Traumatic brain injury
Prevention measures include use of protective technology in vehicles, such as seat belts and sports or motorcycle helmets, as well as efforts to reduce the number of collisions, such as safety education programs and enforcement of traffic laws. Depending on the injury, treatment required may be minimal or may include interventions such as medications, emergency surgery or surgery years later. Physical therapy, speech therapy, recreation therapy, occupational therapy and vision therapy may be employed for rehabilitation. Counseling, supported employment, and community support services may also be useful.
Neural stem cell
Traumatic brain injury (TBI) can deform the brain tissue, leading to necrosis primary damage which can then cascade and activate secondary damage such as excitotoxicity, inflammation, ischemia, and the breakdown of the blood-brain-barrier. Damage can escalate and eventually lead to apoptosis or cell death. Current treatments focus on preventing further damage by stabilizing bleeding, decreasing intracranial pressure and inflammation, and inhibiting pro-apoptoic cascades. In order to repair TBI damage, an upcoming therapeutic option involves the use of NSCs derived from the embryonic peri-ventricular region. Stem cells can be cultured in a favorable 3-dimensional, low cytotoxic environment, a hydrogel, that will increase NSC survival when injected into TBI patients. The intracerebrally injected, primed NSCs were seen to migrate to damaged tissue and differentiate into oligodendrocytes or neuronal cells that secreted neuroprotective factors. Blast injury
Traumatic amputations quickly result in death, unless there are available skilled medical personnel or others with adequate training nearby who are able to quickly respond, with the ability for rapid ground or air medical evacuation to an appropriate facility in time, and with tourniquets (for compression of bleeding sites) and other needed equipment (standard, or improvised; sterile, or not) also available, to treat the injuries. Because of this, injuries of this type are generally rare, though not unheard of, in survivors. Whether survivable or not, they are often accompanied by significant other injuries. The rate of eye injury may depend on the type of blast. Psychiatric injury, some of which may be caused by neurological damage incurred during the blast, is the most common quaternary injury, and post-traumatic stress disorder may affect people who are otherwise completely uninjured. Empathy
It has also been found that empathy can be disrupted due to trauma in the brain such as a stroke. In most cases empathy is usually impaired if a lesion or stroke occurs on the right side of the brain. In addition to this it has been found that damage to the frontal lobe, which is primarily responsible for emotional regulation, can impact profoundly on a person's capacity to experience empathy toward another individual. People who have suffered from an acquired brain injury also show lower levels of empathy according to previous studies. In fact, more than 50% of people who suffer from a traumatic brain injury self-report a deficit in their empathic capacity. Again, linking this back to the early developmental stages of emotion, if emotional growth has been stunted at an early age due to various factors, empathy will struggle to infest itself in that individuals mind-set as a natural feeling, as they themselves will struggle to come to terms with their own thoughts and emotions. This is again suggestive of the fact that understanding one's own emotions is key in being able to identify with another individual’s emotional state. Traumatic brain injury
Cognitive deficits that can follow TBI include impaired attention; disrupted insight, judgement, and thought; reduced processing speed; distractibility; and deficits in executive functions such as abstract reasoning, planning, problem-solving, and multitasking.[120] Memory loss, the most common cognitive impairment among head-injured people, occurs in 20–79% of people with closed head trauma, depending on severity.[121] People who have suffered TBI may also have difficulty with understanding or producing spoken or written language, or with more subtle aspects of communication such as body language.[85] Post-concussion syndrome, a set of lasting symptoms experienced after mild TBI, can include physical, cognitive, emotional and behavioral problems such as headaches, dizziness, difficulty concentrating, and depression.[4] Multiple TBIs may have a cumulative effect.[117] A young person who receives a second concussion before symptoms from another one have healed may be at risk for developing a very rare but deadly condition called second-impact syndrome, in which the brain swells catastrophically after even a mild blow, with debilitating or deadly results. About one in five career boxers is affected by chronic traumatic brain injury (CTBI), which causes cognitive, behavioral, and physical impairments.[122] Dementia pugilistica, the severe form of CTBI, affects primarily career boxers years after a boxing career. It commonly manifests as dementia, memory problems, and parkinsonism (tremors and lack of coordination).[123] Altered state of consciousness
The first condition, traumatic experience, is defined as a lesion caused by an external force (Trauma. (n.d.) In Merriam-Webster Dictionary online, 2013). Examples include impact to the brain caused by blunt force (i.e., a car accident). The reason a traumatic experience causes altered states of consciousness is that it changes how the brain works. The external impact diverts the blood flow from the front of the brain to other areas. The front of the brain is known as the prefrontal cortex responsible for analytical thought (Kunsman, 2012). When the damage becomes uncontrollable, the patient experiences changes in behavior and impaired self-awareness. This is exactly when an ASC is experienced (Spikman et al. 2013). Ciclosporin
Ciclosporin has been investigated as a possible neuroprotective agent in conditions such as traumatic brain injury, and has been shown in animal experiments to reduce brain damage associated with injury. Ciclosporin blocks the formation of the mitochondrial permeability transition pore, which has been found to cause much of the damage associated with head injury and neurodegenerative diseases. Ciclosporin's neuroprotective properties were first discovered in the early 1990s when two researchers (Eskil Elmér and Hiroyuki Uchino) were conducting experiments in cell transplantation. An unintended finding was that CsA was strongly neuroprotective when it crossed the blood–brain barrier. This same process of mitochondrial destruction through the opening of the MPT pore is implicated in making traumatic brain injuries much worse. Trauma Systems Therapy
Traumatic events that affect children are seen in households where sexual, mental, or physical abuse is present. The inability to regulate self-emotions either directly or indirectly is a clinical sign that a traumatic event has affected the child. According to child psychiatrist Dr. Glenn Saxe, “TST is a comprehensive model for treating traumatic stress in children and adolescents that adds to individually based approaches by specifically addressing the child’s social environment and/or systems of care”. This may include children or adolescents having social problems in school or in their home secondary to rape, physical abuse, neglect, death of a caregiver and/or any significant life altering emotion trauma. Sexual, physical, or mental traumatic events can affect present, past memory, and the anticipated future. Saxe’s theory in “The March of the Moments: Traumatic Stress in the Past, Present, and Future,” begins with “survival-in-the-moment” which causes severe emotions, unexplained personality changes, erratic behavior due to a sudden trigger that reminds the child of the event. Second, “Past memory” refers to “laying down of the present, conscious moments in the brain so that they can be accessible if we need them”. This causes significant long-term trauma because if a child is not able to understand what has happened to him or her in the past, then he or she will go through life with a band-aid on this wound instead of healing mentally and physically. Finally, “marching into the future” refers to one of the most detrimental causes of traumatic stress, its effect on the child’s ability to think into the future. Saxe states, “If consciousness is about the present, and memory is about the past, then planning and anticipation are about the future”. One’s ability to see into the future is part of the human cognition, when a child starts to “calculate survival-related risk”; this causes significant stress by continuously reliving the trauma. When a child or adolescent plans their future around what might happen, this never allows the cause of the problem to be resolved, insuring they will never mentally or emotional heal. In addition to the black and white causes of Traumatic Stress, there are also secondary causes that are directly related to these events. So TST not only addresses the event at hand but also the associated problems that come along with it. Traumatic brain injury
Complications are distinct medical problems that may arise as a result of the TBI. The results of traumatic brain injury vary widely in type and duration; they include physical, cognitive, emotional, and behavioral complications. TBI can cause prolonged or permanent effects on consciousness, such as coma, brain death, persistent vegetative state (in which patients are unable to achieve a state of alertness to interact with their surroundings),[115] and minimally conscious state (in which patients show minimal signs of being aware of self or environment).[116][117] Lying still for long periods can cause complications including pressure sores, pneumonia or other infections, progressive multiple organ failure,[85] and deep venous thrombosis, which can cause pulmonary embolism.[16] Infections that can follow skull fractures and penetrating injuries include meningitis and abscesses.[85] Complications involving the blood vessels include vasospasm, in which vessels constrict and restrict blood flow, the formation of aneurysms, in which the side of a vessel weakens and balloons out, and stroke.[85] Brain damage
