Transcript Understanding Traumatic Brain Injury Friday April, 25

Understanding
Traumatic Brain Injury
Friday April, 25, 2008
Workshops Session l
9:30 a.m. – 10:30 a.m.
Southwestern Arizona Conference on Disability
Rights
Yuma Civic and Convention Center
Yuma, Arizona
Ann Tarpy, M.Ed.
Education, Prevention & Training Officer
Arizona Governor's Council on Spinal & Head Injuries
10640 N. 28th Drive Ste. B-102
Phoenix, AZ 85029
602.863.0484
[email protected]
Objectives
• By the end of this Session, the
participant will:
– Comprehend the nature and
consequences of brain injury.
– Identify resources for persons with
brain injury and families.
Agenda
•
•
•
•
•
Opening activities
Part 1 - Understanding the brain
Part 2 – Understanding brain injury
Part 3 – What happens after brain injury
Closing activities and evaluation
Understanding Brain Injury
• Traumatic brain injury is not:
– An acute illness with symptoms that
will resolve over time.
– A single, unified disorder with a clear,
consistent set of symptoms
Understanding Brain Injury
• Traumatic brain injury is:
– A condition with potential life-long implications
that may require ongoing services and
supports
– A multidimensional syndrome affecting a wide
variety of areas of function including:
•
•
•
•
•
•
Cognitive
Sensory
Motor
Social
Emotional
Physical
Part 1
Understanding
the brain –
Understanding the Brain
• A basic understanding of brain
structure may help understand
what happens to the brain in
brain injury
Understanding the Brain
• The brain is a very
complex and delicate
structure with
pathways that
determine memories,
emotions, and basic
motor functions. In
sum – who we are.
Understanding the Brain
• It is through our brains that we experience
ourselves, the environment and understand
our relationships to others.
Understanding the Brain
• We do not come into this
world with a fully
developed brain.
• The brain begins
development in-utero and
continues into early
adulthood.
Understanding the Brain
• The brain is made up of
billions of nerve cells
(neurons) through which
messages are
transmitted.
• As the brain matures the
nerve cells develop into
different “systems” that
develop at specific
times.
16 - 19:…
Judgment
12 - 16:
The
Developmental
Pyramid
Integration/
Problem Solving
6 - 12:
New Learning/Attention
3 - 6:
Thinking/Emotion/Behavior
0-3
Cause/Effect Relationships
12
Understanding the Brain
• These systems are
designed to serve
specific and
important functions
and are designed
to work together.
Cognitive Skills/Functions Associated with
Hemispheres of the Brain
Left Hemisphere – Logical
Words (spelling)
Verbal meaning
Vocabulary in language
Details – rules
Analysis
One-by-one selectivity
Step-by-step instructions
Sequential ordering
Cause and effect relationships
Learned facts
Letter-symbol associations
Abstract reasoning
Academically-learned information
Ideas
Serial/ordered structures
Self-verbalizations
Selective attention
Consciousness – reasoning
Scientific logic
Right Hemisphere – Aesthetic
Images, pictures, and colors – spatial
Music and feelings
Gestalt – whole/relational
Synthesis, comparisons
Simultaneous patterning
Whole process
Whole units
Analogies
Creativity – new combinations
Visual symbolism
Concrete
Practical – common sense knowledge
Patterns of things/theory
Random-without structure body language
Facial expression, tone of voice
Sustained attention
Meditation, spontaneous ideas, subconscious
Spiritual – mythical
Patterns of logical associations
Brain-Behavior Model
OUTPUTS
(motor, oral, written)
Concept formation, reasoning,
logical analysis
Language skills
Manipulations in
Active
Working Memory
Visual-spatial skills
Attention, concentration, memory
Inputs
Visual
Inputs Inputs
Auditory
Kinesthetic
Part 2
Understanding
Brain Injury
Understanding Brain Injury
Understanding Brain Injury
• Examples of non-traumatic brain injury from
medical conditions include:
– Infectious disease (e.g., meningitis, encephalitis)
– Brain tumor and their treatments (chemotherapy and
radiation can cause diffuse brain damage)
– Neurological disease (e.g. multiple sclerosis)
– Cerebrovascular disorders (e.g. stroke)
– Toxic chemical or drug reactions (e.g., lead
poisoning, carbon monoxide poisoning)
– Hydrocephalus
– Substance abuse
Understanding Brain Injury
• Hypoxia/Anoxia may be traumatic or
non-traumatic and results in
generalized, diffuse damage to the
brain:
– Suffocation
– Suicide attempts
– Near drowning
– Other injuries (cardio or pulmonary)
can reduce blood flow to the brain
Understanding Brain Injury
A traumatic brain
injury (TBI) is a
result of:
• Blunt or
penetrating
trauma to the
head such as a
gunshot wound.
Understanding Brain Injury
• Coup – contrecoup
injury from
acceleration deceleration forces
such as motor
vehicle crashes or
shaken baby
syndrome.
Understanding Brain Injury
• Mild, moderate, and severe brain injury
are the clinical terms used to describe
the “type” of brain injury the person
sustained.
• However, these same descriptors often
fail to tell us about the “functional
outcome” of the injury.
Part 3
What happens after
brain injury
What happens after brain injury
• After brain injury, traumatic or nontraumatic, a person may present
with a complex interplay of:
– physical,
– psychological,
– cognitive symptoms or signs…
What happens after brain injury
• … that may lead to behavioral
changes and social impairments that
can continue in varying degrees after
physical recovery.
What happens after brain injury
• It is the complex neurobehavioral
problems that may cause the
greatest disruption in the
survivor’s and family’s life.
