The Effects of TBI and CTE

Last week I attended a continuing education class titled “Brain Trauma, Concussion and Dementia.” This class was timely, interesting, challenging, scary, and detailed. Briefly, the following consists of information that I found relevant. 1. Traumatic brain injury [TB I] was defined as an alteration in brain function, or other evidence of brain pathology, caused by external force. 2. TBI is a major cause of death and disability in persons between ages 1 to 44. 3. Adults over 65 are in the highest risk category for TBI, but the age groups 5 to 9 and 15 to 24 are also high 4. Yearly economic cost of TBI has been estimated at $40-$60 billion a year. 5. Most common causes of civilian hospitalization for TBI’s, in the US, are falls; followed by motor vehicle accidents; followed by being struck by/against and then assaults. TBI results in a wide array of mental, emotional and physical deficits .It is not limited to the effects from injury to the frontal lobes .The frontal lobe area of the brain may present the greatest psychosocial impairments and most significant barriers to recovery .Injury to the frontal lobe results in a cluster of deficits in three major areas of functioning :Cognitive [short attention span, poor short term working memory, difficulty in planning and organization, problems in reasoning, abstract thinking, poor impulse control and social judgment, lack of empathy and impairment in understanding how other people think]. Emotional [angry outbursts, overly excitement, prolonged sadness, clinical depression, lack of fear in threatening situations and exaggerated fear in other situations]. Behavioral [compulsive behavior and lack of recognition of consequences, inability to respond to social cues with inappropriate social behavior, inappropriate aggression, out of context sense of humor, exaggerated laughing, exaggerated inappropriate sexual behavior, and the telling of pointless and boring stories]. These three areas are called the Frontal Lobe Syndrome. Two populations of TBI diagnosis come to mind- military service and sports. For the military service, blast {bomb} related TBI’s are a major concern. There were close to 28,000 medically diagnosed TBI’s battle related and non-battle related incidents in 2009 alone. The Department of Veterans Affairs reported that over 7% of veterans presenting for care had TBI with persisting symptoms. Can you imagine a Navy Seal, on a special assignment, with a TBI diagnosis? With a Frontal Lobe Syndrome, you are a danger to yourself, as well as a danger to your buddies. How many military suicides had an underlying TBI diagnosis? Being exposed to an explosion, now days, is much more dangerous and frequent than being shot. In one Marines study, in 2008, the ratio was 97, compared to 3%. Athletes in contact sports like football, rugby, ice hockey, baseball and softball are also have an increased risk of TBI. It has been estimated that 1.6 to 3.8 million individuals have sports related mild and moderate TBI’s, in the US, every year. Children under age 15 have twice as many TBI’s from sports as from auto accidents. Boxers and riders in equestrian events also have an especially high TBI risk. In sports, the greatest TBI risk, however, is for football players. The statistics suggest that 20% of high school football players and 40% of college football players have sustained TBI injuries. Unfortunately, a football helmet does not prevent a concussion To Be Continued