Traumatic Brain Injury (TBI)

By Terry Zeigler, EdD, ATC

Snowboarder Kevin Pearce was a top-ranked halfpipe rider and considered one of the top snowboarders coming into the 2010 Winter Olympic Games. However, while he was preparing to qualify for the United States Olympic team, he sustained a traumatic brain injury after hitting his head during a halfpipe training run.

Pearce sustained a catastrophic brain injury while training in the halfpipe at Park City, Utah. Although Pearce was wearing a helmet, it was not able to prevent his brain injury. However, the helmet was credited for saving his life.

The sides of halfpipes can rise up to 22 feet in the air with the riders flying higher than that because of the momentum that the riders attain. Pearce was completing a cab double cork (a twisting double back flip) when he caught his board on the edge of the halfpipe. He hit his head just above his eye and was knocked unconscious.

He was immediately transported to a local hospital where he was diagnosed with a severe traumatic brain injury. He was initially treated in an intensive care unit and was listed in critical condition. Because of the brain’s capacity to heal, Pearce has been able to make steady progress and has recently been moved to a long term rehabilitation center.

What is traumatic brain injury (TBI)?

According to the Centers for Disease Control and Prevention (CDC), approximately 1.5 million people suffer from TBI every year. Of those who suffer an acute TBI, 50,000 die and the rest suffer from long term disabilities.

Traumatic brain injury occurs when the brain has been injured. According to experts, no two brain injuries are alike meaning that the consequences of similar brain injuries may differ remarkably. Some individuals recover fully functional ability while others may need long term care.

What are the symptoms of TBI?

A traumatic brain injury is classified as mild, moderate, or severe depending upon the amount of time that an athlete is initially rendered unconscious along with the length of time that the individual suffers from cognitive symptoms (confusion and disorientation).

Although a TBI can be diagnosed as “mild”, the effects on the individual can be long lasting and devastating to the family. TBI is diagnosed as mild if the loss of consciousness and/or confusion is shorter than 30 minutes. Common symptoms of mild TBI include:

• Fatigue
• Headaches
• Visual disturbances
• Memory loss
• Poor attention/concentration
• Sleep disturbances
• Dizziness/loss of balance
• Irritability/moodiness
• Feelings of depression
• Seizures

Mild TBI can be easily missed because the person may look normal and the symptoms may be subtle. Symptoms may also be delayed and not appear until weeks after the initial injury.

Moderate TBI is defined as those individuals with a loss of consciousness from 20 minutes up to 6 hours and a Glasgow Coma Scale of 9 – 12. The Glasgow Coma Scale is a scale used by medical professionals to determine the level of an individual’s coma based on the individual’s motor response, verbal response, and eye opening in response to simple commands.

The highest score than a healthy individual can get on the Glasgow Coma Scale is a 15. An individual with moderate disability would score in the range of 9-12, severe disability would score 3-8, and an individual in a vegetative state would score less than 3.

A severe TBI is defined as a brain injury resulting in a loss of consciousness for over 6 hours with a Glasgow Coma Scale of 3-8. How a moderate or severe brain injury affects the individual is dependent on a number of factors including:

• Severity of initial injury
• Areas of brain that were affected by the injury
• Areas of brain unaffected by the injury
• Resources available to help the individual recover

Moderate and severe TBI can affect a wide range of behaviors including speech, cognitive ability, sensory ability, vision, perception, hearing, smell, taste, social-emotional interactions, plus physical changes. Because the brain controls all of these aspects, any one of them can be affected because of the neurological changes incurred when the brain is injured.

What are the causes of traumatic brain injury

The top three causes of TBI include vehicle crashes, firearms, and falls. Injuries can further be classified by the mechanism of injury including open head injury, closed head injury, deceleration injuries, chemical/toxic, hypoxia (lack of oxygen), tumors, and infections and stroke.

 How can traumatic brain injury be prevented? 

