Transcript Traumatic Brain Injury

Traumatic Brain Injury
Not degenerative
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Case Study
From a survivors perspective:
“ after a car accident, I awoke in the hospital to a world I
didn’t understand. I had to learn to ask people to talk
slower. Some stranger had taken over my body. She
reacted in ways that were foreign to me, like making
obscene gestures and saying things that I would never
be caught dead saying.”
-Before her injury she had no emotional or psychiatric
problems.
(Bryant, 2002)
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Prevalence
1. Main cause of death and disability in youth in U.S.
a. fastest growing disability group in U.S. due to
increased survival rates
b. 25% of all pediatric injuries are brain injuries
c. called “the silent epidemic”
2. 65-75 % mild in nature MTBI (missing a lot of these
kids)
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Child Biogenetic Factors
Family Factors
(Cognitive & Behavioral)
Environmental Etiologies
No Oxygen
External Force
Types of Damage
CONCEPT
MAP
Concussion
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Contusion
Shearing
Child Risk Factors
BEHAVIORAL FACTORS
Active & Risk –Taking
(e.g., ADHD)
COGNITIVE FACTORS
LD & MI/MH
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Family Factors
– Disorganized families
– 1/4 of TBI occur for
children less than 2 yrs.
Examples are:
• shaken babies
• tossed babies
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Environmental Etiologies
Environmental CAUSES
External Forces
LACK Oxygen
 Birthing
process
 Drowning
 Strokes
• External Force
 10% from firearms but 9/10 of these die
 Falls: younger than 5 & older than 75
• Opposing Forces
Vehicles (car, bike, pedestrian)
account for ½ adolescent TBIs
 Contact sports
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Contact sports in high school
About 63,000 cases of MTBI annually in H.S. varsity
athletes
(Powell, 2000)
Football accounts for 63% of the cases.
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Look at this link
 http://www.hbo.com/docs/programs/coma/index.html
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Types of Damage
1.
2.
3.
Concussion
Contusion
Shearing
1. bruising = focal effects
that are recovered --no
damage of tissue
2. bleeding and toxic effects
to brain = focal damage to
brain cells
3. layers riding up on each
other therefore cutting of
nerve pathways = global
damage
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Indicators of Damage
1. Seizures and types
2. Auras (warnings that may be
motor or sensory)
3. Coma
4. Secondary (co-occurring)
disabilities
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Physical Outcomes
Physical stamina can by less (fatigue)
Gross motor coordination--73% have good recovery of
these functions but (severe injury may require
wheelchairs)
Fine motor speech impairments
Headaches (even 1 year out)
Seizures (within 2 years of injury)
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Sensory & Somatic Outcomes
 Dizziness
 Insomnia
 Nausea
 Vision problems (e.g.,
blurred or double, low
vision/blindness, visual
field cuts)
 Loss of smell or taste
(CDC, 2003)
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Possible Cognitive Outcomes
Declines in general intelligence—especially nonverbal
abilities
Slowed processing and response speed
Cognitive fatigue and attention/concentration deficits
Language and visual processing deficits
Deficits in memory and new learning
Problems with executive functions (e.g., working
memory)
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Cognitive Characteristics
Focal mild
Global
 attention/concentration
 attention/concentration
 visual perceptual
 visual perceptual
Different
Different
 short term memory
 long term memory
 judgment
 IQ--problem-
solving/disorganization
-- loss of old learning
 loss of academic new learning
or language (naming and
receptive)
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School and Vocational Outcomes
1.
Problems initiating and completing work
2.
Slowed work pace
3.
Increased impulsivity
4.
Trouble navigating physical surroundings, especially
in new settings (e.g., motor limitations, spatial
deficits)
5.
Decreased productivity
6.
Loss of employment
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Social
Characteristics
Communication
 May say inappropriate things
 Difficulty understanding another’s perspective
 Poor awareness of social environment
Functioning losses
 Relationships: loss of friends, relationships
 Loss of the ability to manage home or school
environment
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Emotional
In general, the presence of an acquired
brain injury places individuals at greater
risk for developing a new psychiatric
disorder (about 5 times expectancies)
 Depression
 Anxiety
 Sleep disturbances
 Frequent mood changes or
difficulty regulating emotions
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Which type of disability is more likely to
have secondary psychiatric disorders?
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Case Study II
 A 15 year old girl with a history of anorexia nervosa.
 She sustained a head injury when she fell from her bicycle.
 Initially she was drowsy, slow to respond, and disoriented in
time but oriented in place and person.
 During the following 3 weeks, she was tired, lost interest in
activities, and had poor hygiene, slept excessively, and
worried about not being able to remember the accident.
 Then difficulties in thinking, and hearing voices, but was
unable to elaborate on her thinking and hearing.
 Finally diagnosed with Bipolar disorder from
the
(Sayal,sustaining
2000)
head injury.
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Interventions
Interventions may depend upon which area of the brain
was affected:
 Memory
 Reviewing
 Consistent Routine
 Comprehension
 Repetition
 Emphasize Main Points
 Attention
 Break down large assignments into smaller tasks
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Interventions:
May require changes in instructional
formatting:
1. Advance Organizers
 Draw maps in planning the day
 List solutions when giving them a problem
 Use outlines
2. Groupings
 Use groups with different disabilities
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Prevention of Mild TBI
Supervision
Safety rules and education
 Never drive while under the influence
Protective gear
 Wear a seat belt.
 Wear a helmet and make sure your children wear
helmets
 Avoid falling at home by:
using a step stool,
installing handrails,
installing window guards,
and using safety gates.
(CDC,2003)
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T or F in Response to Seizure
1.
2.
3.
4.
put something soft under the 5. call for assistance if the seizure
person’s head
is longer than 5 min
put something in the person’s 6. try to revive the student and
mouth
bring him/her around
hold onto the person’s tongue 7. turn person onto their side
clear the floor around the
person
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Answers
1.
2.
3.
4.
5.
6.
7.
T
F
F
T
T
F
T
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