A traumatic brain injury (TBI) can be defined in literal terms as a hit or penetration on
the head that causes an alteration of the normal functionalities of the brain. TBI can result when
the head experiences an abrupt intense contact with a heavy object or is perforated through. The
symptoms can be slight, mildly moderate or severe. Symptoms are dependent upon the extent of
the damage caused to the brain. Mild incidences result in short term mental consciousness, coma
and at times death (Fuentes et al., 2018).
The Biological Dimensions of Traumatic Brain Injury
Damage to the brain that is traumatized is as a result of the mechanical injury that may
subsequently cause stimulation of secondary pathogenic cascades that influence the progression
of the initial primary damage (Suter, 2016). Human TBI is a heterogeneous defect in which
factors associated with pathogens may vary in magnitude and are manifested in different
combinations. A generalized view as is in studies in various models considers four phases. The
classification provides a broader context for a clear comprehension of the relationship between
the initial and subsequent pathogenic scenarios.
Phase 1 is set to represent primary physical damage resulting in the rapture of the
vascular and cellular membranes, the release of the contents of intercellular and cessation of
blood. The destruction of blood flows and metabolism may result in anaerobic activities and the
accumulation of lactic acid (Suter, 2016). The membrane ions may fail depending on energy as
adenosine triphosphate that has been stored is used up.
Phase 2 mainly involves progressive worsening of the axis of neurons that emanates from
both molecular and biochemical events that may promote the death of apoptotic and necrotic
cells. The increment is an outcome of the rupture of the barrier between the blood and the brain
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and subsequent exposure of the brain to the excessive release of synaptic and decreased
glutamate transporter (Suter, 2016). Glutamate is known to be the most abundant excitatory
transmitter in the human brain. In the context of TBI, an increment in the glutamate results in
simulations of ion channel and G-protein glutamate linked receptors. Excess activation of the ion
channels results in ionic imbalances and at times prolonged ionization. Intracellular calcium
tends to rise after TBI. This is attributed to increased Ca 2+ from the components of extracellular
and a release of Ca 2+ from stores within the cells (Suter, 2016). The increase in intracellular
calcium ions results in the activation of proteases within the cells. Those events may lead to
cytoskeletal physical damages and result in the injury of cells and death.
Under physiologic situations, antioxidants that are endogenous such as glutathione
peroxides and superoxide dismutase and catalase usually prevent the damage of oxidation from
superoxide dismutase and catalyze the formation of hydrogen peroxide from the conversion of
superoxide (Suter, 2016). A collection of genes known as vitagenes prevents the occurrence of
homeostasis during strain. This group consists of a group of proteins, HO-1, and Hsp32 that
absorbs heat. Generally, the inflammatory response occurring in the brain is different from that
in other organs. On the contrary, brain microglia are activated and forced to release mediators of
inflammation.
In phase 3, events including hypotension, ischemia, increase in intracranial pressure,
swelling of the brain and failure of metabolism processes further perturb the functionalities of the
brain as in phase 2, These insults occur in an extended period after the injury and are convenient
targets of therapeutic intervention measure. In human TBI, hypotension and hypoxia occur in
30% of victims of TBI (Suter, 2016). Hypotension is similarly a result of poor outcomes after
Traumatic Brain Injury. Incidences of hypoxia are particularly significant as they cannot be
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directly associated with death, notably, they are independently predictive of death and occur
despite medical attention
Post-traumatic ischemia has been portrayed in both humans and animals. The factors
causing post-traumatic ischemia are among others physical damages to the blood vessels,
hypotension and insufficient endogenous vasodilators (Suter, 2016). Metabolic failure results
from the dysfunction of mitochondria, insufficiency of a pool of nicotine coenzymes and
intramitochondrial overload. It is a scenario in which transmembrane ionic fluxes and
neuroexcitation are not met by the blood flow. Phase 4, is portrayed to represent functional and
the recovery outcomes that are a result of both the primary and secondary damage responses.
Efforts have been put in place to reverse pathogenesis with concern on treating the acute injury
beyond this actual phase.
