Epidemiology of Traumatic Brain Injury (TBI)
In 2003, the Center for Disease Control and Prevention (CDC) issued a report to the United States Congress proclaiming there exists a “silent epidemic” in America: traumatic brain injury (TBI). Shortly following that report an increased awareness of head injuries in sports developed, particularly football. TBI was eventually declared the “signature injury” of the Operation Iraqi Freedom/Operation Enduring Freedom offensive in the Middle East.
In 2003, the Center for Disease Control and Prevention (CDC) issued a report to the United States Congress proclaiming there exists a “silent epidemic” in America: traumatic brain injury (TBI). Shortly following that report an increased awareness of head injuries in sports developed, particularly football. TBI was eventually declared the “signature injury” of the Operation Iraqi Freedom/Operation Enduring Freedom offensive in the Middle East.
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What is Mild Traumatic Brain Injury (mTBI)? The following definition of mild traumatic brain injury (mTBI) comes from the American Congress of Rehabilitation Medicine and the World Health Organization: “An occurrence of an injury to the head resulting from blunt trauma or acceleration or deceleration forces with one or more of the following conditions attributable to the head injury during the surveillance.
* In infants and young children, irritability, lethargy or vomiting following head injury. * Symptoms among older children and adults such as headache, dizziness, irritability, fatigue or poor concentration when identified soon after injury.” |
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TBI by the Numbers
The official estimate of the incidence of traumatic brain injuries in the United States is approximately 1.7 million documented cases per year. This number refers only to those who sought medical attention, so some authors speculate the actual number is likely much higher. It is probable, according to other published reports, an equal number of TBIs occur yearly and do NOT seek medical attention. That would translate to estimates ranging up to 3.8 million new TBI cases per year. Of the documented TBI cases, approximately 80% fall into the mild category and the other 20% into the moderate to severe category. Given that non-documented cases by definition consist of non-life threatening and/or less severe head injuries, it is probable that mild traumatic brain injuries constitute closer to 90% of all TBIs sustained each year in the United States.
The Center for Disease Control and Prevention (CDC) estimates that from the documented cases, each year, in the US:
The numbers are staggering, if one does the math on total cases of TBI in the United States. There are approximately 2.5 to 5 million new cases per year times a conservative estimate of 90% falling into the mild category with a minimum of 10% of these going on to develop permanent symptoms of PCS. This equates to a minimum of 200,000 and upwards to as many as 400,000 new cases of permanent brain damage arising from individuals sustaining only mild TBIs each year.
Causes of TBI
The highest rates of TBI incidents are found in those involved in violence, construction, car/motorcycle accidents, current military personnel and veterans, sports, and people who have fallen.
The official estimate of the incidence of traumatic brain injuries in the United States is approximately 1.7 million documented cases per year. This number refers only to those who sought medical attention, so some authors speculate the actual number is likely much higher. It is probable, according to other published reports, an equal number of TBIs occur yearly and do NOT seek medical attention. That would translate to estimates ranging up to 3.8 million new TBI cases per year. Of the documented TBI cases, approximately 80% fall into the mild category and the other 20% into the moderate to severe category. Given that non-documented cases by definition consist of non-life threatening and/or less severe head injuries, it is probable that mild traumatic brain injuries constitute closer to 90% of all TBIs sustained each year in the United States.
The Center for Disease Control and Prevention (CDC) estimates that from the documented cases, each year, in the US:
- 1.7 million people in the US suffer traumatic brain injuries
- 50,000 people die
- 85,000 people suffer from long-term disabilities
- 5.3 million people live with disabilities caused by TBI
The numbers are staggering, if one does the math on total cases of TBI in the United States. There are approximately 2.5 to 5 million new cases per year times a conservative estimate of 90% falling into the mild category with a minimum of 10% of these going on to develop permanent symptoms of PCS. This equates to a minimum of 200,000 and upwards to as many as 400,000 new cases of permanent brain damage arising from individuals sustaining only mild TBIs each year.
Causes of TBI
The highest rates of TBI incidents are found in those involved in violence, construction, car/motorcycle accidents, current military personnel and veterans, sports, and people who have fallen.
- In the US, between 1.6 and 3.8 million TBIs occur as a result of sports and recreation activities each year
- Falls are the most common source of TBIs in children ages 2-4; in older children, falls and traffic accidents are an equal source of TBIs
- Child abuse accounts for 19% of pediatric TBIs
- Men are twice as likely to have a TBI
- Domestic violence, work-related, and industrial accidents are all significant sources of TBIs
Brain Injury as a Disease Process
In cases of severe TBI with serious primary injuries such as skull fractures, subdural bleeding and/or penetrating injuries with associated mass swelling, obvious brain damage occurs.
