Understanding Traumatic Brain Injury Southern Arizona Disability Rights and Resources Conference Sat

1
Understanding Traumatic Brain Injury Southern
Arizona Disability Rights and Resources
Conference Saturday April 4, 2009 Session l
Workshops 915 a.m. 1045 a.m.Windemere Hotel
and Convention CenterSierra Vista, Arizona
Ann Tarpy, M.Ed. Acting Executive
Director Arizona Governor's Council on Spinal and
Head Injuries 10640 N. 28th Drive Ste.
B-102 Phoenix, AZ 85029 602.863.0484 atarpy_at_azdes
.gov
2
Objectives

• By the end of this Session, the participant will
• Comprehend the brain behavior relationships and
  the impact of brain injury.
• Describe the impact of brain injury on the family
  system.

3
Agenda

• Opening activities
• Part 1 - Understanding brain injury
• Part 2 Understanding brain behavior
  relationships and what happens when these
  relationships are interrupted from brain injury
• Part 3 - Impacts on the Family System
• Part 4 Brain Injury Association of Arizona
  (BIAAZ)
• Closing activities and evaluation

4
Understanding Brain Injury

• Traumatic brain injury is
• A condition with potential life-long implications
  that may require ongoing services and supports
• A multidimensional syndrome affecting a wide
  variety of areas of function including
• Cognitive
• Sensory
• Motor
• Social
• Emotional
• Physical

5
Part 1

• Understanding Brain Injury

6
Understanding Brain Injury

• Individuals can sustain brain injuries from
  medical conditions such as
• Infectious disease (e.g., meningitis,
  encephalitis)
• Brain tumor and their treatments (chemotherapy
  and radiation can cause diffuse brain damage)
• Neurological disease (e.g. multiple sclerosis)
• Cerebrovascular disorders (e.g. stroke)
• Toxic chemical or drug reactions (e.g., lead
  poisoning, carbon monoxide poisoning)
• Hydrocephalus
• Substance abuse

7
Understanding Brain Injury

• Hypoxia/Anoxia are other forms of brain injury.
  Examples are
• Suffocation
• Suicide attempts
• Near drowning
• Other injuries (cardio or pulmonary) can reduce
  blood flow to the brain

8
Understanding Brain Injury
A traumatic brain injury (TBI) is a result of

• Blunt or penetrating trauma to the head such as a
  gunshot wound.
• Coup contrecoup injury from acceleration -
  deceleration forces such as motor vehicle crashes.

9
Understanding Brain Injury

• Mild, moderate, and severe brain injury are the
  clinical terms used to describe the type of
  brain injury the person sustained.
• However, these same descriptors often fail to
  tell us about the functional outcome of the
  injury.

10
Part 2

• Understanding brain behavior relationships and
  what happens when these relationships are
  interrupted from brain injury

11
Part 2Understanding Brain Behavior Relationships
Brain Function
12
Understanding Brain Behavior Relationships

• The brain is a very complex and delicate
  structure with pathways that determine such
  things as memories, emotions, and basic motor
  functions. In sum who we are.

13
Understanding Brain Behavior Relationships

• It is through our
• brains that we
• Experience ourselves and the environment
• Understand our relationships to others.
• Form our perceptions of our world. We dont react
  to the world out there, but rather to our
  perception of it.

14

• The Role of the Neuron
• The Messenger

15
Understanding Brain Behavior Relationships

• The brain is made up of billions of nerve cells
  (neurons) through which messages are transmitted.
• Neurons of the brain connect and organize into
  functional units/networks with specific roles to
  sense, perceive, process and act on information
  from both outside of us and within us.
• The units serve specific and important functions
  and are designed to work together.

16
Interruption of Brain Behavior Relationships

• During brain injury, these neurons/axons and
  networks can be damaged causing an interruption
  in the way that information flows through the
  networks within and between the functional units.

17
Brain Functions
18
Cognitive Skills/Functions Associated with
Hemispheres of the Brain
19
(No Transcript)
20
Interruption of Brain Behavior Relationships

• Areas of Impact
• Functional / Physical
• Cognitive
• Personality / Emotional
• Psychological / Behavioral

21

• What Happens
• during
• Cognitive
• Development?

22
Understanding Brain Behavior Relationships

• Cognitive development
• Is a dynamic and interactive process of the
  development of skills gross motor, fine motor,
  language, cognitive, and social.
• Causes maturation in thinking ability, behavior,
  emotional regulation, and social capabilities.

23
Interruption of Brain Behavior Relationships

• Injury during cognitive development
• Results in an underdevelopment of the brain
  functions of the areas impacted by the injury,
• Impacts further cognitive development,
• Impacts how those working with the individual set
  realistic expectations regarding behavior and
  accomplishments.

24
Understanding Brain Behavior Relationships

• Role of the Information Processing Model

25
Understanding Brain Behavior Relationships

• When the brain is functioning normally-
• It receives messages/information through our
  senses and interprets them filters out
  irrelevant information.
• It puts together the messages in a way that has
  meaning for us,
• Stores that information in our memory
• Uses that memory and retrieves the information
  timely and accurately.

