 My name is Jamie Burroughs and I'm a postdoctoral researcher at the University of Western Australia and Perrin Institute. And today on behalf of the Brain Foundation, I'm going to give you a very brief and basic overview of our Traumatic Brain Injury. The Traumatic Brain Injury, or TBI, as I will be referring to it during this presentation, can be defined as damage or trauma to the brain and usually it's defined as external physical damage to the brain rather than kind of internal damage as something like other neurological diseases or disorders like stroke. And Traumatic Brain Injury is one of the leading worldwide causes of death and disability and it's estimated that there's approximately 200,000 cases of TBI in Australia per year and it's also estimated that there's millions of cases worldwide. We actually think that this number is underrepresented because we don't think that everyone that undergoes a form of Traumatic Brain Injury, especially the milder types like concussion. Not everyone seeks hospitalization or further treatment for it so we actually think it's underrepresented but it represents a significant issue to society. And we can define TBI as, depending on its injury type, it can be penetrating injuries where a foreign object penetrates through the skull and damages the brain tissue. But there can also be closed head injuries which is one of the most common types which is where you have something like a very strong knock to the head, for example. And this can result in local damage to the underlying brain tissue under the area that was hit or damaged but it can also result in diffuse injury and spread to other neighbouring regions or even further areas of the brain as well. And because the brain is basically, is the supercomputer that controls everything in our body, depending on where this injury is located, it can result in loss of function. So for example, if you damage part of the brain that is responsible for moving your left arm, you might have difficulty moving your left arm afterwards. So depending on the injury, this can result in lifelong disability and in very severe cases this can result in death as well. But because of this, TBI can have very high socioeconomic costs. So healthcare costs, loss of employment, losses to sectors, also carers, all that kind of stuff, it adds up to very high socioeconomic costs. So before we talk about traumatic brain injury, we need to kind of, I'll give you a very brief overview about the brain anatomy. So like I said before, the brain is the control centre of our body, it's located within our skull and again it's like our supercomputer, it controls all our movements, our thoughts, emotions, speech, unconscious functions, organ functions, everything is controlled by our brain. And if we look at, let's just say you're probably familiar with this image of the brain here, this pink organ. But if you look at it under like part of this brain tissue under very high magnification, you'll see that the brain is made up of millions and millions of these very specialised cells called neurons. And these are the actual cells that carry out these functions, so these thoughts and movements are all carried out by these neurons. There's also other supporting cell types in the brain, but we won't go into it too much, just we're going to focus mostly on these neurons. So this is a kind of diagram, typical diagram of a neuron. This is what it looks like, a specific neuron that's been grown on a piece of glass and then labelled with different colours and looked under high magnification. So this is what it can look like in a real life example, but this is a cartoon here. And it's kind of similar to the cell types that you see in high school or primary school, you kind of got that circular cell with a nucleus. Well, the neuron has that circular cell with a nucleus here, but there's also a lot of these finger-like projections that connect to other neurons as well. And then you also have typically this elongated, this is called the axon here, which also connects to other neurons. But basically these cells, they generate electrical signals, and then they send these electrical signals through its neighbouring connections to other neurons and to other brain or other bodies, parts as well, so things like the arm, liver, heart, all that kind of stuff. It's all from these neurons here. And if we zoom out a little bit, so we're not just looking at one neuron, we'll see that these neurons again are very interconnected with each other. So this is just a 3D rendering of a neuron with its connections. And again, this is these neurons growing on glass again. So you can see that all these red finger-like projections, they're connecting with other neurons, basically generating electrical signals and passing them onto the next neurons, which will pass it on to the next neurons. And these kind of create circuits. So you might have like a movement circuit that's responsible for different movements. You might have like a memory circuit which is responsible for your memory. But essentially all it boils down to is these neurons generating electrical signals and sending them to other parts of the brain. They're very highly interconnected, and this is very important for optimal functioning of the brain. So because the brain controls our whole body, it's again very delicate so any damage can result in very strong consequences. But the brain is protected by things like muscle, bone with a skull. There's also some fluid that circulates within the brain that accesses the shock absorber. So we do have some kind of damage mitigation surrounding the brain, but that's not always the case. Traumatic brain injury where you might have a very strong