Transcript Introduction to Brain Injury”

Martin Kerrigan
Traumatic Brain Injury and the ADA
August 11, 2011
Brain injuries are often classified as either traumatic or
acquired.
According to the Brain Injury Association of America
(BIA), “An acquired brain injury (ABI) includes all
types of traumatic brain injuries and also brain injuries
caused after birth by cerebral vascular accidents
(commonly known as stroke), and loss of oxygen to the
brain”
All brain injuries are acquired!
Acquired (ABI)
 Includes all brain injuries
that have occurred after
birth
 Includes “traumatic” and
non-traumatic” brain
injuries
 Can be result of stroke,
hemorrhages, loss of
oxygen to brain, drug
overdoses, etc.
Brain Injury Association of America, www.biausa.org
Traumatic (TBI)
 Caused by a bump, blow,
or penetration to the
head that results in an
impairment in the
function of the brain
 Categorized from “mild”
to severe
 Includes concussions
 According to the Brain Injury Association of America,
“an estimated 1.7 million children and adults in the
U.S. sustain a traumatic brain injury (TBI) and another
795,000 individuals sustain an acquired brain injury
(ABI) from non-traumatic causes each year.”
 The association also reports “currently more than
3.1 million children and adults in the U.S. live with
a lifelong disability as a result of TBI and 6.4 million
have a disability due to stroke.”
 A TBI is caused by a bump, blow or jolt to the head or a
penetrating head injury that disrupts the normal
function of the brain. Not all blows or jolts to the head
result in a TBI. The severity of a TBI 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. The
majority of TBIs that occur each year are concussions
or other forms of mild TBI.
 An estimated 1.7 million people sustain a TBI annually. Of
them:
• 52,000 die,
• 275,000 are hospitalized, and
• 1.365 million, nearly 80%, are treated and released from an
emergency department.
• According to Faul and associates; TBI is a contributing
factor to a third (30.5%) of all injury- related deaths in
the United States.
 In a report to Congress in 2003 the CDC found that “About
75% of TBIs that occur each year are concussions or other
forms of mild traumatic brain injury (MTBI).”
 Direct medical costs and indirect costs of TBI, such as lost
productivity, totaled an estimated $60 billion in the United
States in 2000.
 In a 1996 study Kraus and associates found the following:
 About two million head injuries of all types (including
skull and facial fractures) occur each year in the U. S. (175
to 200 per 100,000 population).
 Over 1.5 million Americans suffer nonfatal traumatic brain
injuries each year which do not require hospitalization.
About the same number are reported to sustain a brain
injury resulting in a loss of consciousness but not severe
enough to result in long-term institutionalization (an
annual rate of 618 per 100,000 person-years).
 Another 300,000 individuals suffer brain injuries severe
enough to require hospitalization, with 99,000 resulting in
a lasting disability. A total of 56,000 people die each year
as a result of traumatic brain injury
 Every brain injury is different
 Brain injury is often referred to as the silent
epidemic
 Brain injuries can manifest themselves in many
different ways and with varying degrees of severity
 The effects, or impact, of a brain injury varies from
person to person and injury to injury
 There is no way to look at someone and tell
whether or not they have been injured, or to what
extent they have been injured
 In two separate studies both Ip and colleagues and
Greenspan and colleagues found that “the largest
group of TBI survivors are young adults in their prime
working years, many survivors, particularly those with
a severe TBI, do not return to work. Estimates vary
widely, ranging from a low of 12.5% to as high as 80%
who do not return to work. The ability to return to
work is highly correlated to the post-acute functional
limitations of the survivor.”
 While a brain injury does not discriminate and can
happen to anyone, it is most common in males and
with young adults followed by young children and the
elderly.
 According to Kraus and MacArthur:
 TBI affects males at twice the rate of females. Higher
mortality rates among males indicate that males are
more likely than females to suffer severe injuries
 Individuals age 15 to 24 have the highest risk of TBI.
The risk also increases after age 60.
 While the costs associated with brain injury vary
greatly Brain and Spinal Cord.org estimates annual
costs of brain injury at estimated that a mild head
injury costs $85,000, a moderate injury costs $941,000,
and a severe injury costs $3 million.
 They also estimated “Overall, it is estimated that the
cost of traumatic brain injuries in the United States
weighs in at $48.3 billion annually. About $31.7 billion
of that is spent on hospitalization costs, while the
additional $16.6 billions goes toward costs associated
with fatalities.”
