Types of Brain Injuries

TBIs are caused by external forces that impact the brain, such as falls, motor vehicle accidents, or a sports-related blow to the head.

• Causes: Falls, motor vehicle accidents, acts of violence, gunshot wounds, and military attacks.
• Severity levels: Can range from mild (brief changes in consciousness) to severe (extended loss of consciousness or amnesia).

NTBIs are caused by internal factors, such as strokes, tumors, lack of oxygen, or infections.

• Causes: Stroke (leading cause), lack of oxygen (anoxic injury), tumors, infections, and other medical conditions.
• Impact: Unlike TBIs, NTBIs affect the entire brain, potentially causing widespread damage and affecting cognitive, motor, and emotional functions.

Concussions are a type of mild TBI often caused by a blow to the head or sudden jarring. Though considered mild, concussions can lead to significant short-term and long-term effects if not managed properly.

Anoxic and hypoxic injuries occur when the brain does not receive enough oxygen, potentially leading to significant damage.

• Anoxic brain injury: Occurs when the brain receives no oxygen, which can happen due to drowning, suffocation, or cardiac arrest.
• Hypoxic brain injury: Caused by restricted oxygen flow to the brain, which can result from respiratory failure or other conditions.
• Symptoms: Can include confusion, speech difficulties, sensory changes, and disorientation.

The Rancho Los Amigos Scale is often used to explain behavioral, cognitive, and emotional changes that take place during healing. It consists of 10 levels, each representing a different stage of recovery:

• Level 1: No response – patient appears to be in a deep sleep and does not respond to voices, sounds, light, or touch.
• Level 2: Generalized response – patient reacts inconsistently and non-purposefully to stimuli; may open eyes but not focus on anything in particular.
• Level 3: Localized response – patient’s responses are purposeful but inconsistent; may follow simple commands.
• Level 4: Confused, agitated – patient is in a heightened state of activity; behavior may be bizarre or aggressive.
• Level 5: Confused, inappropriate, non-agitated – patient responds to simple commands but is easily distracted; may be verbally inappropriate.
• Level 6: Confused-appropriate – patient follows simple directions consistently; some awareness of self and others.
• Level 7: Automatic-appropriate – patient goes through daily routine automatically; poor insight into condition.
• Level 8: Purposeful-appropriate – patient is alert, oriented, and capable of learning new activities; may still have deficits in judgment and reasoning.
• Level 9: Purposeful-appropriate (standby assistance) – patient can shift between tasks independently; may require assistance to anticipate problems.
• Level 10: Purposeful-appropriate (modified independent) – patient can handle multiple tasks but may require periodic breaks; irritability may persist.

The Glasgow Coma Scale (GCS) is used to measure the initial responses or lack of responses to determine the level of brain injury. It assesses three key areas:

• Best Eye Response (1-4): No eye opening to eyes opening spontaneously.
• Best Verbal Response (1-5): No verbal response to being fully oriented.
• Best Motor Response (1-6): No motor response to obeying commands.

The total score ranges from 3 to 15, with lower scores indicating more severe impairments.