A common category with the greatest number of injuries is traumatic brain injury (TBI) following physical trauma or head injury from an outside source, and the term acquired brain injury (ABI) is used in appropriate circles to differentiate brain injuries occurring after birth from injury, from a genetic disorder, or from a congenital disorder. Primary and secondary brain injuries identify the processes involved, while focal and diffuse brain injury describe the severity and localization. Traumatic brain injury
Traumatic brain injury may cause a range of serious coincidental complications that include cardiac arrhythmias[99] and neurogenic pulmonary edema.[100] These conditions must be adequately treated and stabilised as part of the core care. Traumatic brain injury
A person with a moderate or severe TBI may have a headache that does not go away, repeated vomiting or nausea, convulsions, an inability to awaken, dilation of one or both pupils, slurred speech, aphasia (word-finding difficulties), dysarthria (muscle weakness that causes disordered speech), weakness or numbness in the limbs, loss of coordination, confusion, restlessness, or agitation.[35] Common long-term symptoms of moderate to severe TBI are changes in appropriate social behavior, deficits in social judgment, and cognitive changes, especially problems with sustained attention, processing speed, and executive functioning.[28][37][38][39][40] Alexithymia, a deficiency in identifying, understanding, processing, and describing emotions occurs in 60.9% of individuals with TBI.[41] Cognitive and social deficits have long-term consequences for the daily lives of people with moderate to severe TBI, but can be improved with appropriate rehabilitation.[40][42][43][44] Blunt trauma
The primary clinical concern when blunt trauma to the head occurs is damage to the brain, although other structures, including the skull, face, orbits, and neck are also at risk. Following assessment of the patient's airway, circulation, and breathing, a cervical collar may be placed if there is suspicion of trauma to the neck. Evaluation of blunt trauma to the head continues with the secondary survey in which evidence of cranial trauma, including bruises, contusions, lacerations, and abrasions are noted. In addition to noting external injury, a comprehensive neurologic exam is typically performed to assess for damage to the brain. Depending on the mechanism of injury and examination, a CT scan of the skull and brain may be ordered. This is typically done to assess for blood within the skull, or fracture of the skull bones. Roger Härtl
Härtl's scientific work focuses on traumatic brain injury (TBI) and he has lectured and published on the surgical treatment of spine disorders, traumatic brain injury, and spinal cord injury. In conjunction with the Brain Trauma Foundation in New York, where he serves as a member of the Medical Advisory Board, Härtl helped develop the treatment guidelines for the medical and surgical management of head injury that are used nationwide. Traumatic brain injury
Magnetic resonance imaging (MRI) can show more detail than CT, and can add information about expected outcome in the long term.[16] It is more useful than CT for detecting injury characteristics such as diffuse axonal injury in the longer term.[3] However, MRI is not used in the emergency setting for reasons including its relative inefficacy in detecting bleeds and fractures, its lengthy acquisition of images, the inaccessibility of the patient in the machine, and its incompatibility with metal items used in emergency care.[16] A variant of MRI since 2012 is High definition fiber tracking (HDFT).[71] Anger management
People with a traumatic brain injury (TBI) can display impulsive, aggressive and dangerous actions. A study in the "Brain Injury" showed that one way to prevent such actions is a community-based treatment of people with TBI. Results indicated that the need to lash out diminished after the 12-week program, and a series of post-treatment testing showed a decline in self-reported frequency of angry actions. Other specific results included: significant decreases in the frequency of experiencing angry feelings and the frequency of outward expression of anger as well as significant increases in the frequency of controlling feelings of anger. Traumatic brain injury
Recent clinical and laboratory research by neurosurgeon Julian Bailes, M.D., and his colleagues from West Virginia University, has resulted in papers showing that dietary supplementation with omega-3 DHA offers protection against the biochemical brain damage that occurs after a traumatic injury.[80] Rats given DHA prior to induced brain injuries suffered smaller increases in two key markers for brain damage (APP and caspase-3), as compared with rats given no DHA.[81] “The potential for DHA to provide prophylactic benefit to the brain against traumatic injury appears promising and requires further investigation. The essential concept of daily dietary supplementation with DHA, so that those at significant risk may be preloaded to provide protection against the acute effects of TBI, has tremendous public health implications.”[82] Concussions in sport
Concussions, a type of traumatic brain injury, are a frequent concern for those playing sports, from children and teenagers to professional athletes. Repeated concussions are a known cause of various neurological disorders, most notably chronic traumatic encephalopathy (CTE), which in professional athletes has led to premature retirement, erratic behavior and even suicide. Because concussions cannot be seen on X-rays or CT scans, attempts to prevent concussions have been difficult. Brain damage
There are many misconceptions that revolve around brain injuries and brain damage. One misconception is that if someone has brain damage then they cannot fully recover. Recovery depends a variety of factors; such as severity and location. Testing is done to note severity and location. Not everyone fully heals from brain damage, but it is possible to have a full recovery. Brain injuries are very hard to predict in outcome. Many tests and specialists are needed to determine the likelihood of the prognosis. People with minor brain damage can have debilitating side effects; not just severe brain damage has debilitating effects. The side- effects of a brain injury depend on location and the body’s response to injury. Even a mild concussion can have long term effects that may not resolve. Another misconception is that children heal better from brain damage. Children are at greater risk for injury due to lack of maturity. It makes future development hard to predict. This is because different cortical areas mature at different stages, with some major cell populations and their corresponding cognitive faculties remaining unrefined until early adulthood. In the case of a child with frontal brain injury, for example, the impact of the damage may be undetectable until that child fails to develop normal executive functions in his or her late teens and early twenties. Traumatic brain injury modeling
There are an estimated 1.7 million cases of TBI per year, not taking into account the lasting affects that TBI may cause. TBI is also reported to be a contributing factor in about 30% of all injury related death. Given how prevalent TBI is, preventing or minimizing its effects would benefit many people worldwide. Traumatic brain injury
The 20th century saw the advancement of technologies that improved treatment and diagnosis such as the development of imaging tools including CT and MRI, and, in the 21st century, diffusion tensor imaging (DTI). The introduction of intracranial pressure monitoring in the 1950s has been credited with beginning the "modern era" of head injury.[98][152] Until the 20thcentury, the mortality rate of TBI was high and rehabilitation was uncommon; improvements in care made during World War I reduced the death rate and made rehabilitation possible.[143] Facilities dedicated to TBI rehabilitation were probably first established during World War I.[143] Explosives used in World War I caused many blast injuries; the large number of TBIs that resulted allowed researchers to learn about localization of brain functions.[153] Blast-related injuries are now common problems in returning veterans from Iraq & Afghanistan; research shows that the symptoms of such TBIs are largely the same as those of TBIs involving a physical blow to the head.[154] Traumatic brain injury
TBI is usually classified based on severity, anatomical features of the injury, and the mechanism (the causative forces).[13] Mechanism-related classification divides TBI into closed and penetrating head injury.[3] A closed (also called nonpenetrating, or blunt)[7] injury occurs when the brain is not exposed.[8] A penetrating, or open, head injury occurs when an object pierces the skull and breaches the dura mater, the outermost membrane surrounding the brain.[8] Retrospective memory
Traumatic brain injury happens when the head suffers from a sharp blow, or suddenly accelerates or decelerates. In these cases, the brain gets churned around, and can be damaged by the bony bumps and knobs inside the skull, or by the twisting and tearing of fibres in the brain. If the traumatic brain injury is severe enough, it can lead to an initial coma, which is then followed by a time of post-traumatic amnesia. Post traumatic amnesia typically resolves itself gradually, however it will leave a mild, but permanent deficit in the patient's memory. Traumatic brain injury
Since a major cause of TBI are vehicle accidents, their prevention or the amelioration of their consequences can both reduce the incidence and gravity of TBI. In accidents, damage can be reduced by use of seat belts, child safety seats[49] and motorcycle helmets,[75] and presence of roll bars and airbags.[31] Education programs exist to lower the number of crashes.[69] In addition, changes to public policy and safety laws can be made; these include speed limits, seat belt and helmet laws, and road engineering practices.[56] Spinal cord injury
Modern trauma care includes a step called clearing the cervical spine, ruling out spinal cord injury if the patient is fully conscious and not under the influence of drugs or alcohol, displays no neurological deficits, has no pain in the middle of the neck and no other painful injuries that could distract from neck pain. If these are all absent, no spinal motion restriction is necessary.
