941
green . Can you tell us about some of

55:38.941 --> 55:40.830
the ocular and eye injuries often

55:40.830 --> 55:42.941
associated with T . B . Definitely dr

55:42.941 --> 55:45.163
Reynolds injuries to the eye that occur

55:45.163 --> 55:47.163
in connection with TB are often the

55:47.163 --> 55:49.219
result of flying debris entering the

55:49.219 --> 55:51.800
eye or a direct blow to the eye . A

55:51.800 --> 55:53.967
direct blow to the I can cause the eye

55:53.967 --> 55:56.078
to rupture , or it can cause internal

55:56.078 --> 55:58.189
damage to the eye , which can only be

55:58.189 --> 56:00.300
seen with special instruments . These

56:00.300 --> 56:02.522
eye injuries may require surgeries soon

56:02.522 --> 56:04.689
after they occur to remove debris from

56:04.689 --> 56:06.911
the eye and when possible repair damage

56:06.911 --> 56:09.078
to the structures inside the eye . One

56:09.078 --> 56:11.189
of the most common causes for loss of

56:11.189 --> 56:12.967
vision following head trauma is

56:12.967 --> 56:14.856
traumatic optic neuropathy . This

56:14.856 --> 56:17.022
condition involves damage to the optic

56:17.022 --> 56:18.800
nerve , which is the nerve that

56:18.800 --> 56:20.967
provides the ability to see . Patients

56:20.967 --> 56:22.967
with traumatic optic neuropathy can

56:22.967 --> 56:25.550
experience sudden vision loss . In some

56:25.550 --> 56:27.717
cases , the injury is apparent hours ,

56:27.717 --> 56:29.994
days or even months after the incident .

56:30.330 --> 56:32.497
In other cases , the damage may not be

56:32.497 --> 56:34.552
detected until an eye examination is

56:34.552 --> 56:36.663
performed by a health care provider .

56:36.663 --> 56:38.774
Other vision problems can result from

56:38.774 --> 56:40.830
damage to the occipital lobes in the

56:40.830 --> 56:42.886
back of the brain . The signals from

56:42.886 --> 56:45.052
the eyes are received by the occipital

56:45.052 --> 56:47.163
lobes , and these signals are used to

56:47.163 --> 56:49.274
form and interpret images . Damage to

56:49.274 --> 56:51.052
the occipital lobes can make it

56:51.052 --> 56:53.219
impossible to understand what the eyes

56:53.219 --> 56:55.441
are seeing or cause a type of blindness

56:55.441 --> 56:57.880
known as cortical blindness . The brain

56:57.880 --> 57:00.240
also controls the movements of the eyes

57:00.250 --> 57:02.306
damage to the part of the brain that

57:02.306 --> 57:04.361
controls those movements can cause a

57:04.361 --> 57:06.250
number of problems such as double

57:06.250 --> 57:08.139
vision and difficulty following a

57:08.139 --> 57:10.361
moving object or reading tracking words

57:10.361 --> 57:13.110
on a page . Some of the visual problems

57:13.110 --> 57:14.943
that patients with T . B . I can

57:14.943 --> 57:16.943
experience include blurred vision ,

57:16.950 --> 57:19.530
reading difficulties , sensitivity to

57:19.530 --> 57:21.940
light , difficulty understanding images ,

57:21.950 --> 57:24.250
double vision , headache , following

57:24.250 --> 57:27.050
visual tasks , reduction or loss of

57:27.050 --> 57:29.170
peripheral vision , difficulties with

57:29.180 --> 57:31.620
eye movements such as problems shifting

57:31.620 --> 57:33.640
gaze quickly from one point to the

57:33.640 --> 57:35.830
other , challenges focusing and

57:35.830 --> 57:37.497
problems with eye alignment .

