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Traumatic Brain Injury 101: Causes, Consequences

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Title: Traumatic Brain Injury 101: Causes, Consequences


1
Traumatic Brain Injury 101 Causes, Consequences
Coping Strategies
March 20, 2008 Brain Injury Association of Ohio
Staff Members Suzanne Minnich, Ex. Director
Rich Haddix, CSN Coordinator Area 11 Jennie
Horner, CSN Coordinator Area 5 Special thanks to
our panelists
2
Objectives
  • Increase knowledge of demographics scope of
    brain injury
  • Gain understanding of common consequences and
    challenges following brain injury
  • Better understand the impact on the individual
    and his or her family
  • Learn about BIAOH other sources of information
    assistance in a state where TBI lacks a home
    agency within government.
  • Identify skills and strategies to assist
    individuals with brain injury

3
Brain Injury Association of Ohio Key Program
Staff
  • State Office-Columbus
  • CSN 1, Toledo Christine Veronie
  • CSN 3, Cleveland Lori Surtman
  • CSN 5, Lima Jennie Horner
  • CSN 8, New Philadelphia Chris Curtiss
  • CSN 11, Columbus Rich Haddix
  • CSN 12, Caldwell Jenny Rucker
  • CSN 13, Cincinnati Peggy ONeill
  • CSN 15, Marietta Cindy Auker

BIAOHs goal is to create a comprehensive,
statewide, resource facilitation system providing
information, service linkage, education, and
advocacy benefiting children adults with brain
injury and their families the systems blueprint
is known as The Ohio Plan.
4
What is the Brain Injury Association of Ohio?
  • Statewide education advocacy organization for
    people with brain injury their families
  • Affiliated with BIAA (Brain Injury Association)
    - 1 of 44 State Affiliates
  • Grassroots/Consumer Directed Organization,
    started by families, medical rehabilitation
    professionals
  • Non-Profit, Tax Exempt Organization incorporated
    in 1983

5
Who Are the People Behind BIAOH
  • Board of Trustees - Who govern the organization,
    setting direction and providing oversight
  • Staff - Who implement its programs (13 or 10
    FTEs)
  • Volunteers (in addition to Board Members)
    serving in many capacities, including as support
    group leaders
  • Members Constituents
  • Collaborating Organizations Partners
  • Funders Supporters

6
What is BIAOHs Purpose?
  • Vision A world where all preventable brain
    injuries are prevented, all unpreventable brain
    injuries are minimized and all individuals who
    have experienced brain injury maximize their
    quality of life
  • Mission To create a better future through brain
    injury prevention, research, education and
    advocacy

7
What Are BIAOHs Services Supports
  • Information Resource Coordination
  • Helpline
  • Community Support Network (CSN) field offices
    located throughout the state
  • Education Training
  • Peer Support
  • Outreach Prevention
  • Advocacy

8
What is BIAOHs Central goal why is it so
important?

Unlike disability populations of comparable size,
there is no state agency responsible for
addressing the needs of those with BI.
9
Contacting BIAOH is easy . . .
  • 1-866-644-6242 (1-866-OHIO-BIA)
  • Toll-free Helpline within Ohio
  • help_at_biaoh.org
  • www.biaoh.org

10
What is a Brain Injury?
  • Acquired Brain Injury (ABI)
  • Traumatic Brain Injury (TBI)

11
Acquired Brain Injury
  • Any injury to the brain that occurs after birth
    as a result of
  • Physical force (due to an accident)
  • Tumors
  • Strokes
  • Violent Acts (e.g., gun shot wound)
  • Infectious Diseases (e.g., encephalitis)
  • ABI is the broadest category and includes all
    brain injuries that occur after birth.