If an unstable spinal column injury is moved, damage may occur to the spinal cord. Between 3 and 25% of SCIs occur not at the time of the initial trauma but later during treatment or transport. While some of this is due to the nature of the injury itself, particularly in the case of multiple or massive trauma, some of it reflects the failure to adequately restrict motion of the spine. SCI can impair the body's ability to keep warm, so warming blankets may be needed. Traumatic brain injury
Systems also exist to classify TBI by its pathological features.[13] Lesions can be extra-axial, (occurring within the skull but outside of the brain) or intra-axial (occurring within the brain tissue).[18] Damage from TBI can be focal or diffuse, confined to specific areas or distributed in a more general manner, respectively.[19] However, it is common for both types of injury to exist in a given case.[19] Glutamate carboxypeptidase II
Severe head injury (SHI) and traumatic brain injury (TBI) are widespread and have a tremendous impact. “They are the leading cause of death in children and young adults (<25 years) and account for a quarter of all deaths in the five to 15 years age group”. Following initial impact, glutamate levels rise and cause excitotoxic damage in a process that has been well characterized. With its ability to reduce glutamate levels, NAAG inhibition has shown promise in preventing neurological damage associated with SHI and TBI. Early childhood trauma
New research shows that even witnessing traumatic events can impact the physical development of a child’s brain — potentially leading to lifelong health and social issues. Spinal cord injury
Vehicle-related SCI is prevented with measures including societal and individual efforts to reduce driving under the influence of drugs or alcohol, distracted driving, and drowsy driving. Other efforts include increasing road safety (such as marking hazards and adding lighting) and vehicle safety, both to prevent accidents (such as routine maintenance and antilock brakes) and to mitigate the damage of crashes (such as head restraints, air bags, seat belts, and child safety seats). Falls can be prevented by making changes to the environment, such as nonslip materials and grab bars in bathtubs and showers, railings for stairs, child and safety gates for windows. Gun-related injuries can be prevented with conflict resolution training, gun safety education campaigns, and changes to the technology of guns (such as trigger locks) to improve their safety. Sports injuries can be prevented with changes to sports rules and equipment to increase safety, and education campaigns to reduce risky practices such as diving into water of unknown depth or head-first tackling in association football. Childhood acquired brain injury
It encompasses both traumatic and non-traumatic (or atraumatic) injuries. Traumatic brain injury
Findings on the frequency of each level of severity vary based on the definitions and methods used in studies. A World Health Organization study estimated that between 70 and 90% of head injuries that receive treatment are mild,[136] and a US study found that moderate and severe injuries each account for 10% of TBIs, with the rest mild.[65] Traumatic brain injury
Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force injures the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional, and behavioral symptoms, and outcome can range from complete recovery to permanent disability or death. Bone fracture
Both high- and low-force trauma can cause bone fracture injuries. Preventive efforts to reduce motor vehicle crashes, the most common cause of high-force trauma, include reducing distractions while driving. Common distractions are driving under the influence and texting or calling while driving, both of which lead to an approximate 6-fold increase in crashes. Wearing a seatbelt can also reduce the likelihood of injury in a collision. Injury prevention
Injury prevention is an effort to prevent or reduce the severity of bodily injuries caused by external mechanisms, such as accidents, before they occur. Injury prevention is a component of safety and public health, and its goal is to improve the health of the population by preventing injuries and hence improving quality of life. Among laypersons, the term "accidental injury" is often used. However, "accidental" implies the causes of injuries are random in nature. Researchers use the term "unintentional injury" to refer to injuries that are nonvolitional but preventable. Within the field of public health, efforts are also made to prevent or reduce "intentional injury." Data from the U.S. Centers for Disease Control, for example, show unintentional injuries are the leading cause of death from early childhood until middle adulthood. During these years, unintentional injuries account for more deaths than the next nine leading causes of death combined. Traumatic brain injury modeling
Blast-Induced TBI results from wave propagation from a blast source through the brain. These injuries are most commonly found on the battlefield, as explosions occur close enough to humans that the high intensity waves apply stresses and strains that greatly surpass neuron elastic thresholds. As the wave passes through the skull, cerebrospinal fluid, and through the brain, neurons undergo sequences of tension and compression for the duration of the blast wave. Even very short blast waves with high intensity can cause immediate cell death, even through the cerebrospinal fluid buffer. Blast-Induced damage is not localized to a specific region due to its wave nature, and can penetrate deep into the brain before finally subsiding, depending on the blast intensity and proximity. Blunt trauma
Most patients with more severe traumatic brain injury have of a combination of intracranial injuries, which can include diffuse axonal injury, cerebral contusions, as well as intracranial bleeding, including subarachnoid hemorrhage, subdural hematoma, epidural hematoma, and intraparenchymal hemorrhage. The recovery of brain function following a traumatic accident is highly variable and depends upon the specific intracranial injuries that occur, however there is significant correlation between the severity of the initial insult as well as the level of neurologic function during the initial assessment and the level of lasting neurologic deficits. Initial treatment may be targeted at reducing the intracranial pressure if there is concern for swelling or bleeding within this skull, which may require surgery such as a hemicraniectomy in which part of the skull is removed.  Traumatic brain injury
In the 1970s, awareness of TBI as a public health problem grew,[155] and a great deal of progress has been made since then in brain trauma research,[98] such as the discovery of primary and secondary brain injury.[144] The 1990s saw the development and dissemination of standardized guidelines for treatment of TBI, with protocols for a range of issues such as drugs and management of intracranial pressure.[98] Research since the early 1990s has improved TBI survival;[144] that decade was known as the "Decade of the Brain" for advances made in brain research.[156] Chronic traumatic encephalopathy
A putative biomarker for CTE is the presence in serum of autoantibodies against the brain. The autoantibodies were detected in football players who experienced a large number of head hits but no concussions, suggesting that even sub-concussive episodes may be damaging to the brain. The autoantibodies may enter the brain by means of a disrupted blood-brain barrier, and attack neuronal cells which are normally protected from an immune onslaught. Given the large numbers of neurons present in the brain (86 billion), and considering the poor penetration of antibodies across a normal blood-brain barrier, there is an extended period of time between the initial events (head hits) and the development of any signs or symptoms. Nevertheless, autoimmune changes in blood of players may consist the earliest measurable event predicting CTE. Memory disorder
Traumatic brain injury often occurs from damage to the brain caused by an outside force, and may lead to cases of amnesia depending on the severity of the injury. Head injury can give rise to either transient or persisting amnesia. Occasionally, post-traumatic amnesia (PTA) may exist without any retrograde amnesia (RA), but this is often more common in cases of penetrating lesions. Damage to the frontal or anterior temporal regions have been described to be associated with disproportionate RA. Studies have illustrated that during PTA, head injury patients showed accelerated forgetting of learned information. On the other hand, after PTA, forgetting rates were normal. Traumatic brain injury
