March Is TBI Awareness Month

March is TBI awareness month, which is something that is very near and dear to me.  In January of 1998, I suffered a TBI, and the repercussions have been trying, to say the least.  But that is a post for later this week.  This post is for awareness, resources, and advocacy.  Enough said.

What is a TBI?

TBI (traumatic brain injury), as defined by the Centers for Disease Control and Prevention (2015), is caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.  While not all bumps or blows to the head result in a TBI, it is estimated that approximately 2.5 million hospital visits are associated with a TBI which contribute to more than 50,000 deaths per year.

Diagnosis a TBI

TBIs are diagnosed using one of two main systems: The Glasgow Coma Scale or the Ranchos Los Amigos Scale.   The Glasgow Coma Scale is based on a 15-point scale and describes the level of consciousness of a person after a TBI and used to describe the severity of the injury.  It measures the functions of eye opening, verbal response, and motor response.  (To see a more detailed breakdown of these functions, please click here.)  The Ranchos Los Amigos Scale measures the levels of awareness, cognition, behavior, and interaction with the environment.  It uses eight different levels ranging from Level 1: No Response to Level VIII: Purposeful-appropriate.  (To see a more detailed breakdown of these levels, please click here.) 

For simplicity purposes, I am choosing to elaborate using the Glasgow Coma Scale.  Using this scale, the severity can be described as mild, moderate, or severe.

Mild TBI 

• brief loss of consciousness ranging from a usually few second to a few minutes OR no loss of consciousness but some confusion
• post-traumatic anmesia (PTA) for less than 1 hour of the TBI
• normal brain imaging results 

Moderate TBI 

• loss of consciousness for a few minutes to a few hours
• confusion lasts from days to weeks
• PTA for 1-24 hours
• abnormal brain imaging results
• physical, cognitive, and/or behavioral impairments last for months or weeks

Severe TBI

• loss of consciousness for more than 24 hours
• PTA for more than 24 hours
• abnormal brain imaging results
• may affect short or long-term cognition, sensation, language, and emotional impairments 

Causes of TBIs

According to the CDC, TBIs between 2006-2010 were results of the following:

Long-Term Effects

Long-term effects of TBIs are variable and depend on the severity.  Individuals with a mild TBI will most often have no long-term effects.  For those that do, the symptoms may be longer lasting or even permanent including irritability, anxiety, and depression.  Other challenges may also include balance, movement, attention, concentration, judgement, and reaction time.  For many individuals with a moderate to severe TBI, the long-term effects can lead to life-long challenges.  Physical changes can include sleep disorders, changes in appetite, paralysis, seizures, difficulty regulating body temperature, and hormonal challenges.  Cognitive changes can include difficulty with attention, concentration, memory, processing speed, perseveration, confusion, impulsivity, and executive functions.  Speech-language challenges may include understanding spoken words or generating words, slurred speech, reading and writing problems.  Social-emotional challenges may include fluctuating emotions, lack of motivation, irritability, aggression, depression, and and lack of inhibition.  Additional challenges may include sensory, perception, vision, hearing, smell, and taste.  The list is even more extensive, however, these highlight the most common.

Resources

CEMM (Center of Excellence for Medical Multimedia) has great resources for TBI.  Please visit their website to find an interactive brain, videos, and information on caregiver and personal journeys.

The CDC has a four-minute podcast about The Dangers of Brain Injuries that is also a great resource.  You can check it out here. 

References:

BrainLine.org (2015).  Retrieved from http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html

Northern University: Traumatic Brain Injury Resource for Survivors and Caregivers (2010).  Retrieved from http://www.northeastern.edu/nutraumaticbraininjury/what-is-tbi/severity-of-tbi/

Brain Injury Alliance (nd.) Retrieved from http://biau.org/types-and-levels-of-brain-injury/

Center for Disease Control and Prevention (2015).  Retrieved from http://www.cdc.gov/traumaticbraininjury/get_the_facts.html

Center of Excellence for Medical Multimedia (nd.) Retrieved from http://www.traumaticbraininjuryatoz.org

BIKE HELMET SAFETY FOR YOUR CHILD: Follow These Five Easy Steps

I'm a big fan of the Tour (Tour de France), and every July, I get amped up! I'm in complete awe of the athletes' strength and level of physical fitness.  One of my race favorites pulled out of the race after he went down in a crash in one of the early stages with a knee injury.  In fact, many of the major injuries include fractures of the extremities, not head injuries. Why?  Several reasons, two of which include properly fitted helmets and the obvious: the roads are cleared of vehicles for the cyclists.  This post is clearly not about the Tour de France, but it was my segue into talking about proper fit of your child's bike helmet.