57:45.830 --> 57:49.520
Yeah , poly trauma

57:49.520 --> 57:51.353
occurs when a person experiences

57:51.353 --> 57:53.680
injuries to multiple body parts and

57:53.680 --> 57:56.340
organ systems as the result of a single

57:56.340 --> 57:59.190
traumatic event . DR Freeman , can you

57:59.190 --> 58:01.079
tell us more about polyps , rauma

58:01.079 --> 58:03.490
injuries ? Absolutely . Doctor Halmstad ,

58:03.500 --> 58:06.260
blast related events , motor vehicle

58:06.260 --> 58:08.780
collisions and serious falls are the

58:08.780 --> 58:10.724
kinds of traumatic events that can

58:10.724 --> 58:13.290
cause poly trauma outcomes and

58:13.290 --> 58:15.720
treatment vary widely depending upon

58:15.720 --> 58:17.940
which organ systems and body parts are

58:17.950 --> 58:20.200
injured and how severely each is

58:20.200 --> 58:22.780
affected . Some common injuries

58:22.780 --> 58:25.070
associated with severe T . B . I . And

58:25.070 --> 58:28.190
poly trauma include loss of one or more

58:28.190 --> 58:31.780
limbs , spinal cord injuries , burns

58:31.970 --> 58:34.240
and auditory and visual damage .

58:34.820 --> 58:37.360
Additionally , behavioral conditions

58:37.370 --> 58:40.420
such as post traumatic stress , anxiety

58:40.430 --> 58:43.380
or depression may co occur with T . B .

58:43.380 --> 58:46.010
I . And polly trauma . Many of these

58:46.010 --> 58:48.570
injuries and conditions require intense

58:48.570 --> 58:51.120
treatment and rehabilitation and in

58:51.120 --> 58:54.150
some cases cause permanent disability ,

58:58.320 --> 58:58.650
mm

59:01.920 --> 59:04.500
depression , anxiety and irritability

59:04.500 --> 59:06.750
are common symptoms of TB . But

59:06.750 --> 59:08.417
sometimes a person develops a

59:08.417 --> 59:10.472
behavioral condition that may not be

59:10.472 --> 59:12.528
the result of the T . B . But of the

59:12.528 --> 59:14.583
traumatic event that caused the TB .

59:14.583 --> 59:16.583
Other times a person may have a pre

59:16.583 --> 59:18.694
existing behavioral condition that is

59:18.694 --> 59:20.750
aggravated by the traumatic event or

59:20.750 --> 59:22.750
the T . B . I . These are called co

59:22.750 --> 59:24.806
occurring behavioral conditions . Dr

59:24.806 --> 59:26.917
Greene . What can you tell us about ?

59:26.917 --> 59:28.972
Co occurring behavioral conditions ?

59:28.972 --> 59:30.750
Will dr Reynolds Some common co

59:30.750 --> 59:32.972
occurring behavioral conditions include

59:32.972 --> 59:35.820
post traumatic stress or PTS , anxiety ,

59:35.830 --> 59:38.370
depression , substance abuse and

59:38.370 --> 59:41.140
suicidal thoughts . PTS is a mental

59:41.140 --> 59:43.307
health condition that's triggered by a

59:43.307 --> 59:45.529
traumatic event such as war , a natural

59:45.529 --> 59:47.840
disaster , an accident or an assault .

59:48.220 --> 59:50.560
A person can get pts from experiencing

59:50.560 --> 59:52.540
the events or simply witnessing it

59:53.020 --> 59:55.000
symptoms may include flashbacks ,

59:55.010 --> 59:57.660
nightmares and severe anxiety , as well

59:57.660 --> 59:59.716
as uncontrollable thoughts about the

59:59.716 --> 01:00:02.050
event . Depression or depressive

01:00:02.050 --> 01:00:04.272
disorder is another common co occurring

01:00:04.272 --> 01:00:07.100
condition . Symptoms of depression can

01:00:07.100 --> 01:00:09.690
include a depressed mood and inability

01:00:09.690 --> 01:00:12.380
to enjoy things , difficulty sleeping ,

01:00:12.390 --> 01:00:14.560
changes in patterns of sleeping and

01:00:14.560 --> 01:00:16.860
eating problems and concentration and

01:00:16.860 --> 01:00:19.200
decision making feelings of guilt ,

01:00:19.210 --> 01:00:21.820
hopelessness and decreased self esteem .

