Transcript Traumatic Brain Injury: Overview

Traumatic Brain Injury:
Overview
Anastasia Edmonston, TBI
and Person Centered
Planning Trainer-MHA
&
Dawn Roher, Clinical
Resource Manager-BIAMD
MHA’s – Lead Agency in Maryland
for Traumatic Brain Injury
Programs and initiatives:
• Home and Community Based Services Waiver for Individuals
with Brain Injury.
• Staff to the Maryland Traumatic Brain Injury Advisory Board.
• Pilot program for transition age youth with brain injury.
• Statewide TBI training to human service professionals.
• MHA contracts with the Brain Injury Association of Maryland
to provide TBI resources and referral information to
Marylanders with brain injury.
• Additional information about these programs and initiatives
can be found at
http://dhmh.maryland.gov/mha/SitePages/tbi.aspx
What We will Cover Today
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The Basic Brain
Who is affected?
Types of Brain Injury
How are people affected by Brain Injury?
Resources
What might it feel like to be
living with a brain injury?
Writing and processing exercise
Incidence of
TBI
CDC 2010, 2002-2006 data
In the United States, at least
1.7 million sustain a
TBI each year…
275,000 are hospitalized
TBI By Cause
CDC 2010
• Falls-35.2% (young children &
elderly)
• Unknown/Others-21%
• Motor Vehicle-Traffic-17.3%
• Struck by/against-16.5%
(unintentionally by object or another
person)
• Assault-10%
Maryland 2007-2011
Hospitalization Data
updated November 2013, DHMH
• After a 3 year trend of declining TBI
related hospitalizations, rates increased
21% between 2010-2011
• Rates of hospitalization increase with
age, for those 45-54 a 23% rate is
noted, for those 75 and older, 46%
• Most common cause of TBI related
hospitalization are falls, followed by
motor vehicle accidents
The Scope of the Problem
• Distribution of Severity:
– Mild injuries = 80%
(Loss of consciousness < 30 min, Post
traumatic amnesia < 1 hour)
– Moderate = 10 - 13%
(LOC 30 min-24 hours, PTA 1-24 hours)
– Severe = 7 - 10%
(LOC >24 hours, PTA >24 hours)
Skull Anatomy
The base of the skull is
rough, with many bony
protuberances.
The skull is a rounded layer of
bone designed to protect the
brain from penetrating injuries.
These ridges can result in
injury to the temporal and
frontal lobes of the brain
during rapid acceleration.
Bony ridges
adapted from Dr. Mary Pepping of
the University of Idaho’s
presentation The Human Brain:
Anatomy,Functions, and Injury
The Developing Brain
• Children’s brains do not reach their
adult weight of 3 pounds until they are
12 years old
• The brain, and most importantly, the
brain’s frontal lobe region does not
reach it’s full cognitive maturity till
individuals reach their mid twenties
The Developing Brain
• Many of our adult thinking skills reside
in the Frontal Lobe
• The Frontal Lobe is very vulnerable to
injury
• If you have a frontal lobe injury as a
child, you may “grow into your brain
injury”
The Frontal Lobe
The frontal lobe is the area of
the brain responsible for our
“executive skills” - higher
cognitive functions.
These include:
• Problem solving
• Spontaneity
• Memory
• Language
• Motivation
• Judgment
• Impulse control
• Social and sexual
behavior.
adapted from Dr. Mary Pepping of the University of
Idaho’s presentation The Human Brain:
Anatomy,Functions, and Injury
Temporal Lobe
The temporal lobe
plays a role in
emotions, and is also
responsible for
smelling, tasting,
perception, memory,
understanding music,
aggressiveness, and
sexual behavior.
The temporal lobe
also contains the
language area of the
brain.
