Brain Injury–Post Acute Care Issues
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Traumatic brain injury (TBI) is caused by externally inflicted trauma that may result in significant impairment of an individual's physical, cognitive, and psychosocial functioning:
- The management of acute TBI is outside the scope of this chapter.
- Predominant age: Highest incidence in the very young (0–4), in persons 15–24 years of age, and those >75
- Predominant sex: Male > Female (2:1)
- 1.2–1.7 million Americans sustain a TBI per year.
- 50,000 deaths per year
- 80,000–90,000 sustain long-term disabilities.
5.3 million Americans have TBI-related disabilities.
- High risk: Male, age 15–34
- Moderate risk <5 years and >60 years
- Lower socioeconomic status (head injury)
Improved safety standards and programs designed to minimize injury from vehicular-related events (motor vehicle, motorcycle, bicycle, pedestrian), falls, violence, sports, and recreation provide best prevention against TBI (1)[C].
- Cortical contusions due to coup-contrecoup injuries. Although axonal rupture from shear and tensile forces can occur at the time of severe head injury, milder degrees of axonal damage may play a role in mild TBI.
- Disruption of axonal neurofilament organization impairs axonal transport, leading to axonal swelling, Wallerian degeneration, and transection.
- Release of excitatory neurotransmitters acetylcholine, glutamate, and aspartate, and generation of free radicals may contribute to secondary injury.
- Falls and motor vehicle accidents (MVAs) are most common causes
- Violence-related TBI increasing (10% of all cases)
- Sports and recreation injuries (especially in teenagers and young adults)
Commonly Associated Conditions
- Suicide attempts
- Substance abuse
- Attention deficit disorder