June 26 2016

What is traumatic brain injury?

Professor Jennie Ponsford MAPS
By Professor of Neuropsychology, Monash University Director, Monash-Epworth Rehabilitation Research Centre

Traumatic brain injuries (TBI) are common injuries resulting from a blow to the head that often lead to long lasting physical, emotional and behavioral effects.

While people who sustain a moderate to severe traumatic brain injury (TBI) may have a physical disability, the more common and challenging problems are changes to their cognitive, behavioural and emotional state.

These changes include impaired memory, attention and executive function as well as fatigue, sleep disturbance, anxiety and depression. These factors can affect the person’s every-day life, from difficulty returning to work to problems studying or pursuing leisure activities. It can also have a negative impact on their relationships and social life.

It’s important that we address the psychological impact of TBI, not just the physical injury, to improve outcomes for TBI survivors.

What is traumatic brain injury?

TBI is caused by a blow to the head, usually from an external force, that results in a temporary or permanent disruption to brain function. The person may immediately lose consciousness which can last from a few seconds up to many months.

Many people with TBI will experience a range of physical, sensory and cognitive symptoms, depending on the severity of the injury.

Mild TBI can cause symptoms such as headaches, dizziness, blurred or double vision, fatigue, sensitivity to noise or bright lights, tinnitus, insomnia, reduced speed of thinking, poor balance, concentration and memory problems, anxiety, irritability and depression. For about 90 per cent of people, these symptoms are often resolved within a matter of days or weeks.

For moderate to severe TBI, the injury can be long-term and may cause symptoms such as fatigue, deficits of attention, slowed information processing, difficulties with new learning and memory, and impaired planning and problem-solving.

People with moderate to severe TBI will often make a good physical recovery but we know more than half of those will have ongoing cognitive and behavioural changes and many require continuing carer support for their day to day activities. In these cases, TBI can have a major impact not only on the life of the person who sustained the TBI but also on the life of those now caring for them.

How common is TBI?

TBI affects about 100 in every 100,000 people in Australia each year. Research suggests about 80 per cent of people admitted to hospital sustain a mild TBI while the remaining 20 per cent will have a moderate to severe TBI.

TBI most often occurs from falls, bicycle accidents, assaults and sporting injuries while many of the moderate to severe traumatic brain injuries are a result of motor vehicle accidents.

The highest incidence of TBI occurs in those aged 15-25 and most of those are male. With the rapidly ageing population, we’ve seen a growing incidence of TBI in older people as a result of falls, which typically affects more females than males.

How is TBI identified?

A blow to the head that leads to a loss of consciousness or impairment of consciousness, such as the person becoming confused or disorientated, are the two key factors identifying TBI.

In the case of a mild TBI, some people may not realise that they’ve received a brain injury and, as a result, they may not present to the hospital emergency department. These people may experience some of the symptoms of TBI and become anxious. It’s important the injury is diagnosed so that the person is provided with the right information and support to assist their recovery.

How do we help people with TBI?

Psychologists and particularly neuropsychologists have a major role to play in diagnosing the nature of the cognitive, behavioural and emotional changes that commonly occur after TBI.

Psychologists are also pivotal in establishing the most effective management strategies as part of a multidisciplinary team of health professionals, including occupational therapists, speech pathologists and physiotherapists, to assist people throughout their recovery.

Research initiatives are now providing a greater understanding of not only the problems associated with TBI but also in developing effective treatments.

Our research highlights the importance of psychologists taking a different approach to traditional psychological therapies for TBI.

We’ve established the efficacy of delivering an adapted form of Cognitive Behaviour Therapy (CBT) treatment that uses concrete concepts such as repetition, a therapy diary, pictorial handouts and cues. Psychologists can also include a close family member in the therapy to reinforce the use of strategies in the real world. Our team is now working on educating psychologists about the benefits of embracing this adapted CBT therapy to help people in their recovery from TBI.

TBI can result in complex problems and, unfortunately, there is no quick cure. We know that failing to provide the right care for a person with TBI will increase their psychological problems over time, magnifying their experience of factors such as anxiety and depression.

The key lies in understanding all of the multiple factors and how they interact with each other while addressing the different aspects of the problem, all within the context of the person’s every-day life.

Improving a person’s long-term recovery and quality of life means targeting more than just the physical injury from TBI. It’s imperative we also turn our attention to the invisible injury – the psychological impact of TBI. Addressing this from the early stages of the person’s recovery will help them to achieve better long-term outcomes.

Disclosure statement: Jennie Ponsford receives funding from the Institute for Safety, Compensation and Recovery Research (ISCRR) and funding from the National Health and Medical Research Council (Australia). Jennie is a member of the Australian Psychological Society.