Furthermore, acetylcysteine has been confirmed, in a recent double-blind placebo-controlled trial conducted by the US military, to reduce the effects of blast induced mild traumatic brain and neurological injury in soldiers.[83] Multiple animal studies have also demonstrated its efficacy in reducing the damage associated with moderate traumatic brain or spinal injury, and also ischemia-induced brain injury. In particular, it has been demonstrated through multiple studies to significantly reduce neuronal losses and to improve cognitive and neurological outcomes associated with these traumatic events. Acetylcysteine has been safely used to treat paracetamol overdose for over forty years and is extensively used in emergency medicine. Cerebral contusion
Cerebral contusion, Latin "contusio cerebri", a form of traumatic brain injury, is a bruise of the brain tissue. Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Contusion occurs in 20–30% of severe head injuries. A cerebral laceration is a similar injury except that, according to their respective definitions, the pia-arachnoid membranes are torn over the site of injury in laceration and are not torn in contusion. The injury can cause a decline in mental function in the long term and in the emergency setting may result in brain herniation, a life-threatening condition in which parts of the brain are squeezed past parts of the skull. Thus treatment aims to prevent dangerous rises in intracranial pressure, the pressure within the skull. Childhood trauma
The effects of childhood trauma can be mitigated through care and treatment. Early intervention has significant impact. Trauma-informed treatment modalities treat the whole person, recognizing the impact of trauma on physical, psychological, and social health. Primary and secondary brain injury
Since primary injury occurs at the moment of trauma and is over so rapidly, little can be done to interfere with it other than prevention of the trauma itself. However, since secondary injury occurs over time, it can be prevented in part by taking measures to prevent complications such as hypoxia (oxygen deficiency). Furthermore, secondary injury presents opportunities for researchers to find drug therapies to limit or prevent the damage. Since a variety of processes occur in secondary injury, any treatments that are developed to halt or mitigate it will need to address more than one of these mechanisms. Chronic traumatic encephalopathy
Investigators have demonstrated that immobilizing the head during a blast exposure prevented the learning and memory deficits associated with CTE that occurred when the head was not immobilized. This research represents the first case series of postmortem brains from U.S. military personnel who were exposed to a blast and/or a concussive injury. Brain Trauma Foundation
An independent analysis of the effect of the Brain Trauma Foundation’s (BTF) guidelines on traumatic brain injury (TBI) outcome and cost savings by the Centers for Disease Control and Prevention (CDC) found that if the BTF guidelines were used more routinely, there would be a 50% decrease in deaths, improved quality of life and a savings of $262 million in annual medical costs, $43 million in annual rehabilitation costs and a lifetime societal cost of $3.84 billion. Traumatic brain injury
Head injury is present in ancient myths that may date back before recorded history.[143] Skulls found in battleground graves with holes drilled over fracture lines suggest that trepanation may have been used to treat TBI in ancient times.[144] Ancient Mesopotamians knew of head injury and some of its effects, including seizures, paralysis, and loss of sight, hearing or speech.[145] The Edwin Smith Papyrus, written around 1650–1550BC, describes various head injuries and symptoms and classifies them based on their presentation and tractability.[146] Ancient Greek physicians including Hippocrates understood the brain to be the center of thought, probably due to their experience with head trauma.[147] Traumatic brain injury
The incidence of TBI varies by age, gender, region and other factors.[137] Findings of incidence and prevalence in epidemiological studies vary based on such factors as which grades of severity are included, whether deaths are included, whether the study is restricted to hospitalized people, and the study's location.[8] The annual incidence of mild TBI is difficult to determine but may be 100–600 people per 100,000.[56] Second-impact syndrome
Measures that prevent head injuries in general also prevent SIS. Thus athletes are advised to use protective gear such as helmets, though helmets do not entirely prevent the syndrome. Tetris effect
Another 2009 Oxford study suggests that playing "Tetris"-like video games may help prevent the development of traumatic memories. If the video game treatment is played soon after the traumatic event, the preoccupation with "Tetris" shapes is enough to prevent the mental recitation of traumatic images, thereby decreasing the accuracy, intensity, and frequency of traumatic reminders. "We suggest it specifically interferes with the way sensory memories are laid down in the period after trauma and thus reduces the number of flashbacks that are experienced afterwards," summarizes Dr. Emily Holmes, who led the study. Traumagenic neurodevelopmental model of psychosis
Although the original TN model specifically focused on the relationship between early traumatic events and schizophrenia symptoms it has since expanded to include all psychosis and psychotic disorders. Since its proposal, research of links between childhood trauma and psychosis has proliferated, resulting in numerous studies (using both human subjects and animal-models) providing both direct and indirect support of the TN model. Importantly, while the TN model suggests the psychological sequelae of childhood trauma may initiate neurodevelopmental changes resulting in psychopathology, it is not indicative of brain disease. This is a marked contrast from previous popular beliefs that the biological etiology of psychosis rendered it largely irreversible and untreatable, aside from pharmacotherapy-based symptom management. This model also reveals important clinical implications in the primary prevention of psychosis. Proponents of the TN model of psychosis suggest that targeting populations at-risk for experiencing childhood trauma with prevention-focused interventions would lead to profound decreases in the incidence of psychosis. Similarly, the TN model has also emphasized promotion of childhood trauma screening among individuals presenting with psychotic symptoms, as it can help to inform and adapt evidence-based trauma-informed therapeutic interventions aimed at addressing the specific needs of individual clients. Traumatic brain injury
No medication is approved to halt the progression of the initial injury to secondary injury.[56] The variety of pathological events presents opportunities to find treatments that interfere with the damage processes.[3] Neuroprotection methods to decrease secondary injury, have been the subject of interest follows TBI. However, trials to test agents that could halt these cellular mechanisms have met largely with failure.[3] For example, interest existed in cooling the injured brain; however, a 2014 Cochrane review did not find enough evidence to see if it was useful or not.[157] Maintaining a normal temperature in the immediate period after a TBI appeared useful.[158] One review found a lower than normal temperature was useful in adults but not children.[159] While two other reviews found it did not appears to be useful.[160][158] Facial trauma
Measures to reduce facial trauma include laws enforcing seat belt use and public education to increase awareness about the importance of seat belts and motorcycle helmets. Efforts to reduce drunk driving are other preventative measures; changes to laws and their enforcement have been proposed, as well as changes to societal attitudes toward the activity. Information obtained from biomechanics studies can be used to design automobiles with a view toward preventing facial injuries. While seat belts reduce the number and severity of facial injuries that occur in crashes, airbags alone are not very effective at preventing the injuries. In sports, safety devices including helmets have been found to reduce the risk of severe facial injury. Additional attachments such as face guards may be added to sports helmets to prevent orofacial injury (injury to the mouth or face); mouth guards also used. Head injury
A head injury is any injury that results in trauma to the skull or brain. The terms "traumatic brain injury" and "head injury" are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of injuries, there are many causes—including accidents, falls, physical assault, or traffic accidents—that can cause head injuries. Traumatic brain injury