adapted from Dr. Mary Pepping of the
University of Idaho’s presentation The
Human Brain: Anatomy,Functions, and
Injury
Symptoms and functional
manifestations individuals
with brain injury or their
family members may
describe and MAPs
Resource Specialists may
detect
Physical Challenges They
May Report
• Dizziness,
headaches
• Sleep problems
• Diminished
taste/smell
• Tremors/ataxia/poor
coordination
• Speech problems
(reduced rate,
slurring, stuttering)
• Seizures
• Hearing impairment
• Double vision, visual
field cut, tunnel
vision
• Fatigue
• Hemiparisis
Cognitive/Thinking Challenges
They May Report
• Memory, especially for information
recently read or heard
• Trouble organizing themselves, their
day, their household
• Can’t multi-task anymore
• Have difficulty in social/work situations
following the conversation if more than
one person is talking
• Easily distracted (can’t read the paper if
the TV is on)
Cognitive/Thinking Challenges
You May Detect
• Difficulty staying on
topic
• Vague, unclear
language
• Perservation
(repeating
themselves)
• Confused
• Memory lapses
• Very concrete in
their thinking (poor
abstract thinking,
doesn’t get jokes)
• Talks too loud/too
fast
• No first hand
memory of injury
Other Clues to
Cognitive/Thinking Challenges
• Difficulty following
directions
• Might have difficulty
with simple
orientation
questions
• Aggressive or
hostile response to
seemingly benign
questions
• Delayed response
time to your
questions
• Tangential
responses to your
questions
• Confabulation (hard
to determine at first
interaction)
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Personality and Behavioral
Challenges They May
Report
Depression
Anxiety
Moody/Irritable
Loss of/or strained relationships
Insomnia
Substance use/abuse
Personality and Behavioral
Challenges You May Detect
• Impulsivity
• Poor judgment
• Flat affect
(noticeable in
speech pattern)
• Sexually
Disinhibited
• Emotionally labile
• Substance
Use/Abuse
• Aggression
• Poor initiation
Lack of Awareness
AKA
Anosognosia
A common and difficult to remediate hallmark of
a brain injury
“Emergence of Self
Awareness is the Highest of
all Integrated Activities of the
Brain”
Stuss & Benson 1986
Commonly seen Scenarios
Growing into Brain Injury
• Great physical recovery, good initial
cognitive recover
• Returns to school, behind peers
• Academically challenged
• Acts out behaviorally, if the injury
several grades back, not recognized
as TBI related
Continued….
• Drifts after graduation from high
school
• Gets in with the “wrong” crowd
• At risk for mental health issues,
substance abuse, criminal activity,
burn out families and supports
Lack of Awareness X Impulsivity +
Substance Abuse = Crisis
• Severe brain injury with excellent physical
recovery
• Rejects outpatient therapy
• Impulse control, memory problems, work
dries up
• Drugs and Alcohol
• Marriage on the rocks
• Near tragic interaction with a state trooper
• Resolution
“Unidentified traumatic brain
injury is an unrecognized major
source of social and vocational
failure”
Wayne Gordon, Ph.D of the Brain Injury Research Center at
Mount Sinai School of Medicine
Quoted in the Wall Street Journal 1.29.08
Individuals with Brain Injury are
Overrepresented in the Following
Populations
• Incarcerated individuals
• Homeless individuals
• Victims and perpetrators of domestic
violence
• Individuals with behavioral health
disorders (mental health and/or
substance abuse)
• Service members returning from Iraq
and Afghanistan
Treatment and
Rehabilitation
Typical Course of Treatment for
a Severe Brain Injury
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Treatment at a Trauma Center
ICU/Acute Care
Inpatient Rehabilitation
Outpatient Rehabilitation
Other Community Services
Treatment Plan can include therapy
and services from the following……
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Physical Therapy
Occupational Therapy
Speech Therapy
Cognitive Therapy
Social Work
Psychology
Recreation Therapy
Case Management
Nursing
Physician (rehab medicine, neurology)
Neuropsychology
Important Things to
Remember:
 A person with a brain injury is a unique individual first
 No two brain injuries are exactly
the same
 The effects of a brain injury are
complex and vary greatly from
person to person
 The effects of a brain injury
depend on such factors as
cause, location and severity
 THUS…each person’s recovery and
treatment process is unique to them
Factors that can determine
the course of treatment:
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Family support
Finances
Insurance
Age
Co-occurring mental health and substance
abuse issues
• Level of Education
• Geographical location
• Other resources and supports in the
community
When do people ask for
help ?
• When the person is initially injured
• When they hit a “bump in the road”
• Further down the recovery curve, when they
are looking for services and never received
them initially
• When they know something isn’t right and
they are reaching out for education,
validation, and support
• Aging parents with adult children with TBI
Who are the other sources of support
and resources that complete this
picture?
• Specialty clinics, i.e.concussion, mild TBI, sleep,
etc.
• Neuropsychologists
• Medical specialists—
headache, pain, neuroopthamologists, physiatrists,
neuropsychiatrists,
neurologists, etc.
• Vocational counselors
• State vocational
rehabilitation counselors
(DORS)
• Attorneys
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Private case managers
Insurance case managers
Psychotherapists
Educators and school
personnel
Addictions Specialists
Other advocacy agenciesC.I.L., MDLC, etc.
Pediatric resources
Developmental Disabilities
Administration
Support groups
Please refer to the Brain Injury
Resource Handout for a additional
information and educational
materials