Repetitive Head Injuries: Causes, Effects and Rehabilitation of Resulting Traumatic Brain Injuries

Nearly any injury to the head is traumatic and many involve injury to the brain as a Traumatic Brain Injury (TBI). The terms “TBI” and “head injury” are often used interchangeably and can result from direct impacts or other kinds of occurrences. Some of the other kinds of occurrences include:

• Neuronal injuries, which are injuries to the nervous tissues of the brain. These are of different degrees of severity, each bearing a distinct name. They all fundamentally involve damage to the myelin coating of the nerves of the brain and a resulting interruption of the conduction of electrical impulses. The extent of the nerve damage often correlates with the severity of the trauma and can affect various aspects of the individual’s function, including motor, sensory and autonomic;
• Cerebral hemorrhages which can be caused by brain trauma or by a stroke. In either case, it results in bleeding into the brain tissue;
• Vascular injuries; and
• Cranial nerve injuries.

When a TBI occurs from a blow to the head, it can be further classified as an open- or closed-head injury. An open, or penetrating, head injury can result from an impact with an object, such as can happen in a motor vehicle accident or from a gunshot wound. A closed-head injury usually results from a hard impact to the skull without a resulting fracture[1].

Primary TBI results from the initial trauma. It is the direct result of the impact and can result in concussion, contusions, damage to blood vessels in the brain, axonal shearing (where neurons of axons are stretched and torn) and damage to the blood-brain barrier. In turn, the primary injury can lead to a secondary TBI resulting in effects that manifest themselves days or weeks later. The secondary TBI can be ischemia (inadequate blood flow to the brain), hypoxia (insufficient oxygen to the brain), hypotension (low blood pressure), increased intracranial pressure or other complications, including death.

Repetitive head injury, as the term is generally used, is a type of closed-head injury. It is sometimes called “secondary impact syndrome” and occurs when an individual sustains a second TBI before the first one has resolved. The second injury can occur days, weeks or months after the first and loss of consciousness is not required for either. In fact, the visceral symptoms of the first TBI may have dissipated, yet the individual may not have fully recovered from a medical or neurologic standpoint[2]. A prime example of this is in athletic activities such as football, boxing or soccer. A player may fall, be tackled, struck by another player or otherwise sustain trauma to the head. Although the individual may or may not initially feel dazed, a TBI may have occurred. Then, either within the same game or match, or soon thereafter, a second head injury of the same or different type occurs. The second trauma, or the aggregation of many more traumas, may cause brain edema, intracranial bleeding or secondary TBI. Interestingly and often with specific reference to boxers, the term, “punch-drunk” is sometimes used as a pejorative for a condition resulting from repeated head trauma from punches. The result is that the boxer behaves in a bewildered, confused or dazed manner because of the ensuing TBI.

Regardless of the categorization of the TBI, even if mild (MTBI), has the potential of being catastrophic. Once the individual is medically stabilized and becomes a Client of NeuLife Rehab in Mount Dora, Florida, he or she undergoes a comprehensive assessment with a Client Goal Plan meeting established for review by the Client, family members, nurse case manager and attorney, if applicable, at an initial Client Goal Plan Conference scheduled less than one week following admission. Each Client Goal Plan includes clinical needs for rehabilitation and covers personal goals and preferences of the Client. Therapies are provided by NeuLife full-time staff who are Florida licensed and/or certified professionals. These professionals include but are not limited to:

• Board Certified Neurologist
• Board Certified Behavior Analyst
• Board Certified Physiatrist
• Neuropsychologist
• Psychologist
• Board Certified Psychiatrist
• Speech-Language Pathologist/Cognitive Therapist
• Physical Therapist
• Occupational Therapist
• Nurses
• Certified Rehab Counselor

These professionals and all other members of the NeuLife Rehab multidisciplinary team are devoted to their calling to helping individuals with catastrophic injuries in this highly specialized program. This is fully in keeping with NeuLife’s dedication to consistently provide the highest standard of care in the delivery of clinically relevant services. NeuLife Rehab strives to achieve successful, sustained outcomes and exceed the expectations of all persons served.

Proper and timely post-acute rehabilitation that may determine the difference between disability and independence is what NeuLife refers to as the “platinum post-acute period” — the crucial window following acute care that is needed to nurture the whole person to health with specialized, clinically relevant services.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best achieved in a positive and uplifting therapeutic environment where caring staff encourages, assists and supports each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to achieve function and independence.

NeuLife, in Mount Dora, Florida, is an accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with Traumatic Brain Injury (TBI), Spinal Cord Injury (SCI), Amputations, Burns and other Catastrophic Injuries and Challenging Diagnoses.

2725 Robie Avenue

Mount Dora, Florida 32757

[1] http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm (2014)

[2]Repetitive Head Injury Syndrome http://emedicine.medscape.com/article/92189-overview