Causes include falls, vehicle collisions, and violence. Brain trauma occurs as a consequence of a sudden acceleration or deceleration within the cranium or by a complex combination of both movement and sudden impact. In addition to the damage caused at the moment of injury, a variety of events following the injury may result in further injury. These processes include alterations in cerebral blood flow and the pressure within the skull. Some of the imaging techniques used for diagnosis include computed tomography and magnetic resonance imaging (MRIs). Primary and secondary brain injury
Secondary injury is an "indirect" result of the injury. It results from processes initiated by the trauma. It occurs in the hours and days following the primary injury and plays a large role in the brain damage and death that results from TBI. Unlike in most forms of trauma a large percentage of the people killed by brain trauma do not die right away but rather days to weeks after the event. In addition, rather than improving after being hospitalized as most patients with other types of injuries do, about 40% of people with TBI deteriorate. This is often a result of secondary injury, which can damage neurons that were unharmed in the primary injury. It occurs after a variety of brain injury including subarachnoid hemorrhage, stroke, and traumatic brain injury and involves metabolic cascades. Primary and secondary brain injury
Primary and secondary brain injury are ways to classify the injury processes that occur in brain injury. In traumatic brain injury (TBI), primary brain injury occurs during the initial insult, and results from displacement of the physical structures of the brain. Secondary brain injury occurs gradually and may involve an array of cellular processes. Secondary injury, which is not caused by mechanical damage, can result from the primary injury or be independent of it. The fact that people sometimes deteriorate after brain injury was originally taken to mean that secondary injury was occurring. It is not well understood how much of a contribution primary and secondary injuries respectively have to the clinical manifestations of TBI. Traumatic brain injury
Other techniques may be used to confirm a particular diagnosis. X-rays are still used for head trauma, but evidence suggests they are not useful; head injuries are either so mild that they do not need imaging or severe enough to merit the more accurate CT.[70] Angiography may be used to detect blood vessel pathology when risk factors such as penetrating head trauma are involved.[3] Functional imaging can measure cerebral blood flow or metabolism, inferring neuronal activity in specific regions and potentially helping to predict outcome.[72] Electroencephalography and transcranial doppler may also be used. The most sensitive physical measure to date is the quantitative EEG, which has documented an 80% to 100% ability in discriminating between normal and traumatic brain-injured subjects.[73][74] Sports injury
Prevention can be broken up into three broad categories of primary, secondary, and tertiary prevention. Primary prevention involves the avoidance of injury. An example is ankle braces being worn as a team, even those with no history of previous ankle injuries. If primary prevention activities were effective, there would be a lesser chance of injuries occurring in the first place. Secondary prevention involves an early diagnosis and treatment should be acquired once an injury has occurred. The goal of obtaining early diagnosis is to ensure that the injury is receiving proper care and recovering correctly, therefore limiting the concern for other medical problems to stem from the initial traumatic event. Lastly, tertiary prevention is solely focused on the rehabilitation to reduce and correct an existing disability resulting from the traumatic event. An example in the case of an athlete who has obtained an ankle injury the rehabilitation would consist of balance exercises to acquire the strength and mobility back as well as wearing an ankle brace, while gradually returning to the sport. Median nerve palsy
One way to prevent this injury from occurring is to be informed and educated about the risks involved in hurting your wrist and hand. If patients do suffer from median nerve palsy, occupational therapy or wearing a splint can help reduce the pain and further damage. Wearing a dynamic splint, which pulls the thumb into opposition, will help prevent an excess in deformity. This splint can also assist in function and help the fingers flex towards the thumb. Stretching and the use of C-splints can also assist in prevention of further damage and deformity. These two methods can help in the degree of movement the thumb can have. While it is impossible to prevent trauma to your arms and wrist, patients can reduce the amount of compression by maintaining proper form during repetitive activities. Furthermore, strengthening and increasing flexibility reduces the risk of nerve compression. Traumatic brain injury
Regardless of age, TBI rates are higher in males.[31] Men suffer twice as many TBIs as women do and have a fourfold risk of fatal head injury,[107] and males account for two thirds of childhood and adolescent head trauma.[142] However, when matched for severity of injury, women appear to fare more poorly than men.[87] Major trauma
By identifying risk factors present within a community and creating solutions to decrease the incidence of injury, trauma referral systems may help to enhance the overall health of a population. Injury prevention strategies are commonly used to prevent injuries in children, who are a high risk population. Injury prevention strategies generally involve educating the general public about specific risk factors and developing strategies to avoid or reduce injuries. Legislation intended to prevent injury typically involves seatbelts, child car-seats, helmets, alcohol control, and increased enforcement of the legislation. Other controllable factors, such as the use of drugs including alcohol or cocaine, increases the risk of trauma by increasing the likelihood of traffic collisions, violence, and abuse occurring. Prescription drugs such as benzodiazepines may increase the risk of trauma in elderly people. Amyotrophic lateral sclerosis
A 2015 review found that moderate to severe traumatic brain injury is a risk factor for ALS, but whether mild traumatic brain injury increases rates was unclear. A 2017 meta-analysis found an association between head injuries and ALS; however, this association disappeared when the authors considered the possibility of reverse causation, which is the idea that head injuries are an early symptom of undiagnosed ALS, rather than the cause of ALS. Neural tissue engineering
One method to treat CNS injury involves culturing stem cells "in vitro" and implanting the non-directed stem cells into the brain injury site. Implanting stem cells directly into the injury site prevents glial scar formation and promotes neurogenesis originating from the patient, but also runs the risk of tumor development, inflammation, and migration of the stem cells out of the injury location. Tumorigenesis can occur due to the uncontrolled nature of the stem cell differentiation, inflammation can occur due to rejection of the implanted cells by the host cells, and the highly migratory nature of stem cells results in the cells moving away from the injury site, thus not having the desired effect on the injury site. Other concerns of neural tissue engineering include establishing safe sources of stem cells and getting reproducible results from treatment to treatment. Traumatic brain injury
Falls can be avoided by installing grab bars in bathrooms and handrails on stairways; removing tripping hazards such as throw rugs; or installing window guards and safety gates at the top and bottom of stairs around young children.[49] Playgrounds with shock-absorbing surfaces such as mulch or sand also prevent head injuries.[49] Child abuse prevention is another tactic; programs exist to prevent shaken baby syndrome by educating about the dangers of shaking children.[52] Gun safety, including keeping guns unloaded and locked, is another preventative measure.[78] Studies on the effect of laws that aim to control access to guns in the United States have been insufficient to determine their effectiveness preventing number of deaths or injuries.[79] Epileptic seizure
A number of measures have been attempted to prevent seizures in those at risk. Following traumatic brain injury anticonvulsants decrease the risk of early seizures but not late seizures. Childhood trauma