force which can actually damage the brain. So what actually happens when you have traumatic brain injury? Let's just say in this case a closed head injury, something like a knock to the back of your head. Well what actually happens is the brain tissue immediately underneath that part of the skull or head that was damaged will basically be damaged. So you can have damage to the tissue which will result in damage to neurons or maybe even severing a lot of the vasculature at the side of impact. The brain needs a lot of blood supply to basically do all its functions. So there's a lot of capillaries and arteries in the brain so damage doesn't just damage the actual neurons. It can actually cut and sever these blood vessels which can result in bleeding to the brain and loss of blood as well. So immediately after the damage you can have kind of focal damage to the brain tissue. But then what also happens with especially with closed head injuries and traumatic brain injuries is that it's not just underneath that focal or just underneath area that was damaged. The brain actually moves a little bit depending on the amount of force that was applied. So the brain kind of shakes itself within the skull so it can move, it accelerates forward, moves back, it can twist on itself and all these kind of movement can actually damage the brain as well. And this can actually spread not just from this focal site but it can spread throughout the whole brain depending on how much force was applied. So that acceleration, deceleration, twisting can actually damage diffuse areas of the brain as well. This damage can result in kind of damage to neurons so these axons can get severed or you can have damage to the cell body which causes the neuron to die or in this crude example of my capillary here. So you can have the capillary being damaged and then the blood basically escapes from the capillary starts pulling in the brain as well which can cause further damage to brain regions. But all of this can result in again neuron death, loss of connections between these neurons and because there's loss of connections you can have kind of altered activity in these neurons so the brain circuits aren't as optimal and this can eventually lead to loss of function. So if all this kind of happens can also kind of work on each other and then you lose function in some capacity. And there's different types of kind of the severity of traumatic brain injuries. You can have mild traumatic brain injury which is where concussion falls under where the symptoms might not be as damaging as a moderate or severe subcategories which might result in very strong damage to the brain tissue and even death in some cases. So this kind of damage all depends on how much force was applied to the to the head or the brain. But a very interesting hallmark of traumatic brain injury is that the damage does not actually stop after the primary insult has occurred. So after you've done that knock you've stabilized the person maybe they leave hospital the damage doesn't stop there because you've had or experienced this damage you can then experience a series of cellular molecular changes that occurs within the brain tissue that might cause further damage and this is called secondary degeneration. So again in the brain we got different brain type cell types it's not just neurons there's other cells in there I won't get into details but basically their activity of these supporting cells can actually change after you have an injury releasing different molecules and proteins which then might also further damage neurons in that area or surrounding areas. So let's just say you had that knock to that area secondary degeneration might occur after the injury the primary injury which then causes a spread of this damage to neighboring or even uninjured or at risk tissue as well just because of the altered activity of these supporting cells and with secondary degeneration this damage can continue for days weeks and even months following the primary insult and this can result in further damage and loss of function as well. So that's kind of the characteristic hallmark of traumatic brain injury you got the primary damage and secondary degeneration. So how do we actually diagnose the extent of this TBI and this obviously can be challenging depending on the type of injury sustained things like penetrating injuries they might be less difficult to diagnose because it's a foreign object within the brain you might be able to see it in neuroimaging so you can kind of localize that damage but in cases where there's a closed head injury it's really difficult to see which parts of the brain have been affected because it's not always obvious that there's you know damaged brain tissue or kind of blood pooling in the brain as well. So each individual is assessed based on different diagnostic tools one of the most kind of common ones that you hear thrown around is the Glasgow Coma Scale which basically looks at things like consciousness is just speech affected is movement affected things like that so you can kind of understand the extent of brain damage and this can also be paired with neuroimaging techniques so things like MRI and CT scans and this is one example of neuroimaging here so this is a person's brain and skull this white arrow shows where the individual experienced a traumatic brain injury or a hit to the head and then these black arrows show a subdural hematoma so a bit of like bleeding in the brain and then this is it eight hours later so you can kind of pairing these diagnostic tools together you can kind of get an understanding about the extent of the injury which parts of the brain are affected and kind of what is the kind of prognosis