Psychosocial Issues Common to People Experiencing Traumatic Brain Injury
The problems associated with psychosocial consequences such as loneliness and
depression occurring with a good number of TBI affected individuals create a major stumbling
block for recovering patients. Despite the recovery of full functionalities of the brain within
months ranging from four to six months after the recuperation from the time of injury, the above
complications associated with psychology consistently remain persistent for extended periods of
time. Research suggests that these mental problems linked to Traumatic Brain Injury are a
principal concern facing efficient rehabilitation of affected individuals. The results of various
studies propose that individuals experiencing TBI are more susceptible to significant anti
socialization with other people or peers. The second finding indicates that the affected
individuals find hard times setting up new social cycles. The third suggestion as in proposals
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relates to the drop in leisure activities for individuals with TBI. Finally, depression is affiliated
with severe TBI that has lasted for a longer time.
Social Work Intervention Strategies
Patient Education
There is limited possible physical proof supporting the effectiveness of early education
among TBI patients. The evidence remains factors and considerations as opposed to how they
have been put in literature. The education component that is utilized as an intervention measure
includes verbal communication or booklets explaining to the affected TBI patients on what
diagnosis and possibles symptoms are. The purpose of closely educating TBI patients is
recommended in order to make the symptoms appear normal. This minimizes distress about the
symptoms (Brunner, Togher, Palmer, Dann, & Hemsley, 2019). The reassurance element of TBI
intervention involves a verbal professional explanation of the possible signs that might come up
and encouragement on positive recovery. The goal of this component provides clues on better
ways to cope up. According to Brunner et al. (2019), patient education elements and reassurance
have proven effective in minimizing distress.
Psychological Interventions
A review by Brunner et al. (2019) on TBI observed finite evidence of any beneficial
impacts of nonsuicidal therapy on stress mental strain disorders after patients’ recovery from
TBI. There is also limited proof of comprehensive behavioral therapy integrated with
rehabilitation measures and apprehension among the early stages of TBI victims. Research has
also reported good results associated with comprehensive behavioral therapy (CBT) after mild
TBI but more designs are needed to better monitor the effect (Brunner et al., 2019). Due to the
high prevalence of symptoms associated with the psychiatry after mild TBI, psychological
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interventions such as CBT are further modified to meet the needs of the affected individuals for
further understanding.
Cognitive Rehabilitation
Cognitive rehabilitation after mTBI has been researched upon. Statistical trials on the
effect of different programs of rehabilitation with elements of therapy signs and symptoms of
TBI yields a positive result. A review by Weiss, Collett, Kaplan, Omert, and Leung (2018) on
the effect of comprehensive rehabilitation of TBI claimed that training to compensate for
memory recovery proves effective. These strategies involved both visual and imagery support
aids. Due to the interventions involved in education that was in comparison with ordinary care,
specific components and a good number of other concerns such as frequent contact of the mTBI
individuals were responsible for the positive results (Weiss et al., 2018).
Policy, Organizational, and Biotechnological Issues
The National Association of County and City Health Officials (NACCHO) are in direct
support for research, intense surveillance and advancement on strategies preventing traumatic
brain injury (TBI). This support ensures improved long-term TBI management and minimizes its
effects (Bhatnagar, Iaccarino, & Zafonte, 2016). NACCHO recognizes the fact that TBI is a
social and global health concern and draws attention to a critical responsibility to respective
departments. NACCHO recommends the local, state, and federal governments of the US to be in
constant support of the general strategies such as the development of a standard definition for
TBI. That is to research on longitudinal studies associated with prevention, management, and
treatment in some cases.
Monitoring of TBI by creating and maintaining a national TBI database system is also a
recommended strategy. Another recommendation is the allocation of sufficient resources to
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support prevention and treatment. Similarly, the adaptation, implementation, and evaluation of
practice and evidence-based TBI intervention strategies for the vulnerable populations are
recommended (Bhatnagar et al., 2016). Development of state systems entailing details of TBI
victims that are coupled with public health systems to provide close care to TBI victims also
proves a worthy strategy. Comprehensive and integrated effective community-based strategies to
ensure that TBI survivors minimize further injury. Further, a close collaboration with various
agencies and organizations is also a major strategy as proposed by research and experiments
(Bhatnagar et al., 2016). Technological advancement is functional in neuroimaging. This,
however, is associated with ethical derailments and setbacks and implications among the TBI
patients.