01:00:22.310 --> 01:00:24.500
Substance abuse and suicidal thoughts

01:00:24.510 --> 01:00:26.230
are other common co occurring

01:00:26.230 --> 01:00:28.720
conditions . Evidence shows that T . B .

01:00:28.720 --> 01:00:30.850
I . Patients who have one of these co

01:00:30.850 --> 01:00:33.072
occurring conditions have a harder time

01:00:33.072 --> 01:00:35.183
recovering from their traumatic brain

01:00:35.183 --> 01:00:37.239
injury . For that reason , providers

01:00:37.239 --> 01:00:39.183
may use special questionnaires and

01:00:39.183 --> 01:00:41.350
other screening tests to assess new Tv

01:00:41.350 --> 01:00:43.239
patients for these conditions and

01:00:43.239 --> 01:00:45.183
referred them to behavioral health

01:00:45.183 --> 01:00:46.739
specialists for treatment .

01:00:52.270 --> 01:00:54.980
There are many secondary complications

01:00:54.980 --> 01:00:56.924
that can result from a moderate to

01:00:56.924 --> 01:00:59.170
severe TBI . One type of complication

01:00:59.170 --> 01:01:01.430
is swelling of the brain called edema ,

01:01:01.440 --> 01:01:03.384
which can cause increased pressure

01:01:03.384 --> 01:01:05.551
within the skull . Other complications

01:01:05.551 --> 01:01:07.773
are related to the brain getting little

01:01:07.773 --> 01:01:09.940
or no oxygen hypertension or low blood

01:01:09.940 --> 01:01:12.107
pressure can be a serious problem that

01:01:12.107 --> 01:01:14.273
reduces the amount of oxygen delivered

01:01:14.273 --> 01:01:16.273
to the brain tissues , seizures and

01:01:16.273 --> 01:01:18.329
problems with the endocrine system ,

01:01:18.329 --> 01:01:20.162
which controls hormones can also

01:01:20.162 --> 01:01:22.320
disrupt brain function .

01:01:29.510 --> 01:01:31.288
T . B . I . Patients who have a

01:01:31.288 --> 01:01:33.550
haematoma contusion or excessive brain

01:01:33.550 --> 01:01:35.570
swelling called edema can have

01:01:35.570 --> 01:01:37.850
secondary complications that cause

01:01:37.850 --> 01:01:40.390
further damage to the brain . Three of

01:01:40.390 --> 01:01:42.390
these complications are hemorrhagic

01:01:42.390 --> 01:01:45.070
progression of a contusion or HPC ,

01:01:45.270 --> 01:01:47.870
elevated intracranial pressure or I . C .

01:01:47.870 --> 01:01:50.440
P . And breakdown of the blood brain

01:01:50.440 --> 01:01:52.840
barrier . Doctor Freeman . Can you tell

01:01:52.840 --> 01:01:55.173
us more about these three complications ?

01:01:55.173 --> 01:01:59.040
Sure . Dr Halmstad HPcs occur when

01:01:59.040 --> 01:02:01.370
an initial contusion from the primary

01:02:01.370 --> 01:02:03.990
injury continues to bleed and expand

01:02:03.990 --> 01:02:06.810
over time . This creates a new or

01:02:06.810 --> 01:02:09.920
larger lesion or area of damaged tissue .

01:02:10.600 --> 01:02:13.300
This increased exposure to blood which

01:02:13.300 --> 01:02:15.780
is toxic to brain cells , leads to

01:02:15.780 --> 01:02:18.310
swelling and further brain cell death .