12
Traumatic Brain Injury
  • A brain injury from an external force
  • Vehicle accidents
  • Violent Acts (e.g., gun shot wound)
  • Falls
  • Physical Abuse
  • Sports Injuries

13
Severity Continuum
  • Things to Consider
  • Symptomology
  • Pre-injury functioning
  • Symptoms vary

Mild
Severe
Moderate
14
  • 15 of all TBIs are considered moderate to severe
  • 85 of all TBIs are considered mild

15
Severe Brain Injury
  • Severe Brain Injury Almost always results in
    prolonged unconsciousness or coma, brain
    contusions, hematomas, damage to nerve fibers and
    axons, and/or anoxia
  • Often results in permanent physical, behavioral,
    and/or cognitive impairments
  • Significant improvements are generally made
    during the first 1-2 years and continue
    thereafter at a slower rate
  • (Glascow Coma Scale score 3-8)

16
Epidemiology
  • An estimated 5.3 million Americans have a
    long-term or life long need for help with
    activities of daily living as a result of TBI
    (est. 227,000 Ohioans)
  • An estimated 1.4 million people will sustain a
    TBI each year in the United States.
  • Of these
  • 50,000 die
  • 235,000 are hospitalized
  • 1.1 million are treated and released from an ER
  • The number of people with TBI who are not seen
    in an ER or who receive no treatment is unknown.

17
Disability Prevalence Rates
400,000 with Spinal Cord Injuries
500,000 with Cerebral Palsy
2 million Americans with Epilepsy
3 million with Stroke disabilities
4 million with Alzheimers Disease
5 million with persistent mental illness
5.3 MILLION WITH TBI DISABILITY
7.3 million Americans with mental retardation
National organizations web sites, 4/00 Slide
source Brain Injury Association of
America 227,000 Ohioans - Estimate of adults
living w/disability due to TBI - source CDC
18
Leading Causes of TBI
  • 1st Falls (among elderly and very young)
  • 2nd Vehicle accidents, bicycle, or
    pedestrian-vehicle incidents (account for most
    hospitalizations)
  • 3rd Violent acts
  • 4th Sports accidents An estimated 90 are mild
  • and go unreported
  • (Source BIA of America Fact Sheet)

19
  • If you have a brain injury, you are 3 times more
    likely to get another. After the second injury,
    the risk for the third injury is 8 times greater.

20
Who experiences brain injuries?
  • Extremely Diverse
  • Highest risk 0-4 years, 15-24, and 75 years and
    older
  • Males are 1.5 times more likely than females to
    experience TBI
  • 70 of people who incur TBI recover completely
  • 15 remain symptomatic for the remainder of their
    lives
  • Alcohol is reported to be associated with 50 of
    all TBI

21
  • TBI is the leading cause of death and disability
    for children, adolescents, and young adults in
    the United States. 90,000 of those injured will
    sustain permanent injuries.
  • (www.biausa.org)

22
Neuroanatomy and Physiology of the Brain
  • Deficits vary depending upon location and
    severity of brain injury
  • Major Brain Areas
  • Frontal Lobe
  • Parietal Lobe
  • Temporal Lobes
  • Occipital Lobe
  • Cerebellum
  • Brain Stem

23
Simplified Brain Behavior Relationships
Frontal Lobe Initiation Problem solving
Judgment Inhibition of behavior
Planning/anticipation Self-monitoring Motor
planning Personality/emotions Awareness of
abilities/limitations Organization
Attention/concentration Mental flexibility
Speaking (expressive language)
Parietal Lobe Sense of touch
Differentiation size, shape, color Spatial
perception Visual perception
Parietal Lobe
Frontal Lobe
Occipital Lobe
Occipital Lobe Vision
Temporal Lobe
Cerebellum Balance Coordination Skilled
motor activity
Cerebellum
Brain Stem
Temporal Lobe Memory Hearing Understanding
language (receptive language) Organization
and sequencing
Brain Stem Breathing Heart rate
Arousal/consciousness Sleep/wake functions
Attention/concentration
24
Frontal Lobe (Almost always sustains injury due
to coup-contra-coup boney undersurface of
skull domaine of executive functions damage
to this portion of the brain and resulting
deficits considered to be the thumbprint of
brain injury)
  • Problem Solving
  • Planning
  • Judgment
  • Abstract thought
  • Memory
  • Self-monitoring
  • Attention/Concentration
  • Organization
  • Inhibition of Behavior
  • Initiation