What happens after brain injury
• Injury in childhood
results in an
underdevelopment of
the brain functions of
the areas impacted
by the injury.
What happens after brain injury
• Abilities that are just developing or
have not yet emerged are the most
sensitive and more likely to be
disrupted as a result of brain injury.
What happens after brain injury
• These abilities and their associated areas of function
are likely to be the Achilles Heel for a child with a brain
injury, even after growing up. The impacts of the injury
may become more complex as the child matures.
• Often, depending on the age of injury, the effects of
brain injury in childhood is not evidenced until later
when the “developmental expectations” and/or
demands of the “environment” (home, school, and/or
community) increase – challenging the capacity of the
individual to engage.
What happens after brain injury
Brain injury impacts a person’s ability to:
–
–
–
–
–
Receive
Store
process
Accumulate, and/or
Retrieve information
Resulting in changes in the person’s behavior
(e.g. may be inappropriate, not as expected or
anticipated, may no longer be able to function
at their previous level of performance in
school, at home, other environments.)
What happens after brain injury
• If these behaviors or problems are ignored,
misdiagnosed, or not understood as part of
brain injury, they may lead to more lasting
problems (e.g. depression, aggression,
impulsivity, poor self-esteem) that will interfere
with integration or reintegration into home,
school, work, and the community.
What happens after brain injury
Behavior following brain injury, is likely to be influenced by
or an interaction between the following factors:
•
Acquired organically-based changes (e.g. in
personality, cognition and behavior)
•
Complications caused by emotional reactions to
difficulties and changes from the injury
•
Pre-morbid characteristics
•
Family system/family functioning (pre/post injury)
•
•
•
•
Environment
Reaction to medication
History of substance abuse
Level of awareness and understanding of brain injury.
What happens after brain injury
• Environment is the one variable over
which family members, caregivers, and
service providers have the most control.
• Changing the expectations of the
individual in the environment can
change/improve the behavior.
What happens after brain injury
• There are a number of ways that the effects of
TBI impacts the individual’s ability to interact
with the environment and his/her behavior:
– Impaired ability to interpret social cues
– Less able to inhibit impulses or select appropriate
behavior
– Slowed information processing speed
– Poor or delayed recall
– Decreased ability to anticipate consequences
What happens after brain injury
• A person with a brain
injury may engage in
deliberate behaviors
(adaptive and
maladaptive) as a
means of
communication…
What happens after brain injury
– For the purpose of seeking control when
control is threatened (stress reaction)
– To have a basic need met
– When others are not listening
– When all else fails
– Out of frustration due to other impairments
associated with the injury (e.g., delaying
information processing speed, memory
impairments, physical limitations, etc.)
What happens after brain injury
• The cognitive, physical, psychological,
and emotional changes that occur after
brain injury will affect the individual’s
perception of his/her world and how s/he
interacts with and responds to others.
What happens after brain injury
• By understanding that behavior may be
a manifestation of the brain injury or a
means of communication, family
members, caregivers, and service
providers can begin to interpret
“compliance” or lack of compliance in
light of the brain injury, not as volitional
or lack of interest.
What happens after brain injury
• Questions may remain about the volitional intent
behind behaviors, especially if they are related to
brain injury.
• The answer to the question whether a particular
behavior has an underlying organic cause or is
manipulative, willful, or deliberate is complex.
• Default approach is to consider the behavior is
either directly or indirectly related to the injury.
What happens after brain injury
• Important for the family member,
caregiver, and/or service provider to be
aware of his/her perception of what the
behavior means.
What happens after brain injury
• Understanding that changes in behavior after
brain injury are a manifestation of the injury,
helps family members, caregivers, and/or
service providers change their
reaction/response to the behavior(s) which may:
– Increase their tolerance of the behavior(s).
– Allow the family, caregivers, and/or service
providers to blame the injury rather than the
person and not take personal offense.
What happens after brain injury
• Stress is a common reaction when working with
individuals with a brain injury.
• The stress reaction generally occurs in situations
where the demands of the environment exceed
an individual’s (perceived) resources to handle
the situation.
• The stress reaction can occur in the individual
with the brain injury, the caregiver, family
member and/or service provider.
What happens after brain injury
Understanding brain injury
and the impact of the brain
injury on the individual and
the family is really about
understanding loss – at
many levels.
What happens after brain injury
• For the individual – (depending on the level of
awareness) s/he may mourn the loss of:
– Memories of experiences that connect them with
family and friends
– Sense of self – who they were before the injury
– His/her role and status in the family, at work, with
friends
– Physical functioning
– Changes in thinking and behavior
– Ability to do some of the things they did before
– The life they had before the injury
What happens after brain injury
• For the family, they are mourning the loss of:
– Who the individual was before the injury - connection
to the individual through memories of shared
experiences.
– Hopes, dreams, and the future they had for the
individual.
– Their way of life and now facing the reality that life
may never be returning to the way it was before.
– The role the individual played in the family.
• For a spouse, they may be mourning the loss of
their companion, their support, their partner.
What happens after brain injury
• Families members, individually and as a unit,
experience an ongoing journey filled with
challenges and changes through the recovery
period and then adjusting to life after brain
injury.
• In many cases, recovery becomes a lifelong
process of adjustments and
accommodations for the individual and the
family as they deal with acceptance and
understanding of the injury and subsequent
limitations and consequence.
What happens after brain injury
• For the individual with a brain injury,
survivorship is about understanding the
“new person” who is developing.
• For the family, it is understanding the
new family that is emerging.
Resources
•
A separate
handout of
resources is
included in your
packet of materials.
Questions
• Closing activities and evaluation