01:02:18.900 --> 01:02:21.180
Poor blood flow to the brain can also

01:02:21.180 --> 01:02:24.310
cause secondary damage . When the brain

01:02:24.310 --> 01:02:27.000
receives a powerful blow , swelling

01:02:27.000 --> 01:02:29.220
occurs just as it would in other parts

01:02:29.220 --> 01:02:32.020
of the body because the skull cannot

01:02:32.020 --> 01:02:34.970
expand , the brain tissue swells and

01:02:34.970 --> 01:02:37.470
the pressure inside the skull rises .

01:02:38.090 --> 01:02:40.930
This is known as increased intracranial

01:02:40.930 --> 01:02:43.630
pressure or I . C . P . Which can

01:02:43.630 --> 01:02:46.010
prevent blood from flowing to the brain .

01:02:46.790 --> 01:02:48.840
This can permanently damage brain

01:02:48.840 --> 01:02:51.680
function . The blood brain barrier

01:02:51.680 --> 01:02:53.930
preserves the separation between the

01:02:53.930 --> 01:02:56.070
brain fluid and the very small

01:02:56.070 --> 01:02:58.240
capillaries that bring nutrients and

01:02:58.250 --> 01:03:01.710
oxygen to the brain . If a contusion or

01:03:01.710 --> 01:03:03.890
hematoma , causes the blood brain

01:03:03.890 --> 01:03:06.940
barrier to break down blood plasma

01:03:06.940 --> 01:03:09.680
proteins and other foreign substances

01:03:09.690 --> 01:03:12.230
leak into the space between neurons in

01:03:12.230 --> 01:03:14.930
the brain and cause the brain to swell .

01:03:15.500 --> 01:03:18.300
This causes multiple biological systems

01:03:18.300 --> 01:03:20.630
to go into overdrive , which can be

01:03:20.630 --> 01:03:22.686
harmful to the body if they continue

01:03:22.686 --> 01:03:25.550
for an extended period of time . It

01:03:25.550 --> 01:03:27.170
also permits the release of

01:03:27.170 --> 01:03:29.650
neurotransmitters , which are chemicals

01:03:29.650 --> 01:03:31.770
used by brain cells to communicate .

01:03:32.400 --> 01:03:34.456
The release of neurotransmitters can

01:03:34.456 --> 01:03:36.510
damage or kill nerve cells .

01:03:41.700 --> 01:03:45.660
Mhm . The effects of moderate to severe

01:03:45.660 --> 01:03:48.200
TBI I can be long lasting or even

01:03:48.200 --> 01:03:50.040
permanent . While recovery and

01:03:50.040 --> 01:03:52.170
rehabilitation are possible . Most

01:03:52.170 --> 01:03:54.226
people with moderate to severe TBI I

01:03:54.226 --> 01:03:56.448
faced life challenges that will require

01:03:56.448 --> 01:03:58.690
them to adapt and adjust to a new

01:03:58.690 --> 01:04:01.410
reality . Moderate to severe TBI I can

01:04:01.410 --> 01:04:03.354
cause permanent physical or mental

01:04:03.354 --> 01:04:05.243
disability because poly trauma is

01:04:05.243 --> 01:04:07.521
common with moderate to severe TBI . I .