25
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26
Parietal Lobe
  • Sense of touch
  • Sensory integration
  • Spatial perception
  • Visual perception
  • Identification of size,
  • shape, color
  • Language
  • comprehension

27
Temporal Lobe
  • Interpretation of speech/Receptive language
  • Memory of new information
  • Organization Sequencing
  • Hearing
  • Ability to identify smells and sounds

28
Occipital Lobe
  • Vision
  • Ability to process visual info.
  • Ability recognize shapes, colors, letters and
    words

29
Cerebellum
  • Balance
  • Coordination
  • Skilled motor activity
  • Posture

30
Brain Stem
  • Breathing
  • Arousal and consciousness
  • Sleep/wake cycles
  • Attention and concentration
  • Heart rate
  • Basic life functions

31
TRAUMATIC BRAIN INJURY
32
Living with a Brain Injury The Impact on the
Individual
  • Physical
  • Cognitive
  • Social
  • Behavioral Emotional

33
Physical Disabilities
  • Headaches
  • Dizziness
  • Chronic pain
  • Seizures
  • Decreased coordination, balance problems
  • Loss of limbs or use of limbs
  • Nerve Damage (i.e., optic nerve, facial palsy)
  • Sensory limitations (visual disturbances, hearing
    loss, decreased taste and smell, increased
    sensitivity to noise and light)

34
Cognition
  • Broad range of symptoms that occur independently
    or in combination
  • Memory impairment
  • Impaired attention
  • Inability to remain on task
  • Difficulty focusing on thoughts, words, events
  • Deficits in language use
  • Deficits in visual perception

35
Cognition-Deficits in Executive Skills the
thumbprint of brain injury
  • Inability to self-monitor and inhibit responses
  • Poor initiation
  • Difficulty sequencing steps and completing
    activities
  • Poor judgment

36
Social
  • Difficulty attending to social cues
  • Relearning appropriate social skills
  • Loss of friends
  • Loss of familiar activities
  • Loss of self
  • Personality changes
  • Problems with emotional control
  • Susceptible to mood and anxiety disorders
  • Increased risk of suicide
  • Egocentric

37
Behavioral and Emotional
  • Frustration
  • Irritability
  • Restlessness
  • Anxiety
  • Low self esteem
  • Depression
  • Emotional Lability (Mood Swings)
  • Behavioral Outbursts
  • Disinhibition

38
Medications
  • Properly prescribed closely monitored
    medications can help individuals w/BI deal with
    physical, emotional, and/or behavioral
    impairments due to TBI.

39
Medications
  • Often on multiple medications
  • SSRIs (e.g., Prozac) often prescribed for anxiety
    and depression
  • Anticonvulsants (e.g., Tegretol) often prescribed
    to prevent seizure activity or to treat
    behavioral problems
  • Sleep medications (e.g., Melatonin) often
    prescribed for sleep disturbances
  • Neuroleptics (e.g., Risperdal) prescribed for
    psychosis and/or aggression
  • Need for continued re-assessment
  • Physical Medicine Rehabilitation (PMR) doctors,
    experienced in working with those with BI, are
    especially helpful. (AKA physiatrists)

40
Substance Abuse
  • Higher rates of substance abuse
  • Effects 28-32 of individuals with TBI

41
Practical Adaptations/Accommodations
42
Reasoning/Problem Solving
  • Accommodations . . .
  • Instruct and post note for Stop and Think
  • Help identify the problem and possible solutions
  • Help predict consequences
  • Break the task down into several easier steps
  • Write steps in notebook/planner
  • Signs . . .
  • Inappropriate and potentially harmful decisions
  • Unable to make inferences
  • Disorganized thinking
  • Difficulty drawing conclusions
  • Rigidity in changing plans

43
Attention/Concentration
  • Signs . . .
  • Confusion
  • Rambling Conversations
  • Staring
  • Unable to finish a task
  • Difficulty attending to more than one thing at a
    time
  • Accommodations . . .
  • Get individuals attention before beginning a
    discussion
  • Reduce unnecessary noise or unneeded materials on
    desk
  • Limit the amount of information presented
  • Pace the work with short work periods followed by
    brief breaks

