Thank you so much for helping raise our level of awareness and understanding of TBI. Other staff members including our community support supervisors would really benefit from your training.


Traumatic brain injuries are classified as “mild,” moderate or severe. Mild Traumatic Brain Injury (MTBI), or concussion, is one of the most common neurologic disorders. According to the CDC, Emergency Department visits account for about 80 percent of TBIs and include a large number of mild TBIs. Most people recover from a mild TBI, but some have serious long-term consequences. In the CDC findings very young children ages 0 to 4 years had the highest rate of TBI related ED visits (1,035.0 per 100,000 population), followed by older adolescents ages 15 to 19 years (661.1 per 100,000). Mild is a medical term associated with loss of consciousness, not necessarily associated with functional outcomes.

CDC estimates that the likelihood of an athlete in a contact sport experiencing a concussion may be as high as 19 percent per season. Although the majority of athletes who experience a concussion are likely to recover, an unknown number of these individuals may experience chronic cognitive and neurobehavioral difficulties related to recurrent injury. Symptoms following a mild TBI are referred to as “Post-Concussion Syndrome.” A repetitive injury while recovering from an initial concussion can have catastrophic consequences, as in the case of “Second Impact Syndrome,” which has led to approximately 30-40 deaths over the past decade.


To help ensure the health and safety of young athletes, CDC developed the HEADS UP Concussion in Youth Sports initiative to offer information about concussions to coaches, parents, and athletes involved in youth sports. The HEADS UP initiative provides important information on preventing, recognizing, and responding to a concussion.  For more information click on this link:

Parent concussion sheet

Concussion Patient Information


Child SCAT3

Rivermead postconcussive symptom questionnaire

OSU TBI-ID Short_Form


TBI in Prisons:

TBI in Prisons and Jail:

A Guide for Criminal Justice Professionals:

Screening for TBI Among Prisoners:

Family Resources:  Family Resources


The brain can receive several different types of injuries depending on the type of force and amount of force that impacts the head. The type of injury the brain receives may effect just one functional area of the brain, various areas, or all areas of the brain. Types of traumatic brain injuries and their characteristics are discussed below, followed by related definitions.

Brain Injury: A more descriptive term than “head injury”. Damage to the brain that results in impairments in physical, cognitive, speech/language and behavioral functioning. The damage may be caused by an external physical force, insufficient blood supply, toxic substance, malignancy, disease-producing organisms, congenital disorders, birth trauma or degenerative processes.

A concussion is caused when the brain receives trauma from an impact or a sudden momentum or movement change. The blood vessels in the brain may stretch and cranial nerves may be damaged.

  • A concussion can be caused by direct blows to the head, gunshot wounds, violent shaking of the head, or force from a whiplash type injury.
  • Both closed and open head injuries can produce a concussion. A concussion is the most common type of traumatic brain injury.
  • A person may or may not experience a brief loss of consciousness (not exceeding 20 minutes). A person may remain conscious, but feel “dazed” or “punch drunk”.
  • A concussion may or may not show up on a diagnostic imaging test, such as a CAT Scan.
  • Skull fracture, brain bleeding, or swelling may or may not be present. Therefore, concussion is sometimes defined by exclusion and is considered a complex neurobehavioral syndrome.
  • A concussion can cause diffuse axonal type injury resulting in permanent or temporary damage.
  • A blood clot in the brain can occur occasionally and be fatal.
  • It may take a few months to a few years for a concussion to heal.

A contusion is a bruise (bleeding) on the brain.

  • A contusion can be the result of a direct impact to the head.
  • Large contusions may need to be surgically removed.

Coup-Contrecoup Injury
Coup-Contrecoup Injury describes contusions that are both at the site of the impact and on the complete opposite side of the brain.

  • This occurs when the force impacting the head is not only great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion.

Diffuse Axonal Injury
A Diffuse Axonal Injury can be caused by shaking or strong rotation of the head, as with Shaken Baby Syndrome, or by rotational forces, such as with a car accident.