01:04:07.521 --> 01:04:09.188
Many patients face additional

01:04:09.188 --> 01:04:11.077
disabilities as a result of other

01:04:11.077 --> 01:04:13.243
injuries , even patients who appear to

01:04:13.243 --> 01:04:15.354
recover fully may have some long term

01:04:15.354 --> 01:04:17.840
symptoms that never go away challenges

01:04:17.840 --> 01:04:19.840
with work and completing tasks that

01:04:19.840 --> 01:04:21.784
were once routine can be much more

01:04:21.784 --> 01:04:24.050
difficult than before the injury . Some

01:04:24.050 --> 01:04:25.939
patients find that the skills and

01:04:25.939 --> 01:04:27.939
abilities that they used before the

01:04:27.939 --> 01:04:30.161
injury to meet these challenges are not

01:04:30.161 --> 01:04:32.106
as sharp as they once were . These

01:04:32.106 --> 01:04:34.272
ongoing challenges can also affect the

01:04:34.272 --> 01:04:36.328
patient's personal life . People who

01:04:36.328 --> 01:04:38.328
have experienced brain injuries may

01:04:38.328 --> 01:04:40.550
take longer to do cognitive or thinking

01:04:40.550 --> 01:04:42.717
tasks associated with memory , such as

01:04:42.717 --> 01:04:44.772
coming up with the correct change in

01:04:44.772 --> 01:04:44.470
the checkout line at the grocery store ,

01:04:44.550 --> 01:04:46.606
replacing an order at a restaurant .

01:04:46.790 --> 01:04:48.623
Family relationships will almost

01:04:48.623 --> 01:04:50.679
certainly change , and in some cases

01:04:50.679 --> 01:04:52.790
the patient will be totally dependent

01:04:52.790 --> 01:04:54.679
on their caregivers . Despite the

01:04:54.679 --> 01:04:56.457
advances in early diagnosis and

01:04:56.457 --> 01:04:58.568
treatment of moderate to severe TBI ,

01:04:58.568 --> 01:05:00.679
the fact remains that traumatic brain

01:05:00.679 --> 01:05:02.401
injury will be a life changing

01:05:02.401 --> 01:05:04.568
experience for many patients , helping

01:05:04.568 --> 01:05:06.401
the patient , family members and

01:05:06.401 --> 01:05:08.623
caregivers to cope with these long term

01:05:08.623 --> 01:05:10.901
consequences is an important part of T .

01:05:10.901 --> 01:05:11.901
B . I .

01:05:11.901 --> 01:05:16.920
Rehabilitation .

01:05:20.490 --> 01:05:21.490
Mhm .

01:05:24.990 --> 01:05:27.101
There are typically several stages of

01:05:27.101 --> 01:05:29.268
treatment for moderate to severe TBI ,

01:05:29.268 --> 01:05:31.434
but it's important to remember that no

01:05:31.434 --> 01:05:33.546
two patients and no to brain injuries

01:05:33.546 --> 01:05:35.712
are exactly the same . That means that

01:05:35.712 --> 01:05:37.601
each treatment plan will follow a

01:05:37.601 --> 01:05:39.768
unique trajectory and pace that's best

01:05:39.768 --> 01:05:41.823
suited to the individual patient and

01:05:41.823 --> 01:05:43.712
their circumstances . The general

01:05:43.712 --> 01:05:45.990
stages of treatment include acute care ,

01:05:45.990 --> 01:05:48.046
post acute care , day rehabilitation

01:05:48.046 --> 01:05:50.212
and community reentry . And each takes

01:05:50.212 --> 01:05:52.268
place in a different setting of care

01:05:52.268 --> 01:05:54.434
depending on how they progress and the

01:05:54.434 --> 01:05:56.601
precise nature of their injury . TBI I

01:05:56.601 --> 01:05:58.768
patients may enter exit and re enter .

01:05:58.768 --> 01:06:00.990
Various stages of treatment . Treatment

01:06:00.990 --> 01:06:02.657
may be needed continuously or

01:06:02.657 --> 01:06:04.879
intermittently throughout the patient's

01:06:04.879 --> 01:06:04.100
life .

01:06:12.880 --> 01:06:15.650
Emergency medical treatment and time in

01:06:15.650 --> 01:06:17.817
the intensive care unit . Or I see you

01:06:17.817 --> 01:06:20.039
are usually the first line of treatment

01:06:20.039 --> 01:06:22.300
of moderate to severe T . B . I . The

01:06:22.300 --> 01:06:24.578
focus in emergency treatment and the I .