Exposure to maltreatment in childhood significantly predicts a variety of negative outcomes in adulthood. However, not all children who are exposed to a potentially traumatic event develop subsequent struggles with mental or physical health. Therefore, there are factors that reduce the impact of potentially traumatic events and protect an individual from developing mental health problems after exposure to a potentially traumatic event. These are called resiliency factors.  Concussions in high school sports
A traumatic brain injury (TBI) is a blow, jolt or penetration to the head that disrupts the function of the brain. Most TBIs are caused by falls, jumps, motor vehicle traffic crashes, being struck by a person or a blunt object, and assault. Student athletes may be put at risk in school sports, creating concern about concussions and brain injury. A concussion can be caused by
The result of a concussion is neurological impairment that may resolve spontaneously, but may also have long-term consequences. Traumatic brain injury
The incidence of TBI is increasing globally, due largely to an increase in motor vehicle use in low- and middle-income countries.[3] In developing countries, automobile use has increased faster than safety infrastructure could be introduced.[56] In contrast, vehicle safety laws have decreased rates of TBI in high-income countries,[3] which have seen decreases in traffic-related TBI since the 1970s.[48] Each year in the United States, about two million people suffer a TBI,[14] approximately 675,000 injuries are seen in the emergency department,[140] and about 500,000 patients are hospitalized.[137] The yearly incidence of TBI is estimated at 180–250 per 100,000 people in the US,[137] 281 per 100,000 in France, 361 per 100,000 in South Africa, 322 per 100,000 in Australia,[8] and 430 per 100,000 in England.[54] In the European Union the yearly aggregate incidence of TBI hospitalizations and fatalities is estimated at 235 per 100,000.[3] Traumatic brain injury
Once medically stable, people may be transferred to a subacute rehabilitation unit of the medical center or to an independent rehabilitation hospital.[85] Rehabilitation aims to improve independent function at home and in society and to help adapt to disabilities [85] and has demonstrated its general effectiveness, when conducted by a team of health professionals who specialise in head trauma.[103] As for any person with neurologic deficits, a multidisciplinary approach is key to optimising outcome. Physiatrists or neurologists are likely to be the key medical staff involved, but depending on the person, doctors of other medical specialties may also be helpful. Allied health professions such as physiotherapy, speech and language therapy, cognitive rehabilitation therapy, and occupational therapy will be essential to assess function and design the rehabilitation activities for each person. Treatment of neuropsychiatric symptoms such as emotional distress and clinical depression may involve mental health professionals such as therapists, psychologists, and psychiatrists, while neuropsychologists can help to evaluate and manage cognitive deficits.[85] Traumatic brain injury
Biological, clinical, and demographic factors contribute to the likelihood that an injury will be fatal.[134] In addition, outcome depends heavily on the cause of head injury. In the US, patients with fall-related TBIs have an 89% survival rate, while only 9% of patients with firearm-related TBIs survive.[139] In the US, firearms are the most common cause of fatal TBI, followed by vehicle accidents and then falls.[134] Of deaths from firearms, 75% are considered to be suicides.[134] Traumatic brain injury
TBI is present in 85% of traumatically injured children, either alone or with other injuries.[141] The greatest number of TBIs occur in people aged 15–24.[6][31] Because TBI is more common in young people, its costs to society are high due to the loss of productive years to death and disability.[3] The age groups most at risk for TBI are children ages five to nine and adults over age 80,[107] and the highest rates of death and hospitalization due to TBI are in people over age 65.[108] The incidence of fall-related TBI in First-World countries is increasing as the population ages; thus the median age of people with head injuries has increased.[3] Catastrophic injury
The ten strategies are:In "Catastrophic Head Injuries in High School and Collegiate Sports", Frederick Mueller states that the frequency of catastrophic injuries may be reduced by:Preparation for a catastrophic injury event includes a written emergency plan, which should incorporate an evacuation, transportation and communication plan, as well as notifying hospital emergency departments about game and practice schedules for teams and clubs. Response to a catastrophic injury event should reduce its severity, such as via the administration of first aid. In "Catastrophic Injuries in Sports and Recreation: Causes and Prevention : A Canadian Study", Charles Tator states that effective injury prevention programs involve education, engineering, and rule enforcement. Education is intended to inform the participants of potential dangers of risky behaviour in the activity, and engineering "involved modifying the environment to create safer surroundings", such as maintaining playing fields or improving the design of equipment. Traumatic brain injury
Focal injuries often produce symptoms related to the functions of the damaged area.[11] Research shows that the most common areas to have focal lesions in non-penetrating traumatic brain injury are the orbitofrontal cortex (the lower surface of the frontal lobes) and the anterior temporal lobes, areas that are involved in social behavior, emotion regulation, olfaction, and decision-making, hence the common social/emotional and judgment deficits following moderate-severe TBI.[25][26][27][28] Symptoms such as hemiparesis or aphasia can also occur when less commonly affected areas such as motor or language areas are, respectively, damaged.[29][30] Bone cyst
Traumatic Bone Cyst 
The traumatic bone cyst treatment consists of surgical exploration, curettage of the osseous socket and bony walls, subsequent filling with blood, and intralesional steroid injections. Young athletes can reduce their risk of traumatic bone cyst by wearing protective mouth wear or protective head gear. Brain damage
The treatment for emergency traumatic brain injuries focuses on assuring the person has enough oxygen from the brain blood supply, and on maintaining normal blood pressure to avoid further injuries of the head or neck. The person may need surgery to remove clotted blood or repair skull fractures, for which cutting a hole in the skull may be necessary. Medicines used for traumatic injuries are diuretics, anti-seizure or coma-inducing drugs. Diuretics reduce the fluid in tissues lowering the pressure on the brain. In the first week after a traumatic brain injury, a person may have a risk of seizures, which anti-seizure drugs help prevent. Coma-inducing drugs may be used during surgery to reduce impairments and restore blood flow. Head injury
According to the United States CDC, 32% of traumatic brain injuries (another, more specific, term for head injuries) are caused by falls, 10% by assaults, 16.5% by being struck by or against something, 17% by motor vehicle accidents, and 21% by other/unknown ways. In addition, the highest rate of injury is among children ages 0–14 and adults age 65 and older. Brain injuries that include brain damage can also be brought on by exposure to toxic chemicals, lack of oxygen, tumors, infections, and stroke. Possible causes of widespread brain damage include birth hypoxia, prolonged hypoxia (shortage of oxygen), poisoning by teratogens (including alcohol), infection, and neurological illness. Brain tumors can increase intracranial pressure, causing brain damage. Neuroproteomics
 Traumatic brain injury is defined as a “direct physical impact or trauma to
the head followed by a dynamic series of injury and repair events”. Recently, neuroproteomics have been applied to studying the disability that over 5.4 million Americans live with. In addition to physically injuring the brain tissue, traumatic brain injury induces the release of glutamate that interacts with ionotropic glutamate receptors (iGluRs). These glutamate receptors acidify the surrounding intracranial fluid, causing further injury on the molecular level to nearby neurons. The death of the surrounding neurons is induced through normal apoptosis mechanisms, and it is this cycle that is being studied with neuroproteomics. Three different cysteine protease derivatives are involved in the apoptotic pathway induced by the acidic environment triggered by glutamate. These cysteine proteases include calpain, caspase, and cathepsin. These three proteins are examples of detectable signs of traumatic brain injury that are much more specific than temperature, oxygen level, or intracranial pressure.
