Introduction the age of onset in which the

Introduction

A traumatic brain injury is an
injury that is very common, however each case of this kind of injury is
very different. A traumatic brain injury, also known as a TBI has various
different symptoms that affect different aspects of different people
depending on the degree of severity of the traumatic brain injury, where
exactly a brain injury occurred, and many other factors. People that
suffer from a brain injury most often get this injury from a sports
accident or a motor vehicle accident.
One factor that influences the
symptoms and outcome of a traumatic brain injury is the age of onset in
which the injury occurred. Studies that have examined the age of onset on
the prognosis of the traumatic brain injury have found that children that
get a traumatic brain injury between the ages of two and seven have better
outcomes than individuals that get a brain injury later in life. (Anderson
& Catroppa, 2007) This result has been challenged by other research
findings that have determined that a brain injury occurring prior to
school age children have a slower recovery, and a poorer cognitive
outcomes and determined that two years old is significant age of
difference in outcomes of traumatic brain injury (Silberg, Ahonniska-Assa,
Levav, Eliyahu, Peleg-Pilowsky, Brzner, Valki, 2016)
The severity of the traumatic
brain injury also has factors that influence the outcome of the injury.
There are three different types of severities that can occur, including
mild, moderate and severe. A mild traumatic brain injury, also known as a
concussion can cause a loss of consciousness, or a state of confusion
after the accident occurs. A moderate traumatic brain injury can cause a
loss of consciousness up to a few hours, and confusion that lasts up to
weeks. This is when cognitive and behavioral impairments will begin to
appear. Lastly, a severe brain injury can be life threatening and cause
many different short term and long term symptoms due to the injury.

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Degree of Severity of Traumatic Brain Injury on Memory
Deficit Types

As mentioned before, because
traumatic brain injuries are so complex there are many different types of
deficits to the person that can occur. Memory deficits are apparent when
people have brain injuries that are severe, and in studies that have been
conducted in the past have found that people that have suffered from mild
to moderate brain injuries, typically have the same memory capacities as
the healthy control patients. (Albrecht, Masters, Ames, Foster, 2016)
These deficits that happen
after a traumatic brain injury can include memory dysfunctions that
disrupt different forms of memories. The different forms of memories that
have been found to be effected by a traumatic brain injury can include
short term memory – more directly the part of short term memory that includes
working memory, long term memory, episodic memory, and semantic memory.
Other deficits that have been found to be due to a traumatic brain injury
can include tasks such as recall retrieval and language comprehension.

One form of memory that has
been researched in great detail of how it functions after a traumatic
brain injury is the section of short term memory, working memory. Working
memory is the type of memory that plays a role in how we consciously take
in information, and then proceed to process, use, or remember information
provided to us. Working memory is the one type of memory that many
researchers have came to a conclusion that it is the most affected area
of memory after a traumatic brain injury. Many researchers have found
that working memory performance is greatly decreased post traumatic brain
injury, (Anderson & Catroppa, 2003) these performances can include
not being able to add numbers that were given to them on the spot.
(Christodoulou, DeLuca, Ricker, Madigan, Bly, Lange, 2001) This working
memory task regarding adding numbers that were verbally given to patients
was supported by other studies that found that patients with brain
injuries struggle with verbal working memory and verbal short term
memory. (Dunning, Westgate, Adlam, 2016) An impairment of working memory
has also been found to decrease processing speeds in which tasks were
completed. This can help support a conclusion that individuals that have
suffered a traumatic brain injury have working memory impairments because
they cannot recall what was just told to them because they can’t process
it as fast as healthy brain individuals can. (Gorman, Barnes, Swank,
Prasad, Cox, Ewing-Cobbs, 2015)
Another form of memory that
has been researched to determine impairments caused by traumatic brain
injuries is long term memory. Long term memory is the type of memory that
deals with storing information for an extended time period. Although long
term memory is not impaired as often as working memory after a traumatic
brain injury, there has been many studies conducted in efforts of finding
out how brain injuries can affect long term memory. Many researchers have
found that because working memory is most often impaired from a brain
injury, because working memory has to do with the storing of information
given to you, this memory impairment effects long term memory because the
brain cannot properly store the memory. Thus concluding that there is no
memory to be recalled from the long term memory. (Sandry, DeLuca,
Chiaravalloti, 2014) This explanation about working memory capacity
affecting the relationship between cognitive reserve and long term memory
would also further explain why patients with brain injuries struggle with
recall retrieval. Other studies have found that individuals that suffered
from a traumatic brain injury have an increased chance of forgetting long
term memories after performing tasks that were meant to recall these
memories. (Lah, Black, Gascoigne, Gott, Epps, Parry, 2017)

There are other various forms
of memory and memory tasks that have been seen to see impairments after a
traumatic brain injury. These can include episodic and semantic memory,
and recall retrieval and language comprehension tasks.