01:06:24.578 --> 01:06:26.744
C . U . Is to discover and resolve any

01:06:26.744 --> 01:06:28.967
immediately life threatening conditions

01:06:28.967 --> 01:06:31.022
and to stabilize the patient . After

01:06:31.022 --> 01:06:33.860
that acute rehabilitation begins dr

01:06:33.860 --> 01:06:35.860
greene . What can you tell us about

01:06:35.860 --> 01:06:37.860
emergency treatment ? The ICU . And

01:06:37.860 --> 01:06:39.760
acute care ? Well dr Reynolds .

01:06:39.850 --> 01:06:42.072
Emergency medical treatment can include

01:06:42.072 --> 01:06:43.961
unblocking airways , helping with

01:06:43.961 --> 01:06:46.294
breathing and keeping blood circulating .

01:06:46.380 --> 01:06:48.047
Emergency personnel worked to

01:06:48.047 --> 01:06:49.830
administer oxygen as quickly as

01:06:49.830 --> 01:06:51.790
possible after the injury to help

01:06:51.800 --> 01:06:54.022
reduce the risk of additional damage to

01:06:54.022 --> 01:06:55.740
the brain , cardiopulmonary

01:06:55.740 --> 01:06:58.120
resuscitation or CPR may also be

01:06:58.120 --> 01:07:00.610
necessary . Steps are taken to control

01:07:00.610 --> 01:07:02.666
blood loss , replace lost blood with

01:07:02.666 --> 01:07:04.920
fluids and prevent or treat other

01:07:04.920 --> 01:07:08.410
complications . Moderate to severe TBI

01:07:08.410 --> 01:07:11.090
patients may then spend days or weeks

01:07:11.090 --> 01:07:14.320
in the ICU . Severe TBI patients may be

01:07:14.320 --> 01:07:16.590
in a coma and medically unstable for a

01:07:16.590 --> 01:07:18.850
long time . They may need a ventilator

01:07:18.850 --> 01:07:20.820
to help them breathe and ivy's to

01:07:20.820 --> 01:07:23.240
deliver medications and fluids . They

01:07:23.240 --> 01:07:25.073
will also be attached to medical

01:07:25.073 --> 01:07:27.073
equipment that monitors their heart

01:07:27.073 --> 01:07:29.296
activity , their blood pressure and the

01:07:29.296 --> 01:07:31.462
level of oxygen in the bloodstream . A

01:07:31.462 --> 01:07:33.629
device called an intracranial pressure

01:07:33.629 --> 01:07:36.370
or ICP monitor is inserted into the

01:07:36.370 --> 01:07:38.560
patient's brain to monitor the amount

01:07:38.560 --> 01:07:40.820
of pressure inside the skull . If the

01:07:40.820 --> 01:07:42.931
brain swells , too much steps will be

01:07:42.931 --> 01:07:45.340
taken to reduce the pressure . Once a

01:07:45.340 --> 01:07:47.284
patient is stabilized , they enter

01:07:47.284 --> 01:07:49.560
acute care or acute rehabilitation .

01:07:49.710 --> 01:07:51.877
This stage of treatment takes place in

01:07:51.877 --> 01:07:54.099
a special unit of the trauma hospital ,

01:07:54.099 --> 01:07:56.154
a rehabilitation hospital or another

01:07:56.154 --> 01:07:57.740
inpatient setting . Acute

01:07:57.740 --> 01:07:59.880
rehabilitation is a significant phase

01:07:59.880 --> 01:08:01.824
of the recovery process . For many

01:08:01.824 --> 01:08:04.670
severe TBI patients , therapy may take

01:08:04.670 --> 01:08:08.020
place 5-7 days a week for three or more

01:08:08.020 --> 01:08:10.187
hours a day to help the patient regain

01:08:10.187 --> 01:08:12.480
the ability to do everyday activities

01:08:12.490 --> 01:08:15.080
such as dressing , eating , going to

01:08:15.080 --> 01:08:17.600
the bathroom , walking and speaking .

01:08:22.570 --> 01:08:26.380
Yeah because the normal pressure

01:08:26.380 --> 01:08:28.547
inside the skull may increase after an

01:08:28.547 --> 01:08:30.658
injury due to swelling of the brain .