This summer, my daughter started riding her bike, and my husband and I wanted to make sure she was safe, which meant finding the proper helmet.  She had to have a princess bike helmet to match her pink princess bike.  (Coordinating at the age of three?  I could be in trouble in another 10 years!)  It cost a little more than $20, but the peace of mind it has given us is priceless, considering she's already had her share of falls.  Ever since she started riding her bike, I've been paying more attention to other kids and their helmets (or lack thereof) because I have seen some craziness. Take, for example, the teen-age boy riding on a much-too-small-of-a-bike on a busy road while texting on his phone and flipping his Bieber-like hair … who was NOT wearing a helmet.  Several weeks ago, a friend posted a picture of her son riding his bike, and while he was wearing a helmet, it was so ill-fitted that the front of his helmet started past his hairline. 

According to Centers for Disease Control and Prevention, a survey conducted in 2001-2003 revealed only 48% of children ages 4-15 wore bike helmets, and that number decreased as children got older.  The CDC also reported that approximately 26,000 bicycle-injuries of children and adolescents were traumatic brain injuries (http://www.cdc.gov).  Those are very scary statistics.

A 2012 study from the WV Medical Journal took a look at injuries of children ages 14 and younger, focusing on the differences between children who wore a helmet and children who did not wear a helmet.  Their study looked at all pediatric patients treated at the West Virginia Trauma System who were involved in bicycle crashes from 2008 through 2010. They indicated that their findings were similar to other studies (Bergenstal et al. 2012):

• Concussions occurred in 19.4% of helmeted riders and 37.4% of un-helmeted riders.
• Skull fractures occurred in 3.2% of helmeted riders and 17.4% of un-helmeted riders.
• Intra-cranial hemorrhaging occurred in 0% of helmeted riders and 17.4% of un-helmeted riders.
• Zero deaths occurred in helmeted riders, and 2 deaths occurred in un-helmeted riders.

So how should a child's bike helmet fit?  Children's Hospital Los Angeles  and The National Highway Traffic Safety Administration  both offer easy steps to assure proper fit.

1. Size - The helmet should fit snuggly and should not move from side to side.  Sizing pads come with newer helmets to help secure the fit, and extra pads can be removed as your child's head grows.  If the helmet has a universal fit ring instead of pads, the ring can be adjusted to fit your child's head.

2. Position - The helmet should fit low on your child's forehead, allowing for only one or two-figer widths above the eyebrow.  

3. Side Straps - The left and right straps should meet right below your child's ears to form a V-shape under and slightly in front of the years.  Secure the side straps if possible to prevent slipping.

4. Chin Straps - Center the left buckle under the chin.  Buckle the strap and tighten until it is snug.  No more than one finger should fit under the strap.

5. Final Fit 

• Does the helmet fit correctly?  You can check by asking your child to open his/her mouth wide.  In doing so, the helmet should pull down on his/her head.  If you find that the helmet is not fitting correctly, check the tightness of the chin straps.
• Does the helmet lean forward into your child's eyes?  Is there only one or two fingers between the helmet and your child's eyebrows?  If not, then tighten the side straps and chin straps. 
• Does the helmet move while your child shakes his/her head?  If so, check the sizing pads or universal fit ring.
• Roll the rubber band down to the buckle.  All four straps should go through the rubber band.

This quick how-to video may help you to figure out the correct fit for your child's helmet.

Children grow, so it's undeniable that they will also outgrow their helmets. You will need replace your child's helmet if his/her head has outgrown the helmet size, your child has crashed in the helmet, or it has been dropped on a hard surface such as concrete as it may no longer provide the correct protection. It may seem "nit-picky" and "petty" to consider these factors, but then you must also consider the alternative: a traumatic brain injury (TBI).  Even with a mild TBI, children may experience life-long difficulties with attending, working memory, processing speed, organization, and behaviors.   I know this because I suffered from a TBI 16 years ago, and the effects still challenge me, but that's another post on another day.

Sources:

Bergenstal J, Davis S., Sikora R., Paulson D., Whiteman C.  "Pediatric Bicycle Prevention and the Effect of Helmet Use: The West Virginia Experience."  Center for Diseases Control and Prevention. West Virginia Medical Journal, n.d.  Web.  13 July 2014.

"Bicycle Helmets Save Medical Costs for Children."  Children's Safety Network.  n.p.,  n.d. Web. 13 July 2014.

Franco, Cheryl.  "Bicycle Helmets: Getting the Right Fit."  Children's Hospital Los Angeles.  n.p.,  n.d.  Web.  13 July 2014.

"Easy Steps to Properly Fit a Bicycle Helmet."  NHTSA.  n.p., Sept. 2016.  Web.  13 July 2014.