26
Interruption of Brain Behavior Relationships

• If an individual is unable to receive (input)
  information or
• If they receive inaccurate or unreliable sensory
  input, and/or
• If their ability to process information or filter
  out irrelevant information is disrupted from
  injury

27
Interruption of Brain Behavior Relationships

• A persons behavior, ability to function, and
  ability to communicate change.

28
Interruption of Brain Behavior Relationships

• Sensory information may not be able to get into
  the brain or may not be able to get in
  accurately
• Different parts of the brain may no longer be
  able to communicate with one another
• Processing speed (receptive and expressive) may
  be slowed.

29
Interruption of Brain Behavior Relationships

• Changes in the way they are able to process
  information may interfere with the individuals
  ability to control emotions, benefit from
  experience, and be sensitive to the emotional
  needs of others.

30
Interruption of Brain Behavior Relationships

• It is the complex neurobehavioral problems that
  may cause the greatest disruption in the
  survivors and familys life.

31
Interruption of Brain Behavior Relationships
Behavior following brain injury is likely to be
influenced by or an interaction between the
following factors

• Changes based on the parts of the brain that were
  injured (e.g. in personality, cognition and
  behavior)
• Complications caused by emotional reactions to
  difficulties and changes from the injury
• Pre-morbid characteristics
• Family system/family functioning (pre/post
  injury)
• Environment
• Reaction to medication
• History of substance abuse
• Level of awareness and understanding of brain
  injury.

32
Interruption of Brain Behavior Relationships

• Environment is the one variable over which family
  members, caregivers, and service providers have
  the most control.
• Changing the expectations of the individual in
  the environment can change/improve the behavior.

33
Interruption of Brain Behavior Relationships
34
Interruption of Brain Behavior Relationships

• Comments about Medications
• Side-effects of medications can be enhanced after
  brain injury making compliance problematic.
• Typical medication regimens may not produce the
  desired result and may have the opposite
  reaction.
• Individuals with brain injuries are likely to
  need assistance managing their medications.
• Due to the fragmented nature of care following
  brain injury, the survivor may end up with
  multiple medications that they may or may not
  need. They may not have a physician monitoring
  all of the medication and may be over-medicated.

35
Interruption of Brain Behavior Relationships

• A person with a brain injury may engage in
  behaviors (adaptive and maladaptive) as a means
  of communication

36
Interruption of Brain Behavior Relationships

• They may be trying to communicate
• That a basic need is not met
• That others are not listening
• That they need more assistance to do the task or
  activity
• All other efforts have failed
• Frustration due to other impairments associated
  with the injury (e.g., delaying information
  processing speed, memory impairments, physical
  limitations, etc.)

37
Interruption of Brain Behavior Relationships

• By understanding that behavior may be a
  manifestation of the brain injury or a means of
  communication - family members, caregivers, and
  service providers can begin to interpret the
  behavior differently -
• not as volitional or
• a demonstration of a lack of interest.

38
Interruption of Brain Behavior Relationships

• Important for the family member, caregiver,
  and/or service provider to be aware of his/her
  perception of what the behavior means.

39
Interruption of Brain Behavior Relationships

• Stress is a common reaction when living or
  working with individuals with a brain injury.
• The stress reaction generally occurs in
  situations where the demands of the environment
  exceed an individuals (perceived) resources to
  handle the situation.
• The stress reaction can occur in the individual
  with the brain injury, the caregiver, family
  member and/or service provider.

40
Part 3

• Impacts on the Family System

41
Impacts on the Family System

• Understanding brain injury and the impact of the
  brain injury on the individual and the family is
  really about understanding grief and loss at
  many levels.

42
Impacts on the Family System

• For the individual (depending on their level of
  awareness) s/he may mourn the loss of
• Memories of experiences that connect them with
  family and friends
• Sense of self who they were before the injury
• His/her role and status in the family, at work,
  with friends
• Physical functioning
• Changes in thinking and behavior
• Ability to do some of the things they did before
• The life they had before the injury

43
Impacts on the Family System

• For the family, they are mourning the loss of
• Who the individual was before the injury -
  connection to the individual through memories of
  shared experiences.
• Hopes, dreams, and plans for the future they had
  for the individual.
• Their way of life and now facing the reality that
  life may never be returning to the way it was
  before.
• The role the individual played in the family
• For a spouse, they may be mourning the loss of
  their companion, their support, their partner.

44
Impacts on the Family System

• Families members, individually and as a unit,
  experience an ongoing journey filled with
  challenges and changes through the recovery
  period and then adjusting to life after brain
  injury.
• In many cases, recovery becomes a lifelong
  process of adjustments and accommodations for the
  individual and the family as they deal with
  acceptance and understanding of the injury and
  subsequent limitations and consequence.

45
Impacts on the Family System

• For the individual with a brain injury,
  survivorship is about understanding the new
  person who is developing.
• For the family, it is understanding the new
  family that is emerging.

46
Resources

• Brain Injury Association of Arizona will now
  provide you with information about their services.

47
Questions
48

• Closing activities and evaluation

Thank You for attending this session today.