01:08:30.658 --> 01:08:32.970
One important step taken in the first

01:08:32.970 --> 01:08:35.137
stages of treatment is to measure that

01:08:35.137 --> 01:08:37.230
pressure . This pressure is known as

01:08:37.240 --> 01:08:40.370
intracranial pressure or ICP because

01:08:40.370 --> 01:08:42.314
the increase in I . C . P . Can be

01:08:42.314 --> 01:08:44.259
dangerous . It needs to be closely

01:08:44.259 --> 01:08:46.148
watched . Choosing an I . C . P .

01:08:46.148 --> 01:08:48.314
Monitor . Dr Freeman . Can you tell us

01:08:48.314 --> 01:08:50.426
how elevated I . C . P . Is treated ?

01:08:50.426 --> 01:08:53.280
Sure thing . Dr Halmstad . If the I . C .

01:08:53.280 --> 01:08:55.930
P . Rises too high medications are

01:08:55.930 --> 01:08:58.280
given to reduce the pressure , slow

01:08:58.280 --> 01:09:00.970
brain function down and increased blood

01:09:00.970 --> 01:09:03.192
flow to the injured part of the brain .

01:09:03.570 --> 01:09:05.570
The patient can also be placed on a

01:09:05.570 --> 01:09:08.100
breathing machine known as a ventilator .

01:09:08.470 --> 01:09:10.670
If the I . C . P . Monitor shows that

01:09:10.680 --> 01:09:12.830
the intracranial pressure is building

01:09:12.830 --> 01:09:15.230
to a dangerous level . A catheter may

01:09:15.230 --> 01:09:18.170
be used to drain cerebral spinal fluid

01:09:18.170 --> 01:09:21.140
from the brain . In some cases of

01:09:21.140 --> 01:09:24.080
moderate to severe TBI , eye surgery

01:09:24.080 --> 01:09:25.760
may be required to reduce the

01:09:25.760 --> 01:09:27.980
intracranial pressure and provides

01:09:27.980 --> 01:09:30.600
space for any swelling of the brain .

01:09:31.270 --> 01:09:33.492
There are two kinds of surgery that are

01:09:33.492 --> 01:09:36.370
often used to do this . One of these

01:09:36.370 --> 01:09:38.780
involves the temporary removal of part

01:09:38.780 --> 01:09:41.590
of the skull in the form of a bone flap .

01:09:41.970 --> 01:09:44.700
This procedure is called a craniotomy .

01:09:44.710 --> 01:09:47.280
The brain can then be accessed for

01:09:47.280 --> 01:09:49.336
treatment , pressure on the brain is

01:09:49.336 --> 01:09:52.440
relieved and the bone flap is replaced

01:09:52.450 --> 01:09:55.450
if the bone is not replaced immediately .

01:09:55.460 --> 01:09:57.900
The procedure is called a craniectomy .

01:09:58.570 --> 01:10:01.060
In this case the original bone may be

01:10:01.060 --> 01:10:03.470
replaced at a later time or an

01:10:03.470 --> 01:10:05.230
artificial replacement made

01:10:05.230 --> 01:10:07.230
specifically for the patient may be

01:10:07.230 --> 01:10:10.240
used . While the bone flap is not in

01:10:10.240 --> 01:10:12.740
place , many patients wear a helmet to

01:10:12.740 --> 01:10:14.290
protect their brain

01:10:17.760 --> 01:10:20.320
mm . Yeah ,

01:10:22.360 --> 01:10:24.470
When moderate to severe TBI patients

01:10:24.470 --> 01:10:26.692
are well enough , they progress to post

01:10:26.692 --> 01:10:28.360
acute care , sometimes called

01:10:28.370 --> 01:10:30.660
transitional rehabilitation . Doctor

01:10:30.660 --> 01:10:32.882
Green . Can you tell us more about post

01:10:32.882 --> 01:10:34.993
acute care ? Definitely dr Reynolds .