 Research has found that there is a disproportionately
higher rate of individuals living with brain injury in
these situations than in the general public:
 Incarcerated
 Chronically unemployed/under-employed
 Substance abuse issues
 Mental health issues such as clinical depression
 Many times the individual with the brain injury has
had some type of pre-morbid history with violence,
drugs and/or alcohol.
 Once the brain injury has occurred traditional
interventions usually do not work.
 Often times due to the consequences of their injury
their self esteem is lowered as is their feelings of self
worth.
 One of the most commonly
affected aspects of a persons
life following a brain injury is
their career
 Most employers do not
understand brain injury
 The closer to the injury, the
greater the impact of the
injury
 The individual’s assessment of their strengths and
weaknesses may not be accurate
 The individual may not have gotten over the “loss” of
previous skills
 Co-workers may not understand or get brain injury
 Drug and/or alcohol use may be an impediment to
both recovery and employment
 There are several things that can be
done to improve the likelihood of
successful employment:
 Job coaching
 Employer and workplace education
 Flexible working situations
 Consumer involvement and buy in
 A job coach is described by the website America’s
Heroes at Work as “a person, usually supplied by an
outside agency, who provides specialized on-site
training to employees with disabilities.”
 Individuals living with the effects of brain injury can
have a variety of physical, cognitive, and emotional
symptoms that can get in the way of work.
 The right job coach can help the individual with brain
injury work around these symptoms.
 By assisting the individual with brain injury
through one-on-one mentoring, guidance, help,
and assistance job coaches can help the employee
with on the job success and can potentially lead to
a greater sense of independence.
 Job coaches can also provide education to the
employers regarding the individual with brain
injury.
 Job coaching does not have to permanent and can
be weaned away over time.
 Most employers are familiar with the
American’s with Disabilities Act (ADA),
which includes brain injury
 As long as the accommodation is deemed
“reasonable” any employee should be able
to work as long as they are able to perform
the basics of their job with
accommodations.
 Disclosure of criminal history
 Tax benefits available
 The increase of veterans returning home with brain
injuries suffered while in combat has lead to an
increased awareness of brain injury.
 The Mayo Clinic has published a Guide that can help
employers when it comes to employees with brain
injuries, Understanding Brain Injury: A Guide for
Employers available at:
http://mayoresearch.mayo.edu/mayo/research/tbims/
 Depending on the needs of the individual and the
requirements of the job, employers should be flexible.
 It might take some creative or “outside the box”
thinking but many times solutions can be found.
 No matter how great of a program is designed if the
individual does not “buy” into it, or believe in it, the
chances of success are low.
 The consumer needs to be an integral part of the
process.
America’s Heroes at Work, http://www.americasheroesatwork.gov
Brain and Spinal Cord.org, http://www.brainandspinalcord.org/
Brain Injury Association of America, http://www.biausa.org/
Center for Disease Control, http://www.cdc.gov/TraumaticBrainInjury/
Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the
United States: Emergency Department Visits, Hospitalizations and
Deaths 2002–2006. Atlanta (GA): Centers for Disease Control and
Prevention, National Center for Injury Prevention and Control; 2010.
 Finkelstein E, Corso P, Miller T and Associates. The Incidence and
Economic Burden of Injuries in the United States. New York (NY):
Oxford University Press; 2006.
 Greenspan, A. I., Wrigley, J. M., Kresnow, M., Branche-Dorsey, C. &
Fine, P. R. (1996) Factors Influencing Failure to Return to Work Due to
Traumatic Brain Injury. Brain Injury, 10(3): 207-218.
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 Ip, R. Y., Dornan, J. & Schentag, C. (1995) Traumatic Brain Injury:
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Factors Predicting Return to Work or School. Brain Injury, 9(5): 517532.
Kraus, J. F, and MacArthur, D. L. (1996) Epidemiologic Aspects of Brain
Injury. Neurologic Clinics, 14(2): 435-450.
Morton, M. V., & Wehman, P., (1995) Psychosocial and Emotional
Sequelae of Individuals with Traumatic Brain Injury: A Literature
Review and Recommendations. Brain Injury, 9(1): 81-92.
Report to Congress on Mild Traumatic Brain Injury in the United States:
Steps to Prevent a Serious Public Health Problem. Atlanta (GA): Centers
for Disease Control and Prevention, National Center for Injury
Prevention and Control; 2003.
U.S. Dept. of Transportation, National Highway Traffic Safety Division
(1997), Traffic Safety Facts 1996:Alcohol.Washington, DC: National
Center for Statistics & Analysis, Research & Development.
 Contact information:
Martin Kerrigan
[email protected]