Traumatic Brain Injury

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Traumatic Brain Injury

• TBI

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Part I

• FACTS

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What is TBI?

• The Center for Disease Control and Prevention
  defines TBI as a BLOW or jolt to the head or a
  PENETRATING head injury that disrupts the
  function of the brain.
• The severity of such an injury may range from
  mild, i.e., a brief change in mental status or
  consciousness to severe, i.e., an extended
  period of unconsciousness or amnesia after the
  injury.

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Comparison of Annual Incidence
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TBI Statistics

• 5.3 million Americans currently live with
  disabilities resulting from TBI
• 1.4 Million sustain a TBI each year in U.S.
• Of those
• 50,000 die
• 235,000 hospitalized
• 1.1 million treated and released

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Leading Causes - CDC

• 28 Falls
• 20 Motor vehicle-traffic crashes
• 19 Struck by/against
• 11 Assaults

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Leading Causes - BIA

• The Brain Injury Association (2006) tells us that
  the leading causes of brain injury are
• Motor vehicle accidents
• Recreation
• Violence
• Falls
• Bicycles
• Motor vehicle violence
• Shaken infant syndrome
• Falls are the leading cause of traumatic brain
  injury for people over 65.

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Who is at highest risk?

• Ages 0-4 and 15-19
• Males are 1.5 times more likely than females to
  sustain a TBI
• African Americans have the highest death rate
  from TBI
• Certain military duties increase risk of
  sustaining TBI (e.g. paratrooper)

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Costs of TBI

• Direct medical costs and indirect costs such as
  lost productivity totaled an estimated 56.3
  billion in the U.S. in 1995

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Part II

• Physiology

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2 Types of TBI Open or Closed

• Open or Penetrating
• Skull is fractured (such as by a blow) or
  penetrated (such as by a gunshot wound).
• Functional impairments tend to be localized.
• Closed
• Skull is not fractured rather, the brain is
  damaged because the head has been hit with
  sufficient force that the brain slams against the
  other side of the skull or twists within the
  skull, causing shearing of blood vessels or nerve
  fibers throughout the brain.
• Damage can be diffuse. Additional injury can be
  caused by the following
• Edema swelling of the brain
• Hemorrhage or Hematoma bleeding in the brain or
  blood filled sac
• Contusions bruising of the brain

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Brain Anatomy

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Brain Functions

• Frontal Lobe Involved in movement, speech,
  reasoning and aspects of emotion
• Parietal Lobe Integrates sensory information
  plays a role in spatial reasoning
• Temporal Lobe Processes sound and smell,
  regulates emotions, and is involved in aspects of
  learning, memory, and language
• Occipital Lobe Interprets visual information
• Cerebellum Coordinates motor movements
• Brain Stem Controls vital functions such as
  heart rate, blood pressure respiration

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Signs and Symptoms of Mild TBI

• Can be subtle
• May not appear until days or weeks after the
  injury
• People may look fine even though they act or feel
  differently
• Common signs can include
• Headaches, dizziness, blurred vision
• Problems with memory, concentration, orientation
• Irritability, depression, mood changes

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Disabilities

• Disabilities resulting from a TBI depend upon the
  severity of the injury, the location of the
  injury, and the age and general health of the
  individual.

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Common Disabilities

• Problems with
• cognition (thinking, memory, and reasoning)
• sensory processing (sight, hearing, touch, taste,
  and smell)
• communication (expression and understanding)
• behavior or mental health (depression, anxiety,
  personality changes, aggression, acting out, and
  social inappropriateness)
• motor physical skills (muscle coordination,
  motor changes, abnormal movements, seizures,
  headaches, fatigue)

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Terminology

• Ataxia impairment of muscle coordination
• Dyskinesia abnormal involuntary movements
• Dystonia abnormal muscle tone
• Dysarthria impairment in the coordination and
  accuracy of the movement of the lips, tongue, or
  other parts of the speech mechanism
• Aphasia (Brocas, Global, Wernickes aphasia)
  Inability to communicate through speech, writing
  or signs due to brain dysfunction
• Diplopia Double vision