44
Memory Loss
  • Signs . . .
  • Confusion regarding appointments or daily
    schedule
  • Unable to remember tasks from day to day
  • Unable to remember new information
  • Confabulates (makes up stories to fill memory
    gaps this is not lying)
  • Accommodations . . .
  • Establish consistent schedule
  • Structure tasks
  • Provide written cues (memory book, chart, etc.)
  • Provide verbal cues (initial sounds, choices)
  • Use compensatory tools (alarm, watches,
    calculators)
  • Link new information with old information

45
Loss of Impulsivity/Poor Self Control
  • Signs . . .
  • Acts or speaks without considering the
    consequences
  • Inappropriate comments to or about others
  • Lower tolerance for frustrating situations
  • Inappropriate laughing or crying
  • Gets stuck on one idea or thought
  • Accommodations . . .
  • Encourage the person to slow down and work
    through task
  • Provide verbal and/or nonverbal feedback in a
    supportive way
  • Respond to inappropriate ideas, but maintain
    focus on original discussion
  • Expect the unexpected
  • Provide alternatives for inappropriate or
    perseverative behavior
  • Give frequent and consistent positive
    reinforcement
  • Remove the individual from a frustrating task or
    environment

46
Impaired Self-awareness, Difficulty with Social
Situations
  • Signs . . .
  • Lack of awareness of deficits and limitations
  • Inaccurate self-image/self perception
  • Accommodations . . .
  • Anticipate lack of insight
  • Prompt accurate self-statements
  • Use feedback generously in a positive way
  • Give realistic feedback as you observe behavior

47
Problems with Conversations
  • Signs . . .
  • Does not respond to another persons
    conversation, questions or comments
  • Does not start, or is slow to start
    conversations, ask questions, or make comments
  • Leaves long pauses
  • Has difficulty explaining what he or she means
  • Accommodations . . .
  • Encourage the individual to participate, e.g.,
    ask What do you think about that?
  • Ask open-ended questions Tell me about…
  • Give time to organize thoughts
  • Give the individual your full attention and allow
    them to complete the thought
  • Re-phrase what the person has said, Do you
    mean…

48
Problems w/Non-verbal Communication
  • Accommodations . . .
  • Ask the person to maintain a comfortable distance
  • Politely ask the individual to modify their
    physical contacts explain that you are
    uncomfortable with such contact
  • Tell the person you are confused by the
    difference in body language and spoken message
  • Ask the person what he or she is feeling
  • Politely ask the individual to stop distracting
    movements
  • Signs . . .
  • Poor eye contact
  • Does not understand non-verbal cues
  • Stands too close
  • Uncomfortable number/type of physical contacts
  • Body language/facial expressions dont seem to
    match what is said (flat affect)

49
General Suggestions
  • Structure the environment
  • Break tasks into component parts
  • Pace the work (consider headaches, fatigue, etc.)
  • Help develop organizational systems
  • BE CONSISTENT

50
Other considerations . . .
  • Accommodate for both cognitive and physical
    fatigue they often impact multiple areas of
    functioning
  • When thinking through a persons A-B-C patterns
    (antecedents, behavior, consequences),
    recognizing addressing antecedents to
    undesirable behavior often is more effective than
    an emphasis on consequences. Ditto to increase
    positive behaviors.
  • A person-centered, individualized approach is
    paramount

51
Resources to Remember
  • TBI Technical Assistance Center at NASHIA
    (National Association of State Head Injury
    Administrators)
  • http//www.tbitac.nashia.org/tbics/
  • Brain Injury Association of America (Their
    mission is to create a better future through
    brain injury prevention, research, education and
    advocacy) www.biausa.org
  • Brain Injury Association of Ohio (BIAOH)
  • 1-866-644-6242 www.biaoh.org

52
March is Brain Injury Awareness Month
  • Pick up a green mind matters wrist band
  • Consider wearing it through the end of the month
    share with others information youve learned
    about BI
  • Thank you safe travels!
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