Ethical Issues and Dilemmas
In various specific clinical environments handling rehabilitation services, the affected
individuals must adhere to clinical evaluation that requires general homeostasis assessment.
The sequential psychosocial consequences that raise specific ethical concerns and dilemmas
include the fact that TBI is sudden and in most cases unexpected. Physical functionalities of the
body, emotional and behavioral systems are compromised as well. The outcome is in most cases
not known nor defined. Only a small proportion of the population is affected hence the dilemma
on how to address TBI patients. Life expectancy is likely to be shorter than it should be.
Sensitivity and dignity for the affected individuals with respect to social boundaries also raise
concerns. Treating their consequent impairments and socialization skills and weakness becomes
a major challenge to worry about.
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Critical Issues and Future Directions for Medical Treatment, Social Work
Intervention, and Policy Changes
According to Fuentes et al. (2018), a more modernized view on the interventions and
policies of the state and general literature on research protocol attempts to simplify and define
unresolved legal ethical issues pertaining to experiments with adults with traumatic brain injury.
Remedies that protect the rights and prevent unnecessary impediments to the clinical inquiries
are also demonstrated using standard protocols. Research protocol identifies a number of areas in
the law affecting TBI among adults such as advanced directives on TBI, probate acts, power of
attorney acts, surrogacy acts, health insurance portability and accountability (Fuentes et al.,
2018). Bioethics literature that has been published and respective feedback responses from local
Institutional Review Boards (IRBs) suggest that some of the unresolved ethical issues involved
in experiments involve vulnerability, voluntary consent, choices and decision making using those
who care as main subjects and multi-organizational agencies. There is a need for collaboration
between members of IRB, administrators and other legal research institutions so as to develop
strategies to resolve the dilemmas in TBI rehabilitation.
An urgent need for a clear regulatory law and guidelines on TBI has also been suggested
by modern research experiments. TBI individuals’ rehabilitation has also been considered and
has been given value for the quality of life and social interactions regarding outcomes of
interventions and management of the disability. Although a cure is important, finding strategies
on how to adapt has been fronted. This conceptualization has been of significant aid in
promoting accommodation of individuals affected by traumatic brain injury. This consequently
lures the medical and social and empowers people with the disability. The healthcare system has
devised its policies as the industry adjusts to economic situations. Insurance companies continue
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to increase financing for the rehabilitation of TBI affected patients. There are several recognized
alliances and organizations being registered making it more accommodative for TBI victims.
Hospitals and hospital systems are also improving their service delivery by training their social
workers and health care providers to cater for TBI victims.
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References
Bhatnagar, S., Iaccarino, M. A., & Zafonte, R. (2016). Pharmacotherapy in rehabilitation of post-
acute traumatic brain injury. Brain Research, 1640, 164-179.
Brunner, M., Togher, L., Palmer, S., Dann, S., & Hemsley, B. (2019). Rehabilitation
professionals’ views on social media use in traumatic brain injury rehabilitation:
Gatekeepers to participation. Disability and Rehabilitation, 1-10
Depression Anxiety Stress Scales (DASS-21): factor structure in traumatic brain injury
rehabilitation. Journal of Head Trauma Rehabilitation, 32(2), 134-144.
Fuentes, M. M., Wang, J., Haarbauer-Krupa, J., Yeates, K. O., Durbin, D., Zonfrillo, M. R., … &
Rivara, F. P. (2018). Unmet rehabilitation needs after hospitalization for traumatic brain
injury. Pediatrics, 141(5).
Suter, P. S. (2016). Rehabilitation and management of visual dysfunction following traumatic
brain injury. In Traumatic Brain Injury (pp. 323-370). CRC Press.
Weiss, E., Collett, A., Kaplan, M., Omert, L., & Leung, P. S. (2018). Complement inhibition
mitigates secondary effects of traumatic brain injury (TBI). Critical Care Medicine,
46(1), 401.