Update on Update on Closed Head Closed Head
InjuriesInjuries
Sponsored bySponsored by
Barss Residential Long Barss Residential Long Term CareTerm Care
January 15, 2009January 15, 2009
Fort Gratiot, MIFort Gratiot, MI
www.barssresidential.comwww.barssresidential.com
GoalsGoals
Appreciate impactAppreciate impact
Improve careImprove care
Encourage preventionEncourage prevention
ObjectivesObjectives
Describe primary causes Describe primary causes
Describe how the brain worksDescribe how the brain works
Utilize strategiesUtilize strategies
Discuss preventionDiscuss prevention
OutlineOutline
What they areWhat they are
Why importantWhy important
Who is at riskWho is at risk
How brain injury impacts functionHow brain injury impacts function
What you can doWhat you can do
Traumatic brain injury Traumatic brain injury (TBI)(TBI)
An injury to the brainAn injury to the brain
caused by externalcaused by external
trauma to the head ortrauma to the head or
violent movement of violent movement of thethe
headhead
Thurman et al., Thurman et al., 19941994
PrevalencePrevalence
In In Michigan...Michigan...
200,000 citizens live with 200,000 citizens live with disabilitiesdisabilities
2,500 new citizens per 2,500 new citizens per yearyear
1,500 fatalities in 20041,500 fatalities in 2004
Major Causes of TBI in MichiganMajor Causes of TBI in Michigan
Motor Vehicle – cars, motorcycle, recreational vehicles.
Motor Vehicle – cars, motorcycle, recreational vehicles.
Violence – substance abuse related, domestic, and shaken baby syndrome.
Violence – substance abuse related, domestic, and shaken baby syndrome.
Falls – primarily among elderly and children.
Falls – primarily among elderly and children.
Blast - "Signature Wound"
In Michigan...In Michigan...
SeveritySeverity
Mild (75%)Mild (75%) 1-3 months1-3 months
Moderate (10-30%)Moderate (10-30%) 1 year1 year
Severe (5-10%)Severe (5-10%) higher risk for long higher risk for long
term disabilityterm disability
Post acute care should be Post acute care should be based on assessment of based on assessment of
current functioning rather current functioning rather than on diagnosis of severity than on diagnosis of severity
made immediately after injurymade immediately after injury
What happensWhat happens
Primary eventsPrimary events
Axonal shearingAxonal shearing
ContusionContusionBruisingBruisingBleedingBleeding
Depressed skull fractureDepressed skull fracture
Secondary eventsSecondary events
Swelling (cerebral edema)Swelling (cerebral edema)
HematomaHematoma
Increased intracranial pressureIncreased intracranial pressure
AnoxiaAnoxia
ConsequencesConsequences
No two are alikeNo two are alike
Minority of survivors have long-term, Minority of survivors have long-term, physical signsphysical signs
Cognitive/Behavioral/EmotionalCognitive/Behavioral/Emotional
Physical ConsequencesPhysical Consequences
PainPain
Swallowing and speechSwallowing and speech
SensorySensory
FatigueFatigue
Body movementBody movement
Behavioral Behavioral ConsequencesConsequences
Emotional dyscontrolEmotional dyscontrol
Social inappropriatenessSocial inappropriateness
Difficulty with relationshipsDifficulty with relationships
Lack of response to social cuesLack of response to social cues
Mood swingsMood swings
Cognitive consequencesCognitive consequences
Slower processingSlower processing
Language difficultiesLanguage difficulties
InattentionInattention
Poor concentrationPoor concentration
Memory deficitsMemory deficits
Brain Behavior Brain Behavior RelationshipsRelationships
Brain-behavior Brain-behavior relationshipsrelationships
RightRight The big pictureThe big picture
Visuospatial Visuospatial relationshipsrelationships
Self-awareness Self-awareness
CreativityCreativity
Visual memory Visual memory
Brain-Behavior Brain-Behavior RelationshipsRelationships
LeftLeft LanguageLanguage
Emotional regulationEmotional regulation
Verbal memory Verbal memory
LogicLogic
SequencingSequencing
Brain-Behavior Brain-Behavior RelationshipsRelationships
FrontalFrontalParietalParietalOccipitalOccipitalTemporalTemporalBrain stemBrain stemHippocampusHippocampusAmygdalaAmygdala
Frontal lobeFrontal lobe
Executive Executive functionfunction Purposeful Purposeful
behaviorbehavior Complex Complex
reasoningreasoning OrganizationOrganization Problem solvingProblem solving FlexibilityFlexibility SpeakingSpeaking
Frontal lobeFrontal lobe
InitiationInitiation
Self-monitoringSelf-monitoring
Inhibition Inhibition
JudgmentJudgment
Temporal LobeTemporal Lobe
MemoryMemory
Understanding Understanding languagelanguage
Organizing and Organizing and sequencingsequencing
HearingHearing
Standing in the Standing in the Shoes...Shoes...
Susan WehrySusan Wehry
Standing in the Standing in the Shoes...Shoes...
Standing in the Standing in the Shoes...Shoes...
ComplexComplex
•Mild to severe
•Different areas
•Multiple areas
•Recovery varies
RecoveryRecovery
Weeks Weeks Years Years
LifelongLifelong
UniqueUniquePre-injury personalityPre-injury personalityLearning styleLearning styleLocation and severityLocation and severityPsychological Psychological
reactionreactionFamily involvementFamily involvement
RehabilitationRehabilitation
Functional assessmentFunctional assessment
Targeted to specific strengths, Targeted to specific strengths, deficitsdeficits
Family involvement and support Family involvement and support criticalcritical
RehabilitationRehabilitation
CognitiveCognitive
SpeechSpeech
OccupationalOccupational
PhysicalPhysical
SocialSocial
Primary PreventionPrimary Prevention
CausesCauses Seat beltsSeat belts Environmental hazardsEnvironmental hazards Conflict resolutionConflict resolution
Risk factorsRisk factors AgeAge GenderGender AlcoholAlcohol
Secondary PreventionSecondary Prevention
Physical deficits may Physical deficits may further injury further injury Attend to risk of falls, chokingAttend to risk of falls, choking
Cognitive deficits Cognitive deficits further disability further disability Target rehabilitation towards strengthsTarget rehabilitation towards strengths
What you can doWhat you can do Personal preventionPersonal prevention
Share what you've Share what you've learnedlearned
Act as an advocateAct as an advocate
Become involvedBecome involved Brain Injury Brain Injury
Association of Association of MichiganMichigan
References and References and ResourcesResources
www.cdc.gov/ncipc/tbi/TBI.htm
www.mitbitraining.org/
http://www.bianys.org/veterans/BeyondTheInvisible320x240.wmv
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