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Outline

Title
Abstract
Normal Participants
Tbi Patients
Event-Related Potentials
Greater Effort in the Tbi Patient
Intervention Results
Conclusion and Recommendations
References

Thornton Carmody chapter from Carlstedt Handbook

Profile image of Kirtley ThorntonKirtley Thornton

Abstract

This chapter has two goals: to provide the reader with a general awareness of traumatic brain injury (TBI), mild in particular, and the multiple complex issues involved in this area, and to offer a detailed understanding of the role of quantitative electroencephalography (qEEG) in the assessment and treatment of the cognitive defi cits of the TBI patient. Sections I-IV address the fi rst goal. Section I discusses defi nitions, sports, vulnerable groups, the concept of spontaneous cure, and roles of loss of consciousness and post-traumatic amnesia criteria. Section II addresses the biomechanics of a TBI. Section III discusses the physical damage to the brain caused by the TBI as measured by modern medical imaging. Section IV reviews the neuropsychological and emotional results of a TBI that may be clinically manifested in a patient.

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A commitment of governmental and non-governmental funding bodies, as well as industrial partners, is needed to facilitate global collaborations and legacy research. Section 9 injuries. This accumulating knowledge makes it clear that TBI is not a single event, but can be a chronic and often progressive disease with long-term consequences. Even after an ostensibly good recovery, patients might have to live with a continuing process of coping and adaptation (panel 1). Panel 1: Living with traumatic brain injury a patient testimony In 2011, James Piercy sustained a traumatic brain injury (TBI) in a car accident in the UK. Like many people with TBI, he lives with the long-term effects of brain injury. He is now an ambassador for the UK Acquired Brain Injury Forum. In the following patient testimony (abridged), Piercy describes the aftermath of his injury and highlights what can be achieved with high-quality management and support. However, for many patients with TBI, systems of care are still suboptimal, poor, or even absent in some regions. For the full testimony, see appendix. The injury Like many others, I acquired my TBI in a car accident. I was unconscious at the scene (Glasgow Coma Scale score of 3 to 5). By good fortune, I was attended very soon after the accident by a police officer with good first-aid training. He kept my airway open until a doctor and paramedic from the air ambulance could take over my care. I was sedated and intubated at the scene before transfer to the local trauma centre. A scan revealed a bleed in my frontal lobe and smaller haemorrhages through the brain. Prognostic indicators gave a poor chance of good outcome after 6 months, but I have done better than expected. Better prognostic models for individual patients and families would be very valuable. I was monitored closely, emerging from post-traumatic amnesia after 25 days and transferring to a hospital closer to home. I was discharged after 7 weeks and began slow rehabilitation. The aftermath After 5 years, I am doing well. I have made a very good recovery and am back to work part-time. I need to plan my time carefully and avoid stressful and unpredictable situations, which leave me very fatigued. This fatigue can be very debilitating, leaving me with speech problems and making decisionmaking and concentration very difficult. Learning to live with the chronic conditions which follow TBI remains a huge challenge for the individuals and the services which aim to support them. I consider myself very lucky to have done so well and put the recovery down to good, prompt intervention, strong support from family and friends, and my own determination to improve. Clinical progress has not kept pace with the rising global burden of TBI and recognition of the prolonged effects of injury. The most recent major breakthrough in clinical management was the introduction of computed tomography (CT) scanning into routine care now more than 40 years ago. Since then, there have been no major improvements in outcome after TBI in HICs with developed trauma systems. This lack of progress can be attributed to many factors, both in thepolicy and clinical domains. Public and political awareness of the magnitude of the problems caused by TBI including the clinical impact on patients, families, and society, and public health burden and costs to society Cost Initial costs of some instruments and stipulation of payment per use Copyright Copyright issues and related difficulties in reproducing materials Access Restriction of some assessments to particular professional groups Scoring Charges and restrictions imposed by proprietary scoring systems Limited availability of many instruments in languages other than English is a major barrier to their use in international settings. Additionally, ensuring cultural applicability of assessment methods is an important challenge when collecting and analysing data across countries. The CANTAB and the

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