TBI, particularly mild or moderate, is no longer being viewed as an isolated event in which the brain is simply momentarily stunned, shocked or where the worst symptoms occur first with day-by-day improvement expected. Recent scientific advances into the exact cellular mechanisms involved in TBI indicate that rather than being an instantaneous, spontaneously resolving event, mTBI is actually a complex disease process that unfolds over time. Mild to moderate brain injuries fundamentally involve disruptions of the neurovascular unit commonly called the blood-brain barrier. It is this disruption that evolves and worsens over the subsequent hours, days, weeks and months that results in development of the so-called secondary or “invisible injuries. Those suffering from TBI can be affected physically, cognitively, socially, emotionally, and behaviorally. Outcomes can range from complete recovery to permanent disability, or death.
In cases of severe TBI with serious primary injuries such as skull fractures, subdural bleeding and/or penetrating injuries with associated mass swelling, obvious brain damage occurs.
TBI, particularly mild or moderate, is no longer being viewed as an isolated event in which the brain is simply momentarily stunned, shocked or where the worst symptoms occur first with day-by-day improvement expected. Recent scientific advances into the exact cellular mechanisms involved in TBI indicate that rather than being an instantaneous, spontaneously resolving event, mTBI is actually a complex disease process that unfolds over time. Mild to moderate brain injuries fundamentally involve disruptions of the neurovascular unit commonly called the blood-brain barrier. It is this disruption that evolves and worsens over the subsequent hours, days, weeks and months that results in development of the so-called secondary or “invisible injuries. Those suffering from TBI can be affected physically, cognitively, socially, emotionally, and behaviorally. Outcomes can range from complete recovery to permanent disability, or death.
The impact of a mTBI can include:
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Cognitive deficits including difficulties with:
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Physical Changes
Hearing
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Diagnosing Mild TBI:
The Role of Imaging When an individual sustains a mTBI, it is not uncommon, depending on the severity of the initial symptoms, to seek medical attention at a doctor’s office or emergency room. An examination will take place and, quite often, a CT scan of the head is ordered.
It is important to know, the primary purpose of a head CT scan in the acute setting is to rule out possible fractures or bleeding within the head which could evolve into more immediate serious, potentially life-threatening medical conditions. However, cellular abnormalities that occur in mTBI are beyond the detection capability of either CT or MRI. Therefore, the scan result will often be interpreted as “negative.
When a “closed head injury” or a “concussion” is diagnosed the patient is commonly instructed to follow-up with their primary care physician in a few days. Then, at the patient’s initial follow-up visit, he or she is usually told the symptoms of PCS will likely resolve in a few weeks or so.
What happens if a person’s symptoms persist and warrant a diagnosis of PPCS? What are the options at this point? Often, six to nine months later, a mTBI patient with persistent symptoms will be referred to a neurologist who will typically order MRI scan. In the case of a patient with a mTBI, the scan results are usually negative, the patient is diagnosed with a concussion or mild TBI, sent home with various pills and told to get counseling.
Sometimes, given the normal MRI, patients are mistakenly told “nothing is wrong” with them. Unfortunately, this often occurs in the face of a patient being totally disabled from their PPCS. Patients at this time, either directly from the TBI or indirectly from loss of function, employability, and selfesteem, become hopeless and increasingly depressed. In many worst-case scenarios, patients are sometimes told they are “faking.”
This is where a more sensitive type of brain scan that looks at the functional status of a person’s brain cells should come into play; either positron emission tomography (PET) or single photon emission computed tomography (SPECT).
The Role of Imaging When an individual sustains a mTBI, it is not uncommon, depending on the severity of the initial symptoms, to seek medical attention at a doctor’s office or emergency room. An examination will take place and, quite often, a CT scan of the head is ordered.
It is important to know, the primary purpose of a head CT scan in the acute setting is to rule out possible fractures or bleeding within the head which could evolve into more immediate serious, potentially life-threatening medical conditions. However, cellular abnormalities that occur in mTBI are beyond the detection capability of either CT or MRI. Therefore, the scan result will often be interpreted as “negative.
When a “closed head injury” or a “concussion” is diagnosed the patient is commonly instructed to follow-up with their primary care physician in a few days. Then, at the patient’s initial follow-up visit, he or she is usually told the symptoms of PCS will likely resolve in a few weeks or so.
What happens if a person’s symptoms persist and warrant a diagnosis of PPCS? What are the options at this point? Often, six to nine months later, a mTBI patient with persistent symptoms will be referred to a neurologist who will typically order MRI scan. In the case of a patient with a mTBI, the scan results are usually negative, the patient is diagnosed with a concussion or mild TBI, sent home with various pills and told to get counseling.
Sometimes, given the normal MRI, patients are mistakenly told “nothing is wrong” with them. Unfortunately, this often occurs in the face of a patient being totally disabled from their PPCS. Patients at this time, either directly from the TBI or indirectly from loss of function, employability, and selfesteem, become hopeless and increasingly depressed. In many worst-case scenarios, patients are sometimes told they are “faking.”
This is where a more sensitive type of brain scan that looks at the functional status of a person’s brain cells should come into play; either positron emission tomography (PET) or single photon emission computed tomography (SPECT).
What is Brain SPECT Imaging?