Recall retrieval has been seen
to be decreased in individuals that have sustained a traumatic brain
injury, this could be an effect from the working memory impairment
because these individuals cannot store the memories as easily (or at all)
compared to healthy control individuals in studies. (Silberg,
Ahonniska-Assa, Levav, Eliyahu, Peleg-Pilowsky, Brzner, Valki, 2016)
Language comprehension is
another task that working memory effects, which can again be explained as
this task deficit is a causation of the working memory impairment.
Language comprehension relies on working memory to make sense of longer
sentences and word order, which an individual with a working memory
impairment would struggle with. One study that was conducted found that
individuals with a traumatic brain injury performed worse than the
healthy control individuals in a language comprehension working memory
task. (Moran & Gillon, 2004) 
Episodic memory has been found
to be poorer in individuals with a traumatic brain injury that in healthy
control individuals. (Perbal, Couillet, Azouvi, Pouthas, 2003) This has
been challenged by other research findings that found episodic memories
to be preserved in traumatic brain injury individuals, it may just be
harder for them to access them in a speedily manner. (Wammes, Good,
Fernandes, 2016)
Semantic memory is another type
of memory that has been seen to be impaired after a traumatic brain
injury. It was discovered that semantic memories appear to deteriorate in
individuals that have suffered a traumatic brain injury. However, these
researchers also determined that it is possible that semantic knowledge
of these memories may increase with age. (Wammes, Good, Fernandes, 2016)

Different Brain Areas Damaged, Different Affected
Outcomes

Similarly to how the severity
of a traumatic brain injury can cause different outcomes of impairments
and deficits to various different areas in an individual, the area that is
damaged in the injury also plays a role in impairments. For example,
dorsolateral prefrontal cortex damage is has been discovered to affect
working memory, causing disorganized memory in many different instances.
Damage to the mid ventrolateral
prefrontal cortex damage causes impairments of the active retrieval of
memories.

Cerebral Brain Activity Post Traumatic Brain Injury

When comparing individuals with
a traumatic brain injury to healthy control individuals, many researchers
found that the healthy controls showed a significant amount of brain
activation in areas include the right prefrontal cortex, right cingulate
gyrus, left parietal lobe, and the bilateral posterior parietal cortices.
These findings suggest that a traumatic brain injury can cause these
specific areas to become not as active, thus leading to impairments in
which those areas control. (Christodoulou, DeLuca, Ricker, Madigan, Bly,
Lange & Ni, 2001, Gillis & Hampstead, 2015)
Individuals that suffered from
a traumatic brain injury that weren’t showing signs of activation in these
areas mentioned above, showed more activation in the visual and spatial
processing areas and the right dorsolateral prefrontal cortex and
bilateral posterior parietal cortices. The suppression of the areas that
are usually active that aren’t in individuals with brain injuries suggest
that they rely on the areas that do become more active than the healthy
individuals do. (Gillis & Hampstead, 2015, Lah, Black, Gascoigne,
Gott, Epps, Parry, 2017)
The left cerebellum activation
in individuals that have traumatic brain injuries increases after
receiving a dosage of methylphenidate, which increased the individual’s
ability to successfully complete working memory tasks. This which suggests
that working memory relies on this brain area to complete tasks and that
methylphenidate may help aid individuals that suffer from a brain injury
and have working memory impairments. (Manktelow, Menon, Sahakian,
Stamatakis, 2017)

Conclusions

Overall, is has been discovered
that severe traumatic brain injury causes impairments in working memory
more than any other type of memory. Due to the working memory impairment,
this causes deficits in many different tasks that the healthy brain can
typically perform. This can include encoding or learning, recall
retrieval, language comprehension and many other abilities.
It has also been determined
that traumatic brain injuries can change what areas of the brain become
active when attempting to complete tasks, depending on what areas of the
brain became injured during the accident that caused the traumatic brain
injury.
Limitations that have not been
researched included studies that use different tools to determine
impairments. For example, there is only a limited standard clinical tool
that can be used to examine brain activation areas. There is also only a
few various different memory tasks that researchers tend to use when
assessing memory ability.
Future research ideas could
look into if there are any sex differences in the outcome of memory after
a traumatic brain injury. For example, if hormones have anything to do
with how well memory works or what brain areas become activated after a
traumatic brain injury. Another future research idea could collect a much
larger sample of individuals that suffer from a traumatic brain injury and
compare many different age groups, different age groups of when the
traumatic brain injury occurred, and the different levels of severity to
see if any differences are discovered that have not been discovered in the
studies that have been conducted that have a small sample size.