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Severe TBI Disabilities

• More serious head injuries may result in
• Stupor, an unresponsive state, but one in which
  an individual can be aroused briefly by a strong
  stimulus, such as sharp pain
• Coma, a state in which an individual is totally
  unconscious, unresponsive, unaware, and
  unarousable
• Vegetative state, in which an individual is
  unconscious and unaware of his or her
  surroundings, but continues to have a sleep-wake
  cycle and periods of alertness
• Persistent vegetative state (PVS), in which an
  individual stays in a vegetative state for more
  than a month

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Glasgow Coma Scale

• Used to rate seriousness of brain injury
• Scores assigned according to level of response
  in 3 areas eye opening, verbal response and
  motor response
• Scores range from 3 to 15
• The lower the score, the deeper the level of
  unconsciousness
• Mild score of 13 to 15
• Moderate score of 9 to 12
• Severe score of 8 or less

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Part III

• Treatment

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Initial Treatment

• Stabilize to prevent further injuries
• Ensure proper oxygen supply to the brain and body
• Maintain adequate blood flow
• Control blood pressure
• Little can be done to reverse the initial brain
  damage in moderate to severe cases

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Other Treatment

• Approximately half of severely head-injured
  patients will need surgery to remove or repair
  hematomas or contusions

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Rehabilitation

• May include the following
• physical therapy
• occupational therapy
• speech/language therapy
• physiatry (physical medicine)
• psychology/psychiatry
• social support.
• rehabilitation counseling

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Simple Assistive Devices

• Individuals with TBI often need more cues and
  tools to help them remember daily living tasks,
  including getting dressed, eating and other
  routine daily needs
• Simple devices include
• daily planners
• calendars
• to do lists
• memory boards

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Sophisticated Assistive Devices

• PDAs and computers that incorporate task
  management software
• Augmentative Technology Devices are designed to
  aid persons who have lost some of their ability
  to speak
• Communication boards provide the user with the
  ability to communicate their needs by pressing
  picture buttons

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Mobility Devices

• Chair lifts
• Ramps
• Walkers
• Canes
• Wheelchairs
• Leg braces

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Part IV

• Issues

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Vocational Issues

• The National Association of State Head Injury
  Administrators (NASHIA) (2006) finds that
  historically75 of persons with TBI who return
  to work will lose their job within 90 days if
  they do not have supports. Those who do attain
  successful employment may return for VR services
  due to changes in job duties, promotion, or lack
  of support system.

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Type of work

• Individuals with TBI are finding jobs in a
  variety of settings, including high technology,
  scientific laboratories, self-employment, and
  government agencies. However, jobs with the
  following features have greater success
• Regular daily schedules
• Routine tasks
• Low levels of distracting noise and light
  (fluorescent lights may be especially
  distracting)
• Regular breaks
• National Association of State Head Injury
  Administrators, 2006

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Examples of Job Supports

• Job coaching, supported employment
• Schedule-reminders
• Scheduled rest breaks to prevent stimulus
  overload and fatigue
• Work task checklist on a clipboard
• Tape recorder as a memory aid
• Stop watch for time management

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Psychosocial Issues

• Feelings of depression, anxiety, anger, grief,
  helplessness, worthlessness, guilt
• Impulsivity sex, money, drugs
• Physical aggression
• Social isolation
• Emotional lability
• Memory impairments

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Family Issues

• Personality Changes
• Role Changes
• Prolonged stress
• Financial burden
• Marital strain
• Social isolation

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Substance Abuse

• Often used as a coping mechanism, especially for
  young males
• May have been contributing factor to injury (e.g.
  DWI)
• If problem before accident, may continue to be a
  problem after accident

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PRIMARY PREVENTION

• Seat belts
• Helmets
• Never drive under the influence
• Keep firearms stored unloaded in locked cabinets
• Avoid falls safety gates, stair handrails,
  window guards, non-slip mats
• Shock-absorbing material on playgrounds