Because there is no cure for TBI, the best approach is to prevent a brain injury from occurring. According to the traumatic brain injury website, prevention of TBI include the following:

• Always wear a seat belt in a moving vehicle
• Always use an appropriate child or booster seat
• Never drive under the influence of alcohol or drugs
• Always wear a helmet when on a bicycle, motorcycle, scooter, snowmobile, or other high speed moving objects
• Always wear a helmet when required in the sports of football, baseball, softball, lacrosse, and hockey
• Wear a helmet while skiing, snowboarding, skating, and skateboarding

Athletes need to understand that high risk sports carry the risk of death and/or catastrophic injury. Sports in which the athlete is attempting to reach high speeds or heights place those athletes at risk of TBI because of the nature of the sport.

Although Pearce wore a helmet, the design of the helmet was not enough to withstand the forces of his body combined with the force of gravity when his head hit the side of the halfpipe. Perhaps biomechanists can analyze the helmets currently used in snowboarding to see if the safety of the sport can be improved.

Recent catastrophic injuries to athletes in the sports of pole vault and professional baseball have pushed biomechanists to redesign helmets to withstand the unique forces of each of these sports.

The death of a NCAA pole vaulter prompted his family to start a foundation to prevent future deaths in the sport of vaulting. Because of their efforts, a new helmet was designed and is now on the market specifically for pole vaulters to protect their heads in the event that an athlete misses the protective padding.

Because of the number of professional baseball players sustaining head injuries, Rawlings has designed the Rawlings100 helmet. The helmet was designed to withstand the force of a 100mph fastball. These helmets were distributed to minor league teams during the summer of 2009.

What is the treatment for an individual with traumatic brain injury

Once the individual has been stabilized in an acute care hospital, he/she will most likely be transferred to a rehabilitative treatment center. While the rehabilitative treatment center will continue to provide on-going medical care to the athlete, the primary goal is to help the patient restore their lost functional abilities.

These functional abilities might include assisting the individual to walk independently, use the bathroom, talk, eat independently, and other aspects of activities of daily living. The patient will receive daily therapy provided by a rehabilitation team who may include physical therapists, occupational therapists, rehabilitation nurses, neuropsychologists, and a physician.

What is the prognosis for an individual with traumatic brain injury?

The recovery is based on the individual and the extent of the brain injury. The brain has an amazing capacity to heal by enabling uninjured sections of the brain to take on the functions of injured sections of the brain. This may take months and sometimes even years, but remarkable progress can be made.

Kevin Pearce was able to be transferred to a rehabilitation hospital specializing in the treatment and recovery for patients with brain injuries in early February. According to a report produced by NBC and aired during the Winter Olympic Games, Pearce has made tremendous strides in his recovery and continues to fight daily for a full recovery.

References

  • Associated Press . (February 4, 2010). Kevin Pearce Moved to Brain Injury Hospital. The Huffington Post. http://www.huffingtonpost.com.
  • Associated Press. (December 31, 2009). Pearce Hurts Head Training on Halfpipe. http://www.sports.espn.go.com.
  • Associated Press. (December 31, 2009). Kevin Pearce Injury: Snowboarder Knocked Unconscious. The Huffington Post. http://huffingtonpost.com.
  • Brokaw, T. (February, 2010). Video: Tribute to Kevin Pearce. http://www.nbcolympics.com.
  • Burgess, K. (January 3, 2010). Snowboarder Kevin Pearce Remains in Critical Condition with Traumatic Brain Injury. Los Angeles Times.
  • Lenrow, D. Understanding Traumatic Brain Injury. Accessed on February 26, 2010 at http://www.traumaticbraininjury.com.
  • Zeigler, T. (October 2, 2009). Pole Vaulting Helmet Now Available. http://www.sportsinjuries.suite101.com. Zeigler, T. (September 1, 2009). New Reinforced Baseball Helmets by Rawling.

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