Proteomics thus also offers a tracking mechanism by which researchers can monitor the progression of traumatic brain injury, or a chronic disease such as Alzheimer’s or Parkinson’s. Especially in Parkinson’s, in which neurotransmitters play a large role, recent proteomic research has involved the study of synaptotagmin. Synaptotagmin is involved in the calcium-induced budding of vesicle containing neurotransmitters from the presynaptic membrane. By studying the intracellular mechanisms involved in neural apoptosis after traumatic brain injury, researchers can create a map that genetic changes can follow later on. Catastrophic injury
The study found 79.2% of the injuries were preventable; from over 1,500 responses, 346 involved alcohol consumption, and 1,236 were not supervised. Most alcohol-related injuries were sustained in snowmobiling (124), fishing (41), diving (40), boating excluding canoeing (31), swimming (31), riding an all-terrain vehicle (24), and cycling (23). Other studies have concluded that alcohol consumption is a common risk factor "associated with all types of exposure" (that is, activities) for traumatic brain injury. Neurointensive care
Traumatic brain injury: Sedation, ICP monitoring and management, Decompressive Craniectomy, Hyperosmolar therapy and maintain hemodynamic stability. Traumatic brain injury modeling
Traumatic brain injury modeling attempts to replicate certain aspects of traumatic brain injury (TBI) in order better understand what is physically happening to the brain. A variety of models can be used for this process with different models able to replicate certain aspects of TBI while also producing their own limitations. Primary and secondary brain injury
In TBI, primary injuries result immediately from the initial trauma. Primary injury occurs at the moment of trauma and includes contusion, damage to blood vessels, and axonal shearing, in which the axons of neurons are stretched and torn. The blood brain barrier and meninges may be damaged in the primary injury, and neurons may die. Cells are killed in a nonspecific manner in primary injury. Tissues have a deformation threshold: if they are deformed past this threshold they are injured. Different regions in the brain may be more sensitive to mechanical loading due to differences in their properties that result from differences in their makeup; for example, myelinated tissues may have different properties than other tissues. Thus some tissues may experience more force and be more injured in the primary injury. The primary injury leads to the secondary injury. Traumatic brain injury
Movement disorders that may develop after TBI include tremor, ataxia (uncoordinated muscle movements), myoclonus (shock-like contractions of muscles), and loss of movement range and control (in particular with a loss of movement repertoire).[85] The risk of post-traumatic seizures increases with severity of trauma (image at right) and is particularly elevated with certain types of brain trauma such as cerebral contusions or hematomas.[109] People with early seizures, those occurring within a week of injury, have an increased risk of post-traumatic epilepsy (recurrent seizures occurring more than a week after the initial trauma).[118] People may lose or experience altered vision, hearing, or smell.[4] Post-traumatic seizure
The most important factor in whether a person will develop early and late seizures is the extent of the damage to the brain. More severe brain injury also confers a risk for developing PTS for a longer time after the event. One study found that the probability that seizures will occur within 5 years of injury is in 0.5% of mild traumatic brain injuries (defined as no skull fracture and less than 30 minutes of post-traumatic amnesia, abbreviated PTA, or loss of consciousness, abbreviated LOC); 1.2% of moderate injuries (skull fracture or PTA or LOC lasting between 30 minutes and 24 hours); and 10.0% of severe injuries (cerebral contusion, intracranial hematoma, or LOC or PTA for over 24 hours). Another study found that the risk of seizures 5 years after TBI is 1.5% in mild (defined as PTA or LOC for less than 30 minutes), 2.9% in moderate (LOC lasting between 30 minutes and 1 day), and 17.2% in severe TBI (cerebral contusion, subdural hematoma, or LOC for over a day; image at right). MedStar National Rehabilitation Hospital
Faculty provides care for thousands suffering from mild to traumatic brain injuries. The concussion clinic at Medstar NRH focuses primarily on this form of brain injury and is regarded as one of the best in the country according to U.S. News & World Report. 75 percent of all traumatic brain injuries that occur are concussions. Traumatic brain injuries contribute to a third of all deaths in the United States with over 1.5 million brain injuries occurring each year. During their stay, patients are also educated on precautions they can take to prevent a future incidence. Traumatic memories
Research has shown several cognitive behavioural therapies to be effective methods of reducing the emotional distress and negative thought patterns associated with traumatic memories in both those suffering from posttraumatic stress disorder and depression.
One such therapy is trauma-focused therapy. This therapy involves bringing the most disturbing elements of a traumatic memory to mind and using therapist-guided cognitive restructuring to change the way the memories are thought about. The change in evaluation usually involves highlighting that the feelings of certain death, extreme danger, hopelessness and helplessness within a traumatic memory do not apply to the person now, as they survived the event. The therapy also focuses on extending the memory so it is recalled beyond the most traumatic parts. Extending them to a point where the person felt safe again, so they remember the event in a more complete way with less focus on the negative aspects. As an example, a traumatic memory of wartime combat might be extended to after a battle, to when the person was no longer in immediate danger. In processing the memory in these ways it becomes less likely to intrude into their thoughts as an unwanted flashback.
The memory also becomes less vivid, less distressing and seems more distant to the person's present life. Association football headgear
Injury to the head can occur from repeatedly making contact with the ball through headers or from a single blow. The danger of this trauma is especially significant to children because their bodies are not fully developed and may not be able to counteract a blow to the head. Minor trauma similar to pugilistic dementia may occur from repetitively heading the ball. A study published in the British Journal of Sports Medicine found that headgear does not help reduce the impact on the head from ball contact. This is because a human head is stiffer than the soccer ball. On impact, the ball will deform more than the head. However, studies in 2006 by the University of North Carolina at Chapel Hill and the University of Pennsylvania found no link between brain injuries and routinely heading the ball. Because of this, the aim of wearing headgear turned to mitigating damage from accidental head on head collisions between players on the pitch. It was found that there was an overall 33% reduction of impact force on the head from head to head impacts when headgear was used. The U.S. Soccer Federation sees that protective headgear in soccer can provide measurable benefit in head to head contact, and permits players to wear headgear at their own discretion until more conclusive evidence is obtained. Primary and secondary brain injury
Thus efforts to reduce disability and death from TBI are thought to be best aimed at secondary injury, because the primary injury is thought to be irreversible. Sports-related traumatic brain injury
In the heat of a game, it may be hard to see or feel symptoms relating to cerebral contusions. If any of these signs are visible or as an athlete, you feel them, remove yourself from competition immediately. Cerebral contusions and other injuries can occur in any sport, not just in the traditional “collision” sports. According to the USCPSC, four of the top five sports that cause brain injuries are considered to have limited brain contact: basketball, bicycling, baseball, and playground activities. The most popular sport to cause cerebral contusions is American football due to the drastic acceleration/deceleration of the brain.