for this person depending on the injury and the post-injury symptoms that the individual experiences they can vary just differently depending on the individual's makeup but then also the severity of the injury sustained but typical symptoms that we see are things like memory issues so having difficulty remembering before the event or after the event can have things like mood dysregulation fatigue and also loss of function or loss of movement there's also a few other diagnosed kind of post-injury symptoms but these are kind of like the most common that you see so because of this primary and secondary damage it's very important that the individual is treated or stabilized as soon as possible after the injury just to prevent the spread of damage so one of the first things that happen is stabilizing the individual so stabilizing oxygen and blood levels so there's no blood loss this might involve surgery techniques as well to repair fractures and also you know stop the bleeding in the brain because again pooling of blood if that gets significant enough this can actually damage the surrounding brain tissue as well so it's really important to stabilize the individual and the reason why is because the brain it has a limited ability to repair itself and loss neurons in most cases cannot be replaced so after they've undergone some damage or maybe they've got damage to their axon or cell body or something like that it's not likely that the cell will just immediately make a you know repair itself and make its original connection that it had before the injury it's it doesn't always work like that usually when a neuron's lost or dies it's not really replaced so that can result in loss of function so it's really important that we go in there and basically reduce and stabilize the individual so that we reduce the spread of damage and so a lot of treatment options especially in the literature that we're pursuing are usually neuroprotective strategies so it's basically keeping those damaged cells alive and also preventing that spread of the damage to uninjured or at-risk brain tissue so this can be pharmacological interventions like anti-inflammatories or antioxidants or diuretics to basically stop pooling of blood or reduce secondary degeneration to basically prevent that damage to these at-risk neurons and we look and this can be you know it might not just be a very short acute kind of treatment option like a few days or weeks this can actually persist for chronic treatment to basically preserve long-term function as well so it might be you might be managing and doing these treatments for a long period of time and I won't go into too many of the treatments because there is another video in this series detailing some of the research surrounding traumatic brain injury and treatments so I'll just go over very the most kind of comment type which is rehabilitation therapy so this is things like physical therapy speech therapy psychological counseling basically to improve these post-injury symptoms and also promote recovery and restoration of function as well so it's very important you know to keep moving so that you don't lose this function and also to promote the brain to recover itself. There's a lot of other novel techniques that is being pursued in the literature as well the scientific literature surrounding traumatic brain injury I won't go into too much detail but one of these is gene therapy so this is where you actually change or alter the genetic material or the DNA of cells so if we can use genetic therapy maybe we can make damaged cells we can change their DNA so that they're more protected so they're less likely to die or maybe we can change the genetic DNA so that these neurons will actually repair themselves and make good connections or the the connections that they had before the injury so maybe we can promote that by changing the genetic material of these neurons and one of these is you probably heard before which is stem cell therapy so maybe we can replace lost neurons with these kind of techniques to basically restore function. Another novel technique is brain stimulation so the brain actually changes a lot just during the life just during everyday life and this is because the activity that the brain undergoes just through normal functioning can actually induce changes so with brain stimulation this is basically a way that you can externally change the activity of neurons and then hopefully by this we can promote beneficial changes in the brain by doing this so maybe we can promote the brain to be a bit more protected just by changing the activity of neurons with brain stimulation so things like transcranial magnetic stimulation for example so again that's just a very very brief overview about traumatic brain injury and kind of what it encompasses so in summary it's one of the leading causes of death and disability and involves significant interpersonal and social economic costs and TBI can result in widespread brain damage and this can continue long after the initial insult has occurred so therefore reducing the extent of damage and halting progression is key to improving recovery and preserving function to prevent lifelong disability. So I'll put some citations in further reading here if you're interested in further diving into the topic but with that I'd like to thank the Brain Foundation for allowing me to present and also supporting my research hopefully you found this interesting and I'd also encourage if you did find this interesting a courage you to watch the other videos within this series to also understand a bit more about your brain and kind of the research that Brain Foundation is funding and why it is so important so thank you for tuning in.