01:10:34.993 --> 01:10:37.240
Post acute care offers more intensive

01:10:37.240 --> 01:10:39.240
therapy than acute care and usually

01:10:39.240 --> 01:10:40.851
takes place in a residential

01:10:40.851 --> 01:10:42.851
rehabilitation facility . Treatment

01:10:42.851 --> 01:10:44.962
focuses on helping the patient regain

01:10:44.962 --> 01:10:46.907
as much independent functioning as

01:10:46.907 --> 01:10:48.851
possible . It involves re learning

01:10:48.851 --> 01:10:50.796
abilities and learning new ways to

01:10:50.796 --> 01:10:53.018
compensate for potentially long term or

01:10:53.018 --> 01:10:55.073
permanent disability . Some patients

01:10:55.073 --> 01:10:57.296
who are well enough to leave acute care

01:10:57.296 --> 01:10:59.184
but still have medical needs that

01:10:59.184 --> 01:11:01.018
required 24 hour a day , skilled

01:11:01.018 --> 01:11:02.962
nursing care or rehabilitation may

01:11:02.962 --> 01:11:04.629
enter what's called sub acute

01:11:04.629 --> 01:11:06.851
rehabilitation , a less intense therapy

01:11:06.851 --> 01:11:09.073
program that lasts over a longer period

01:11:09.073 --> 01:11:11.240
of time . Sub acute rehabilitation may

01:11:11.240 --> 01:11:13.018
take place in a skilled nursing

01:11:13.018 --> 01:11:15.790
facility or a nursing home . Mhm .

01:11:20.760 --> 01:11:22.927
Once a patient with moderate to severe

01:11:22.927 --> 01:11:25.190
TBI I progresses past post acute care .

01:11:25.330 --> 01:11:27.520
They may enter day rehabilitation ,

01:11:27.530 --> 01:11:29.697
sometimes called outpatient therapy or

01:11:29.697 --> 01:11:31.880
outpatient rehabilitation . In this

01:11:31.880 --> 01:11:34.047
stage , the patient is able to live at

01:11:34.047 --> 01:11:35.991
home , usually with family members

01:11:35.991 --> 01:11:37.936
while they continue rehabilitation

01:11:37.936 --> 01:11:40.102
during the day . Day rehab often takes

01:11:40.102 --> 01:11:42.310
place in a structured group setting at

01:11:42.310 --> 01:11:44.610
an outpatient rehabilitation or therapy

01:11:44.610 --> 01:11:47.010
center . In some cases , patients may

01:11:47.010 --> 01:11:49.232
be able to receive home health services

01:11:49.440 --> 01:11:51.551
rehabilitation therapies can continue

01:11:51.551 --> 01:11:53.384
within the home as needed and as

01:11:53.384 --> 01:11:55.718
recommended by the health care provider .

01:11:55.718 --> 01:11:57.440
Most but not all hospitals and

01:11:57.440 --> 01:11:59.551
rehabilitation companies provide home

01:11:59.551 --> 01:12:00.551
health services .

01:12:07.660 --> 01:12:10.020
Eventually a moderate to severe TBI I

01:12:10.020 --> 01:12:12.187
patient will be ready for transitional

01:12:12.187 --> 01:12:14.740
care or community reentry . Community

01:12:14.740 --> 01:12:16.684
re entry programs help the patient

01:12:16.684 --> 01:12:18.573
prepared to return to independent

01:12:18.573 --> 01:12:20.684
living and , if possible , to work or

01:12:20.684 --> 01:12:22.910
school . The goal of community reentry

01:12:22.910 --> 01:12:24.966
treatment is to develop higher level

01:12:24.966 --> 01:12:27.560
skills and functions such as social

01:12:27.560 --> 01:12:29.770
interaction skills , goal setting ,

01:12:29.780 --> 01:12:32.360
money management skills and safety in

01:12:32.360 --> 01:12:34.590
the community . Some programs offer

01:12:34.590 --> 01:12:36.870
vocational training as well .