If any of these symptoms are felt or noticed, a hospital visit is needed where further machine testing is done. In boxing, the rapid deceleration of the brain after an impact causes the symptoms to progress much faster or at a more traumatic rate. Doctors ringside monitor a boxer’s attitude and brain function throughout the fight and are able to stop the match following startling news. Tracheobronchial injury
Vehicle occupants who wear seat belts have a lower incidence of TBI after a motor vehicle accident. However, if the strap is situated across the front of the neck (instead of the chest), this increases the risk of tracheal injury. Design of medical instruments can be modified to prevent iatrogenic TBI, and medical practitioners can use techniques that reduce the risk of injury with procedures such as tracheotomy. Traumatic brain injury
Secondary injury events include damage to the blood–brain barrier, release of factors that cause inflammation, free radical overload, excessive release of the neurotransmitter glutamate (excitotoxicity), influx of calcium and sodium ions into neurons, and dysfunction of mitochondria.[56] Injured axons in the brain's white matter may separate from their cell bodies as a result of secondary injury,[56] potentially killing those neurons. Other factors in secondary injury are changes in the blood flow to the brain; ischemia (insufficient blood flow); cerebral hypoxia (insufficient oxygen in the brain); cerebral edema (swelling of the brain); and raised intracranial pressure (the pressure within the skull).[67] Intracranial pressure may rise due to swelling or a mass effect from a lesion, such as a hemorrhage.[45] As a result, cerebral perfusion pressure (the pressure of blood flow in the brain) is reduced; ischemia results.[33][68] When the pressure within the skull rises too high, it can cause brain death or herniation, in which parts of the brain are squeezed by structures in the skull.[45] A particularly weak part of the skull that is vulnerable to damage causing extradural haematoma is the pterion, deep in which lies the middle meningeal artery, which is easily damaged in fractures of the pterion. Since the pterion is so weak, this type of injury can easily occur and can be secondary due to trauma to other parts of the skull where the impact forces spreads to the pterion. Nerve injury
Methods to help prevent peripheral nerve injury include injection pressure monitoring.  The presence of a high opening injection pressure (> 20 PSI) is a sensitive sign of intrafascicular/intraneural needle tip placement.  Extrafascicular needle tip placement is associated with low pressures (< 20 PSI).  Also, high pressure injection was associated with neurologic deficits and severe axonal damage after the block.  Other methods of preventing peripheral nerve injury include electrical nerve stimulation and ultrasonography. Electrical stimulation with a motor response at < 0.2 mA only can occur with an intraneural/intrafasciular needle tip location. University of Texas Southwestern Medical Center
Research at UTSW's Texas Institute for Brain Injury and Repair focuses on various types of brain injuries and conditions, including traumatic brain injury (TBI), stroke, and Alzheimer's disease. The Institute also promotes brain injury education and prevention. The Texas Legislature provided $15 million for the current biennium – the largest allocation for a brain injury initiative in state history. Traumatic memories
Neuroscience has shown that memories are vulnerable to disruption for several hours after they form. Holmes and colleagues proposed that because of this visuospatial distractors like Tetris, if administered within six hours of a traumatic event could help prevent symptoms of flashbacks. Also there is some evidence that memories can become vulnerable to disruption even at longer periods of time in a process known as reconsolidation. Traumatic brain injury
TBI is one of two subsets of acquired brain injury (brain damage that occur after birth); the other subset is non-traumatic brain injury, which does not involve external mechanical force (examples include stroke and infection).[5][6] All traumatic brain injuries are head injuries, but the latter term may also refer to injury to other parts of the head.[7][8][9] However, the terms head injury and brain injury are often used interchangeably.[10] Similarly, brain injuries fall under the classification of central nervous system injuries[11] and neurotrauma.[12] In neuropsychology research literature, in general the term "traumatic brain injury" is used to refer to non-penetrating traumatic brain injuries. Catastrophic injury
One paradigm used in injury prevention is the Haddon Matrix developed by William Haddon Jr. of the National Highway Safety Bureau in the late 1960s. The matrix was designed to categorize highway safety phenomena, and applied a public health model to traffic-related epidemiology. It consists of ten strategies that are implemented based on temporality, that is pre-event strategies (primary prevention), event strategies (secondary prevention), and post-event strategies (tertiary prevention). The purpose of injury prevention is to decrease the "burden of injury to the individual and to society", which includes mortality, morbidity, disability, and economic cost. American football
Repeated concussions (and possibly sub-concussive head impacts[115]) can increase a person's risk in later life for CTE (chronic traumatic encephalopathy) and mental health issues such as dementia, Parkinson's disease, and depression.[116] Concussions are often caused by helmet-to-helmet or upper-body contact between opposing players, although helmets have prevented more serious injuries such as skull fractures.[117] Various programs are aiming to reduce concussions by reducing the frequency of helmet-to-helmet hits; USA Football's "Heads Up Football" program is aiming to reduce concussions in youth football by teaching coaches and players about the signs of a concussion, the proper way to wear football equipment and ensure it fits, and proper tackling methods that avoid helmet-to-helmet contact.[118] However, a study in the Orthopaedic Journal of Sports Medicine found that Heads Up Football was ineffective; the same study noted that more extensive reforms implemented by Pop Warner Little Scholars and its member teams were effective in significantly reducing concussion rates.[119] Trauma risk management
Trauma risk management (TRiM) is a method of secondary PTSD (and other traumatic stress related mental health disorders) prevention. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM training provides TRiM Practitioners with a background understanding of psychological trauma and its effects. Traumatic brain injury modeling
While modeling itself only gives estimations, research based on these estimations could give rise to amazing technology. For example, a human head and combat helmet were modeled under blast waves, and the results showed that the helmet did very little to stop blast-induced damage. With this information, a new type of combat helmet could be created that minimizes the damage that blast waves can cause. This technology could then also be applied to general armor, or even clothing (blast waves damage internal organs as well). This kind of advancement is only the beginning of TBI reduction. Methods such as genetic manipulation may also become available in the future that could increase the stress and strain thresholds for neurons, or perhaps methods for healing the brain altogether will be created based on the modeling done in the present. Traumatic brain injury
As of 2010, the use of predictive visual tracking measurement to identify mild traumatic brain injury was being studied. In visual tracking tests, a head-mounted display unit with eye-tracking capability shows an object moving in a regular pattern. People without brain injury are able to track the moving object with smooth pursuit eye movements and correct trajectory. The test requires both attention and working memory which are difficult functions for people with mild traumatic brain injury. The question being studied, is whether results for people with brain injury will show visual-tracking gaze errors relative to the moving target.[180] Back injury
Diagnosis of a back injury begins with a physical examination and thorough medical history by health-care personnel. Some injuries, such as sprains and strains or herniated discs, can be diagnosed in this manner. To confirm these diagnoses, or to rule out other injuries or pathology, imaging of the injured region can be ordered. X-rays are often used to visualize pathology of bones and can be ordered when a vertebral fracture is suspected. CT scans produce higher resolution images when compared to x-rays and can be used to view more subtle fractures which may otherwise go undetected on x-ray. MRI is commonly referred to as the gold standard for visualizing soft tissue and can be used to assist with diagnosing many back injuries, including herniated discs and neurological disorders, bleeding, and edema.
Suggestions for preventing various back injuries primarily address the causes of those injuries. The risk for back sprains and strains may be reduced with lifestyle choices, including smoking cessation, limiting alcohol, maintaining a healthy weight, and keeping bones and muscles strong with adequate exercise and a healthy diet. The risk for disc herniations can be reduced by using proper techniques when lifting heavy loads, smoking cessation, and weight loss to reduce the load placed on the spine. Vertebral fractures may be difficult to prevent since common causes are related to accidents or age-related degeneration associated with osteoporosis. Treating osteoporosis with pharmacotherapy, enrolling in a fall prevention program, strengthening muscles and bones with a weight-bearing exercise program, and adopting a nutritional program that promotes bone health are all options to reduce the risk of vertebral fractures associated with osteoporosis. Traumatic brain injury
The most common causes of TBI in the U.S. include violence, transportation accidents, construction, and sports.[36][47] Motor bikes are major causes, increasing in significance in developing countries as other causes reduce.[48] The estimates that between 1.6 and 3.8million traumatic brain injuries each year are a result of sports and recreation activities in the US.[49] In children aged two to four, falls are the most common cause of TBI, while in older children traffic accidents compete with falls for this position.[50] TBI is the third most common injury to result from child abuse.[51] Abuse causes 19% of cases of pediatric brain trauma, and the death rate is higher among these cases.[52] Although men are twice as likely to have a TBI. Domestic violence is another cause of TBI,[53] as are work-related and industrial accidents.[54] Firearms[8] and blast injuries from explosions[55] are other causes of TBI, which is the leading cause of death and disability in war zones.[56] According to Representative Bill Pascrell (Democrat, NJ), TBI is "the signature injury of the wars in Iraq and Afghanistan."[57] There is a promising technology called activation database-guided EEG biofeedback, which has been documented to return a TBI's auditory memory ability to above the control group's performance[58][59]