Issues in Developmental Disabilities Traumatic Brain Injury - PowerPoint PPT Presentation

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Issues in Developmental Disabilities Traumatic Brain Injury

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Issues in Developmental Disabilities Traumatic Brain Injury Lecture Presenter: Donald L. Mickey, Ph.D. – PowerPoint PPT presentation

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Title: Issues in Developmental Disabilities Traumatic Brain Injury


1
Issues in Developmental Disabilities Traumatic
Brain Injury
  • Lecture Presenter
  • Donald L. Mickey, Ph.D. 

2
Video of Don Mickey
3
ORGANIC VERSUS PATHOLOGICAL? (Keep In Mind)
  • What is the causal agent for the behavior and
    problems that we see exhibited?
  • We must be aware that each individual is
    different and each person had a life, which they
    may be able to remember, prior to the brain injury

4
Definition
  • Sudden insult to the brain which may or may not
    involve loss of consciousness (LOC)

5
Causes
  • Major Assaults, falls, car accidents, gun shots
  • May also include stroke, anoxia, carbon monoxide
    poisoning, infections, toxic exposure
  • Add-Blasts as additional cause due to the war

6
Prevalence-Risk Groups
  • Males 1.5 times as likely as females to sustain a
    TBI
  • Two age groups most likely 0-4 year olds, 15-19
    year olds, and over 75
  • Now-Military

7
Prevalence
  • TBI results in 1.5 more deaths a year than AIDS
  • Each year 230,000 individuals are hospitalized
    with TBI and survive
  • 4th leading cause of death overall
  • Each day 5,500 individuals sustain a TBI
  • Approximately 1 in every 10 individuals are
    touched by TBI
  • 80,000-90,000 people experience onset of long
    term consequences of TBI

8
Prevalence-Scope
  • 400,000 Americans with spinal cord injury
  • 500,000 with Cerebral Palsy
  • 4 million with Alzheimers disease
  • 5 million with persistent mental illness
  • 5.3 million with TBI disability

9
Pathology of TBI
  • Micro pathology Excitotoxic Injury, Shear
    injury
  • Coup/Contra Coup Injury
  • Diffuse Injury
  • Pharmacological Intervention Timing is Critical
  • Mannitol

10
Outcomes of TBI-Basic Elements
  • Extent and Location of Gross Damage
  • Extent of Microscopic Damage
  • Pre Morbid Brain Factors
  • Response to Post injury Therapies
  • GCS within 24 hours post injury

11
Neuropathology and Neurotransmission Vulnerable
Areas
  • White Matter- Shear Injury Affects Corpus
    Callosum and Basal Ganglia
  • Coup/Contra Coup Injury- Affects Frontal,
    Temporal, and Occasionally Occipital Structures
  • Chronic Injuries May Alter the Homeostasis of
    Neural Transmission

12
Acute Care Treatment Course of Recovery
  • Acute Care Treatment Course of Recovery

13
Ideal Course of Recovery
  • Course of recovery
  • -Coma
  • -PTA (Post Traumatic Amnesia)
  • Retrograde and Anterograde amnesia
  • General Confusion
  • Agitation
  • Hospital Rehabilitation
  • Post Acute Rehabilitation
  • Gradual Return to Community, and work, (with
    Supports)
  • Often Dependent on Insurance

14
The Other Course of Recovery
  • Hospital Management at Acute Level
  • Return to Community with Limited Outpatient
    Therapy
  • Patient and/or Family is Left to Figure Out What
    is Next

15
Neuropsychological Radiological Assessment
  • Neuropsychological Radiological Assessment

16
Neuropsychological Assessment
  • Attention/concentration and orientation
  • Memory
  • Behavioral observation
  • Language ability
  • Visual spatial/visual constructive
  • Motor performance
  • Executive functioning
  • Motivation
  • Personality factors
  • Summary
  • Recommendations

17
Radiological Assessment
  • MRI
  • fMRI
  • PET scans
  • CTs

18
Picture of Whole Brain
19
General Functions Lobes
  • Frontal, left vs right Emotional control center
    and highest intellective area of the brain
    includes language, creative thought, problem
    solving, initiation of movement, judgment, and
    impulse control
  • Temporal Memory, language, sequencing, musical
    ability

