Meeting Special Needs of Individuals with Brain Injury Part I: How the Brain Works Training for 211

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Meeting Special Needs of Individuals with Brain
InjuryPart IHow the Brain WorksTraining for
2-1-1 Specialists
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Brain Works

• Definition
• Causes of Brain Injury
• Basic Brain
• How the Brain is Hurt
• Course of Recovery
• Changes After Brain Injury
• Severity of Injury
• Common Myths
• Prevention
• Q A

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FACT

• TBI is the leading cause of death and disability
  among children and young adults, and those over
  75.

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Congenital / Developmental Disorders vs.
Acquired Brain Injury

• Congenital or developmental disorders result from
  a basic organic cause that manifests as an
  alteration in the developmental process, as
  opposed to being the result of an acquired brain
  injury. Examples include mental retardation,
  learning disability, ADHD, fetal alcohol
  syndrome, etc.

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Congenital / Developmental Disorders vs.
Acquired Brain Injury

• An acquired brain injury is an injury to the
  brain that has occurred after birth. The injury
  generally results in a change in the physical
  integrity, the metabolic activity, or the
  functional ability of the neuron.

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Definition Acquired Brain Injury Contd.

• The brain injury may produce a diminished or
  altered state of consciousness, which results in
  impairment of cognitive abilities or physical
  functioning. It can also result in disturbance of
  behavioral or emotional functioning. These
  impairments may be either temporary or permanent
  and cause partial or total functional disability
  or psychological maladjustment.

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vs. Traumatic Brain Injury (TBI)

• Traumatic brain injury (TBI) is an insult to the
  brain, not of a degenerative or congenital nature
  but caused by an external physical force, that
  may produce a diminished or altered state of
  consciousness, which results in an impairment of
  cognitive abilities or physical functioning. It
  can also result in the disturbance of behavioral
  or emotional functioning. These impairments may
  be either temporary or permanent and cause
  partial or total functional disability or
  psychosocial maladjustment.

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QUESTIONWere you born with the disability or
did it occur due to birth trauma?

• REASON
• Eligibility for many state services depends upon
  whether the disability is congenital or acquired
  during or after the birth process.

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QUESTIONWas the brain injury due to a trauma or
other cause?
REASON Eligibility for many state services
depends upon whether the disability is due to a
TBI vs. other cause.
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FACT

• 144,000 Texans sustain a TBI each year, one every
  4 minutes.

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Causes of Acquired Brain Injury

• Traumatic Brain Injury (TBI) - External forces
  applied to the head and/or neck (most common)
• Stroke (2nd most common)
• Anoxic/hypoxic injury (shortage of O2)
• Brain surgery

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Causes of Acquired Brain Injury, Contd.

• Infectious diseases
• Brain tumor
• Metabolic disorders (e.g., diabetic coma)
• Seizure disorders
• Toxic exposure

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QUESTIONWhat was the cause of the injury?
REASON Some state services may exclude brain
injury due to causes other than TBI.
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Causes of TBI
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FACT

• The annual incidence of TBI is more than that of
  MS, spinal cord injury, HIV/AIDS, and breast
  cancer
• COMBINED.

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Basic Brain

• Brainstem
• Cerebellum
• Cerebrum

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Brain Stem

• Cardiac
• Respiratory
• Arousal
• Movement touch sensation in body

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Cerebellum

• Balance of the body
• Coordination of body movement

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Cerebrum

• Four lobes in each hemisphere
• Frontal
• Temporal
• Occipital
• Parietal

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Frontal Lobe

• Located under forehead
• Largest part of brain
• Last section to evolve
• Executive functioning

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Frontal Lobe Injuries

• Problems with
• Attention
• Planning and organization
• Initiation
• Problem solving/flexibility
• Judgment
• Impulse control
• Personality changes/inappropriate emotional
  expression and behavior
• Speaking
• Muscle weakness paralysis

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Temporal Lobe

• Hearing
• Understanding Speech
• Memory
• Music/ Sound
• Comprehension

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Occipital Lobe

• Located at the rear
• of the brain
• Interpretation of
• visual information

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Parietal Lobe

• Located at the top of brain
• Perception of touch/body
• orientation
• Face and shape
• recognition
• Awareness of spatial
• relationships
• Arithmetic calculations

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Subcortical Areas

• Limbic System-memory and emotions
• Thalamus-relay of incoming sensory information
• Basal Ganglia-control of voluntary movement

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How the Brain is Hurt TBINormal Neuron Firing
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How the Brain is Hurt TBI

• PRIMARY INJURY
• Skull fracture
• Contusion (Coup/Contracoup injury)
• Diffuse axonal injury (DAI)
• Focal Shear Injury

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Diffuse Axonal Injury (DAI)Rotational forces on
the brain cause stretching and snapping of axons.
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Focal Shear Injury
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How the Brain is Hurt TBI, Contd.

• SECONDARY INJURY
• Cerebral edema
• Hydrocephalus
• Hematomas
• Neurotoxic cascade of events

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Secondary Injuries
Edema (swollen brain tissue)
Hydrocephalus (enlarged ventricles)
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Hematoma
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Neurotoxic Cascade of Events
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How the Brain is Hurt STROKE

• Caused by vascular disruption to a region of the
  brain leading to death of neurons in the affected
  area

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How the Brain is Hurt STROKE, Contd.