SPECT is a nuclear medicine procedure which uses a radiopharmaceutical that emits a gamma ray (photon) which is captured by a gamma camera. This gamma camera transduces the gamma ray emissions into an electical signal which is run through a computer program to generate sliced images (tomograms) of the brain. Instead of looking at the anatomic structure of the brain like the CT and MRI, the tomograms depict the relative blood flow of the brain which is a very close approximation to the metabolism of the brain cells, which tells us how they are functioning. If brain cells have been damaged at the microscopic level by elements of the neurometabolic cascade, they will not function normally. When a person’s brain cells are not functioning or metabolizing, they do not demand normal amounts of blood flow. This alteration in blood flow is detected with brain SPECT imaging. Also, when brain cells are not functioning as they should, patients aren’t and likely can’t feel or function normally, even when their head CT or MRI scan is “negative.”
SPECT is a nuclear medicine procedure which uses a radiopharmaceutical that emits a gamma ray (photon) which is captured by a gamma camera. This gamma camera transduces the gamma ray emissions into an electical signal which is run through a computer program to generate sliced images (tomograms) of the brain. Instead of looking at the anatomic structure of the brain like the CT and MRI, the tomograms depict the relative blood flow of the brain which is a very close approximation to the metabolism of the brain cells, which tells us how they are functioning. If brain cells have been damaged at the microscopic level by elements of the neurometabolic cascade, they will not function normally. When a person’s brain cells are not functioning or metabolizing, they do not demand normal amounts of blood flow. This alteration in blood flow is detected with brain SPECT imaging. Also, when brain cells are not functioning as they should, patients aren’t and likely can’t feel or function normally, even when their head CT or MRI scan is “negative.”
Polychromatic Light Therapy (PLT) and TBI
Historically, brain damage caused by TBI was taught in medical schools to be an irreversible event. In addition, it was taught that the brain was incapable of generating new brain cells. Current scientific breakthroughs now reveal neither historical dogma are true. Further, it has been demonstrated in multiple studies that near infrared LED light is capable of penetrating the human skull.
In a small demonstration project, five Veterans with documented mTBI applied InLight Medical polychromatic light LED therapy (PLT) pads with Progressive Multi-Pulse™ technology to their heads for a minimum of 20 minutes, 3 times per week for 12 weeks.
Brain SPECT imaging was obtained before and after the PLT application. The results were impressive. Each Veteran reported a marked improvement in their symptoms. In addition, there were significant increases in the SPECT imaginging of brain blood flow.
The results of this demonstration project are in line with other published studies by Dr. Michael Hamblin and his group out of Harvard Medical School demonstrating improved psychological functioning following treatment with polychromatic (red and near infrared) LED light for traumatic brain injury. The Harvard Medical School studies have also demonstrated positive results using PLT with LEDs for depression and Alzheimer’s disease.
Finally, this author has recently participated in an IRB-approved scientific study measuring not only the effects of InLight Medical’s PLT with Progressive MultiPulse™ technology on the psychological functioning of Veterans with TBI, but has also obtained pre and post measurements of changes in brain blood flow as measured by brain SPECT imaging. That study is now complete and the findings are being submitted for publication.
Historically, brain damage caused by TBI was taught in medical schools to be an irreversible event. In addition, it was taught that the brain was incapable of generating new brain cells. Current scientific breakthroughs now reveal neither historical dogma are true. Further, it has been demonstrated in multiple studies that near infrared LED light is capable of penetrating the human skull.
In a small demonstration project, five Veterans with documented mTBI applied InLight Medical polychromatic light LED therapy (PLT) pads with Progressive Multi-Pulse™ technology to their heads for a minimum of 20 minutes, 3 times per week for 12 weeks.
Brain SPECT imaging was obtained before and after the PLT application. The results were impressive. Each Veteran reported a marked improvement in their symptoms. In addition, there were significant increases in the SPECT imaginging of brain blood flow.
The results of this demonstration project are in line with other published studies by Dr. Michael Hamblin and his group out of Harvard Medical School demonstrating improved psychological functioning following treatment with polychromatic (red and near infrared) LED light for traumatic brain injury. The Harvard Medical School studies have also demonstrated positive results using PLT with LEDs for depression and Alzheimer’s disease.
Finally, this author has recently participated in an IRB-approved scientific study measuring not only the effects of InLight Medical’s PLT with Progressive MultiPulse™ technology on the psychological functioning of Veterans with TBI, but has also obtained pre and post measurements of changes in brain blood flow as measured by brain SPECT imaging. That study is now complete and the findings are being submitted for publication.
Balanced Living, Committed to Your Care
This is one of the main reasons Balanced Living is fully committed to doing all we can to help alleviate the physical and emotional symptoms of mTBI. We usea combination of biofeedback, Polychromatic light therapy and EHT, our medically approved therapies can support you in moving forward with your life.
You deserve a life that is physically and emotionally pain-free, and we are compassionately committed to supporting you along your healing journey.
This is one of the main reasons Balanced Living is fully committed to doing all we can to help alleviate the physical and emotional symptoms of mTBI. We usea combination of biofeedback, Polychromatic light therapy and EHT, our medically approved therapies can support you in moving forward with your life.
You deserve a life that is physically and emotionally pain-free, and we are compassionately committed to supporting you along your healing journey.