20
Picture of Whole Brain
21
General Functions Lobes
  • Parietal Sensation, reading, listening,
    awareness of spatial relationships, and memory
  • Occipital Visual perception

22
Picture of Whole Brain
23
Terminology, Injury and Manifestation
  • Terminology, Injury and Manifestation

24
Specific terms (all caused by the injury)
  • Denial
  • Apathy
  • Emotional Liability
  • Impulsivity and Disinhibition

25
Specific terms (all caused by the injury)
  • Frustration and Intolerance
  • Lack of insight
  • Inflexibility
  • Confusion
  • Forgetting

26
Specific terms (all caused by the injury)
  • Verbosity
  • Perseveration
  • Confabulation
  • Lack of Initiation and Follow-Through
  • Slow and Inefficient Thinking
  • Poor Judgment and Reasoning
  • Social imperception
  • Fatigue

27
Manifestation of injury
  • Decreased alertness and arousal
  • Inadequate attention and concentration
  • -Focused
  • -Sustained
  • -Selective
  • -Alternating
  • -Divided
  • Confusion and disorientation
  • Impaired memory of new information

28
Manifestation of injury
  • Impaired sequential memory of past information
  • Expressive language problems
  • Receptive language problems
  • Agitation and irritability
  • Catastrophic reaction and reactive depression
  • Exacerbation or decrease of pre-injury mental
    health issues

29
Manifestation of injury
  • Impaired adaptive behavior Executive
    functioning
  • -Difficulty in planning a course of action
  • -Planning, organizing, and following through on
    any goal orientated task at home or work

30
Inconsistencies for the Individual
  • Everyone says you look good and are doing well
  • Mirror says I look good
  • No retrograde amnesia so I can remember all the
    things I have done and can do
  • Impairments block understanding of self
    information (right hemisphere injury)

31
Inconsistencies for the Individual
  • The effect of fatigue compounds the effects of
    the injury
  • Cant walk and chew gum!
  • Frontal lobe problems - too many choices and
    decisions
  • Simple definition - no auto pilot now, must
    always be alert

32
Inconsistencies for the Individual
  • Higher functioning individuals who use cognitive
    processes are more aware of even small short
    comings, which in turn magnifies the impairments
  • Major memory impairment and adequate intellectual
    capacity often has impairment as focus of
    treatment versus use of preserved skills
  • Minor memory impairments often are ignored as not
    important

33
Community Issues
  • Lack of understanding of the functional deficits,
    or too much understanding of the deficits
    blocks community success
  • Normal verbal abilities and/or normal IQ
    often has support people down playing the
    impairments or ignoring the impairments as not
    important

34
Community Issues
  • What does brain injury mean to you? Individuals
    often select one or two cases as their idea of
    brain injury - this may not represent the current
    case
  • Underlying or pre-existing mental health and/or
    life style issues are ignored or become focus

35
Community Issues
  • Unawareness of how to treat the brain injured
    individual, i.e. can I set limits, what should I
    say when happens, we dont want him to get upset,
    etc.
  • One size does not fit all

36
Needs
  • Awareness of injury deficits in a functional
    sense - how does a right frontal lobe injury
    affect the person in the environment?
  • This has to be an ongoing educational process
    with supports available following failures to
    process what happened
  • Functional and verifiable knowledge of strengths
    and weaknesses

37
Needs
  • Energy Output
  • -How much
  • -How Long
  • -Crashes/recovery
  • Risk taking to develop new skills or verify
    existing skills
  • Planned failure in the community setting to
    assist the learning process

38
Problems and Changes
  • How can we expect individuals to change if they
    dont know what is wrong?
  • When you know, it is easier to take
    responsibility for your self versus listening to
    others tell you what and why you need to change
  • Planned failure and community challenges

39
Ongoing Needs
  • Neuropsychological examination results
  • Community supports - are they coordinated?
  • Family supports
  • Specific information for care providers so they
    know how to assist individual

40
Questions and Ideas
  • Importance of survival in the community
  • -RISK TAKING-
  • Psychological impact of accepting change
  • Need to adapt everything to a real world
    environment - importance for care providers

41
Caveat
  • Always remember what you are dealing with a WHOLE
    system (person) that had a life prior to becoming
    a brain injured patient or client
  • Always be aware that systems function together
    and may not always fit neatly into specialty areas
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