Traumatic Brain Injury (TBI)
Definition
TBI is a disruption in brain function caused by an external mechanical force such as a blow,
jolt, or penetrating injury to the head.
Types of Injury
1. Primary Injury
Occurs at the moment of impact
Irreversible damage to brain tissue
Includes:
Contusions
Lacerations
Hemorrhage (epidural, subdural, intracerebral)
Diffuse axonal injury
2. Secondary Injury
Develops hours to days after the primary insult
Result of biochemical and cellular responses
Includes:
Cerebral edema
Ischemia
Hypoxia
Raised intracranial pressure (ICP)
Infection
Seizures
Open vs. Closed Brain Injury
Type Description
Closed Brain Injury Brain damage occurs without penetration
of the skull.
More common
Open Brain Injury Object penetrates the skull & damage brain
tissue.
High risk of infection due to exposure to
external environment
Signs & Symptoms
Mild TBI:
Headache, nausea
Dizziness, confusion
Fatigue, memory problems
Moderate to Severe TBI:
Loss of consciousness
Slurred speech
Vomiting, seizures
Limb weakness, poor coordination
Behavioral changes, agitation
Complications
Cognitive deficits (memory loss)
Behavioral/emotional disorders ( depression,anxiety)
Paralysis or motor impairment
Swallowing difficulty (dysphagia)
Post-traumatic epilepsy
Hydrocephalus
Chronic traumatic encephalopathy (CTE)
Diagnosis
Neurological exam (reflexes, pupil response)
Imaging: CT scan, MRI
Cognitive/neuropsychological tests( memory, language tests)
Glasgow Coma Scale (GCS)
Used to assess the level of consciousness based on:
Eye Opening (E): score range 1-4
Verbal Response (V): 1-5
Motor Response (M):1-6
Total Score Interpretation:
13–15 = Mild TBI
9–12 = Moderate TBI
≤8 = Severe TBI (coma)
Medical Nutrition Therapy (MNT)
TBI induces hyper metabolism & hypercatabolism—early and adequate nutrition is critical.
Goals of MNT:
Meet increased metabolic and protein demands
Prevent malnutrition and muscle wasting
Support neuroregeneration and immune function
Control blood glucose levels
Prevent complications such as infection and refeeding syndrome
Energy Needs:
TBI increases metabolic rate due to systemic inflammation, stress hormones, and
catabolism.
Normal adult energy requirement: ~25–30 kcal/kg/day
TBI patient requirement: 35–45 kcal/kg/day
Macronutrient Needs:
Nutrient Requirement
Carbohydrates 45–65% of kcal; brain’s primary energy
source
Protein 1.5–2.0 g/kg/day; supports tissue repair,
immune function
Fat 20–35% of kcal; focus on omega-3s
(DHA/EPA) for neuroprotection
Micronutrients of concern:
Zinc (tissue repair, immune function)
Magnesium (support neurotransmission)
Vitamin D ( bone health, immune regulation)
Vitamin C & E ( Antioxidant, reduce oxidative stress)
B complex vitamins B1, B6, B12 (nerve function, energy metabolism)
Do’s and Don’ts
✅ Do’s
Begin nutrition therapy early
Monitor fluid, electrolyte, and glucose levels
Support rehab with proper protein and energy intake
Consider omega-3 supplementation
Use thickened fluids if dysphagia is present
❌ Don’ts
Avoid underfeeding or overfeeding
Limit simple sugars and high saturated fats
Do not delay rehabilitation efforts
Avoid alcohol and stimulants
Don’t ignore signs of refeeding syndrome in malnourished patients