• Ischemic Stroke
• Blood flow to a region of the brain is blocked by
  plaque in the vessels, or a blood clot from the
  heart, starving brain cells in the area of the
  affected vessel of oxygen and nutrients.

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How the Brain is Hurt STROKE, Contd.

• Hemorrhagic Stroke Bleeding into the brain
  caused by rupture of an aneurysm, malformation of
  a blood vessel, or a weakened blood vessel
  disrupts normal flow of nutrients and oxygen into
  the affected region

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STROKE vs. TBI

• TBI
• Injury is usually to the entire brain (diffuse or
  global injury).
• In addition to diffuse injury due to damage to
  scattered neurons, there are focal injuries due
  to bruising and bleeding in localized areas.

• STROKE
• A single discrete area of the brain is affected,
  but the damage to the area is complete.

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STROKE vs. TBI

• TBI
• In TBI, diffuse injury varies greatly in severity
  from one patient to another.
• No two TBI survivors are exactly alike.
• Similarities may be related to the frequency of
  frontal lobe injury due to the impact of brain
  tissue on the frontal skull during an accident.

• STROKE
• Patients whose stroke was due to damage to the
  same blood vessel will have similar deficits.

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FACT

• More than 381,000 Texans are living with a
  disability from TBI (about 2 of the population).

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Course of Recovery Acute Stage

• Coma or Loss of Consciousness (LOC)
• Medical stabilization
• May last from minutes to months

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Course of Recovery Post-Acute Stage

• Post-Traumatic Amnesia (PTA)-no memory for events
  despite increased awareness
• Increased rate of recovery during first 1.5 to 2
  years post-injury
• Rehabilitation
• May last from days to years

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TOP TEN CHANGESAFTER BRAIN INJURY

• Memory
• Attention
• Communication
• Speed of thought action
• Problem solving/planning

• Mobility
• Fatigue
• Judgment
• Emotional/behavioral control
• Initiation

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Possible Behavioral / Social Effects
IMPAIRED ABILITY TO PERCEIVE, EVALUATE, OR USE
SOCIAL CUES/ CONTEXT
VERBAL / PHYSICAL AGGRESSION
MOOD SWINGS OR EMOTIONAL LABILITY
IMPULSIVITY
IMPAIRED ABILITY TO COPE WITH OVER-STIMULATING
ENVIRONMENTS
LOW FRUSTRATION TOLERANCE
LACK OF AWARENESS OF DEFICITS
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QUESTIONDo you have something to write with?
REASON The individual may need to refer to their
notes later for follow-through.
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QUESTIONWhat problems are you having?
REASON To identify needs as they relate to
available services.
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QUESTIONIs there someone who helps you that
you would want me to talk to?
REASON Individual may have problems
communicating their needs or following up.
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FACT
TBI accounts for more years of lost productivity
than any other injury.
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Severity of Injury MILD

• 75-90 of all brain injuries
• LOC less than 20-30 minutes
• A concussion is a mild brain injury
• Most recover within hours or days
• May have subtle problems over time (e.g.,
  headache, attention, memory, fatigue, emotional
  problems)

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Severity of Injury MODERATE

• 8-10 of all brain injuries
• LOC less than about 6 hours
• 3 months post-injury 2/3 have not returned to
  work
• 33-50 have residual problems (e.g., initiation
  including sexual, memory, temper, poor planning)

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Severity of Injury SEVERE

• Less than 10 of all brain injuries
• LOC more than 6 hours
• Cognitive, emotional/behavioral, physical
  problems
• Socially isolated/psychiatric problems
• Likely greater long-term impairment

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FACT
More than 5,700 Texans are permanently disabled
by TBI each year.
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FACT
Males sustain BI twice as often as females.
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MYTHS ABOUT BRAIN INJURY
REALITY The cognitive and behavioral effects of a
brain injury can last long after the person heals
on the outside.
MYTH Visible, physical recovery is a sign that
the brain is healed.
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MYTHS ABOUT BRAIN INJURY, CONT.
REALITY It may just take longer for the effects
of a brain injury to show up in a growing and
developing brain.
MYTH Younger children are more resilient and can
therefore bounce back easier and more quickly
from a brain injury.
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MYTHS ABOUT BRAIN INJURY, CONT.
REALITY Even a 60 second loss of consciousness
has resulted in DAI (as seen on autopsy).
MYTH Mild brain injury has no long term effects.
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MYTHS ABOUT BRAIN INJURY, CONT.
REALITY There is no cure for a brain injury.
MYTH Time heals.
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Related Issues

• Age at injury/ Stage of development
• Substance abuse problems pre- and post-injury
• Psychiatric problems pre- and post-injury
• Family support and expectations

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Prevention

• Common sense
• Seatbelts
• Use child safety seats
• Helmets
• Education
• Home Safety Check
• Dont drive under influence
• of any substance
• Dont drink to excess
• No drugs of abuse