  • Injury occurs because the unmoving brain lags behind the movement of the skull, causing brain structures to tear.
  • There is extensive tearing of nerve tissue throughout the brain. This can cause brain chemicals to be released, causing additional injury.
  • The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes.
  • This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death.
  • A person with a diffuse axonal injury could present a variety of functional impairments depending on where the shearing (tears) occurred in the brain.
    Source: Brain Injury Source Volume 4 Issue

Traumatic Brain Injury: Damage to living brain tissue by an external mechanical forces or motion. It is usually characterized by a period of altered consciousness (amnesia or coma) that can be very brief (minutes) or very long (months/indefinitely). The term does not include brain injuries that are caused by insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congenital disorders, birth trauma or degenerative processes.

  • Closed Brain Injury: Occurs when the head accelerates and then rapidly decelerates or collides with another object (for example, the windshield of a car) and brain tissue is damaged, not by the presence of a foreign object within the brain, but by the violent smashing, shaking, stretching and twisting of brain tissue. The nerve endings connecting the skull to the brain are often torn or become completely separated from the brain. Closed brain injuries typically cause diffuse tissue damage that result in disabilities, which are generalized and highly variable.
  • Open (Penetrating) Brain Injury: Occurs when an object (e.g. bullet, knife) fractures the skull, enters the brain and injures the brain tissue in the process. These injuries tend to damage localized areas of the brain and result in discrete and relatively predictable disabilities.
  • Acquired Brain Injury (ABI): The implication of this term is that the individual experienced normal growth and development from conception through birth until sustaining an insult to the brain later that resulted in impairment of brain function. ABI is caused by the shearing of brain nerve fiber due to trauma or by cell death related to swelling, bleeding, disease or loss of oxygen to the brain (anoxia). Whether mild, moderate or severe, acquired brain injury can cause physical, cognitive, speech/language and behavioral dysfunction.


Anoxic Event: near drowning, electrical shock, drug overdose, kidney/heart failure, industrial/chemical exposure, injury subsequent to TBI/CVA.

Acquired Brain Disorder (ABD): Acquired brain disorder is a broader category, which includes neurological disorders as well as acquired brain injury. They may each result in trauma or disruption to the brain and nervous system from a variety of sources.

The brain is the control board for all functions of the body. It is comprised of the cortex, which controls most thinking functions, the cerebellum, which coordinates movement, and the brain stem, which controls consciousness, alertness and basic functions such as breathing, respiration and pulse. The brain function can be disrupted in a number of ways: injuries, toxins, illness and unrelated medical conditions. These disorders to the brain and nervous system include, in addition to acquired brain injuries, neurological brain disorders such as multiple sclerosis, Huntington’s Disease, Parkinson’s Disease and other rare neurological disorders.

Second Impact Syndrome “Recurrent Traumatic Brain Injury”
Second Impact Syndrome, also termed “recurrent traumatic brain injury,” can occur when a person sustains a second traumatic brain injury before the symptoms of the first traumatic brain injury have healed. The second injury may occur from days to weeks following the first. Loss of consciousness is not required. The second impact is more likely to cause brain swelling and widespread damage.

  • Because death can occur rapidly, emergency medical treatment is needed as soon as possible.
  • The long-term effects of recurrent brain injury can be muscle spasms, increased muscle tone, rapidly changing emotions, hallucinations, and difficulty thinking and learning.

Shaken Baby Syndrome
Shaken Baby Syndrome is a violent criminal act that causes traumatic brain injury. Shaken Baby Syndrome occurs when the perpetrator aggressively shakes a baby or young child. The forceful whiplash-like motion causes the brain to be injured.

  • Blood vessels between the brain and skull rupture and bleed.
  • The accumulation of blood causes the brain tissue to compress while the injury causes the brain to swell. This damages the brain cells.
  • Shaken Baby Syndrome can cause seizures, lifelong disability, coma, and death.
  • Irritability, changes in eating patterns, tiredness, difficulty breathing, dilated pupils, seizures, and vomiting are signs of Shaken Baby Syndrome. A baby experiencing such symptoms needs immediate emergency medical attention.
    (The Shaken Baby Alliance. [Online August 22, 2002:])

Locked in Syndrome
Locked in Syndrome is a rare neurological condition in which a person cannot physically move any part of the body except the eyes.

  • The person is conscious and able to think.
  • Vertical eye movements and eye blinking can be used to communicate with others and operate environmental controls.

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