Leading causes of  TBI are motor vehicle accidents, work place injuries, acts of violence, falls, sports and recreational  injuries.  TBI can occur without any outward physical evidence of injury or trauma. Examples of such invisible injury include, whiplash and shaken babies.  It is  the damage to delicate  brain as opposed to outward injury that distinguishes brain injury from superficial head injury.  See Concussion in Sports. and Shaken Baby.Org

      Post Concussion Syndrome.   TBI impairs the ability to think, do, and know.  Memory mood and attention are the top three complaints of brain injury patients. Intellectual dullness, and mental rigidity are apparent signs of brain injury. Personality changes are common, and rapid mood swings alternate with waxing and waning energy levels. Taken individually, such impairments might not amount to much.  However, such impairments usually appear in groups or clusters. In many cases the impairments are widespread and disrupt many brain systems. The overall effect can be profoundly disabling.  See TBI  Checklist for a more complete listing of PCS impairments. 

  Great Debate.  For well over a century the validity and voracity of symptoms following mild brain injury have been at the center of a great debate among doctors.  This collection of symptoms has come to be called post concussion syndrome, chronic brain syndrome, and post traumatic syndrome to name a few.  Definitions of these disorders vary widely, and carry different meaning among individual doctors.  Case in point; mild or minor head injury, MHI is not necessarily synonymous with mild traumatic brain injury, MTBI nor is it clear whether either term implies "concussion." 

     Thinking and behavioral disorders such as:  memory, mood, attention, concentration, depression, fatigue, and  increased mental effort constitute the major sources of disability following MHI.  The difficulty of distinguishing between the primary neurological damage, and secondary psychosocial problems is often difficult and can stir controversy, especially where "normal" neurological findings are noted.

     Although the controversy surrounding PCS is not new it gained added momentum in the 1860's.  A growing school of thought emerged that gave credence to the disorder.  Prominent scientists offered theories concerning  causality,  but without hard evidence of structural damage to the brain, such theories were quickly discredited.  However, the flood of patients bringing such complaints continued to grow in proportion to the increases in mechanized transport.  During the 1860's there was an ever increasing amount of railway travel with a high incidence of collisions and sudden stops. Increasingly, doctors  embraced the opinion that the post traumatic disorders resulting from these injuries occurred from mechanical damage to the brain and spinal cord. 

     The scientific atmosphere at the time was increasingly influenced by prominent psychiatrist such as Freud and Charcot, and terms such "hysteria" and "functional" were gaining popularity.  Social and political changes along with legislation providing for Worker's Compensation had a profound influence.  Malingering was considered a common cause of otherwise unexplainable railway injuries among both passengers and workers.  Over the next century the sentiment in both the scientific community and general public was clearly biased against any organic explanation for PCS. 

     In the 1960's the advent of diagnostic imaging devices such as CT Scans, MRI's and PET Scans gave new credence to theories of organic injury of the brain.  However, in the best cases such scans have shown only slight, diffuse abnormalities  in a small number of cases.  It is thought that the newer quantitative EEG's, or brain mapping  with increased sensitivity from computer analysis may provide greater insights.

Pediatric Emergency Medicine Journal - Jay D. Fisher MD FAAP, Editor Pediatric Emergency Services, University Medical Center, Las Vegas, NV url: http://www.pediatric-emergency.com/headtrauma.htm

	Bbicycle helmets for children!
info 206-621-8558	Many parents underestimate the risks of children sustaining a brain injury while riding on wheels In fact, a fall from as little as 2 feet can result in a Brain injury!