Title: Meeting Special Needs of Individuals with Brain Injury Part I: How the Brain Works Training for 211
1Meeting Special Needs of Individuals with Brain
InjuryPart IHow the Brain WorksTraining for
2-1-1 Specialists
2Brain 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
3FACT
- TBI is the leading cause of death and disability
among children and young adults, and those over
75.
4Congenital / 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.
5Congenital / 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.
6Definition 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.
7vs. 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.
8QUESTIONWere 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.
9QUESTIONWas 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.
10FACT
- 144,000 Texans sustain a TBI each year, one every
4 minutes.
11Causes 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
-
12Causes of Acquired Brain Injury, Contd.
- Infectious diseases
- Brain tumor
- Metabolic disorders (e.g., diabetic coma)
- Seizure disorders
- Toxic exposure
13QUESTIONWhat was the cause of the injury?
REASON Some state services may exclude brain
injury due to causes other than TBI.
14Causes of TBI
15FACT
- The annual incidence of TBI is more than that of
MS, spinal cord injury, HIV/AIDS, and breast
cancer - COMBINED.
16Basic Brain
- Brainstem
- Cerebellum
- Cerebrum
17Brain Stem
- Cardiac
- Respiratory
- Arousal
- Movement touch sensation in body
18Cerebellum
- Balance of the body
- Coordination of body movement
19Cerebrum
- Four lobes in each hemisphere
- Frontal
- Temporal
- Occipital
- Parietal
20Frontal Lobe
- Located under forehead
- Largest part of brain
- Last section to evolve
- Executive functioning
21Frontal 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
22Temporal Lobe
- Hearing
- Understanding Speech
- Memory
- Music/ Sound
- Comprehension
23Occipital Lobe
- Located at the rear
- of the brain
- Interpretation of
- visual information
24Parietal Lobe
- Located at the top of brain
- Perception of touch/body
- orientation
- Face and shape
- recognition
- Awareness of spatial
- relationships
- Arithmetic calculations
25Subcortical Areas
- Limbic System-memory and emotions
- Thalamus-relay of incoming sensory information
- Basal Ganglia-control of voluntary movement
26How the Brain is Hurt TBINormal Neuron Firing
27How the Brain is Hurt TBI
- PRIMARY INJURY
- Skull fracture
- Contusion (Coup/Contracoup injury)
- Diffuse axonal injury (DAI)
- Focal Shear Injury
28(No Transcript)
29Diffuse Axonal Injury (DAI)Rotational forces on
the brain cause stretching and snapping of axons.
30Focal Shear Injury
31How the Brain is Hurt TBI, Contd.
- SECONDARY INJURY
- Cerebral edema
- Hydrocephalus
- Hematomas
- Neurotoxic cascade of events
32Secondary Injuries
Edema (swollen brain tissue)
Hydrocephalus (enlarged ventricles)
33Hematoma
34Neurotoxic Cascade of Events
35How the Brain is Hurt STROKE
- Caused by vascular disruption to a region of the
brain leading to death of neurons in the affected
area
36How 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.
37How 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
38STROKE 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.
39STROKE 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.
40FACT
- More than 381,000 Texans are living with a
disability from TBI (about 2 of the population).
41Course of Recovery Acute Stage
- Coma or Loss of Consciousness (LOC)
- Medical stabilization
- May last from minutes to months
42Course 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
43TOP TEN CHANGESAFTER BRAIN INJURY
- Memory
- Attention
- Communication
- Speed of thought action
- Problem solving/planning
- Mobility
- Fatigue
- Judgment
- Emotional/behavioral control
- Initiation
44Possible 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
45QUESTIONDo you have something to write with?
REASON The individual may need to refer to their
notes later for follow-through.
46QUESTIONWhat problems are you having?
REASON To identify needs as they relate to
available services.
47QUESTIONIs there someone who helps you that
you would want me to talk to?
REASON Individual may have problems
communicating their needs or following up.
48FACT
TBI accounts for more years of lost productivity
than any other injury.
49Severity 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)
50Severity 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)
51Severity 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
52FACT
More than 5,700 Texans are permanently disabled
by TBI each year.
53FACT
Males sustain BI twice as often as females.
54MYTHS 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.
55MYTHS 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.
56MYTHS 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.
57MYTHS ABOUT BRAIN INJURY, CONT.
REALITY There is no cure for a brain injury.
MYTH Time heals.
58Related Issues
- Age at injury/ Stage of development
- Substance abuse problems pre- and post-injury
- Psychiatric problems pre- and post-injury
- Family support and expectations
59Prevention
- 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