Stroke or Cerebral Vascular Accident (CVA): a disruption of blood flow (thrombi emboli) in the brain; aneurysms; arteriovenous malformations; and intracerebral hemorrhage.

Anoxic Injury: damage to the brain due to lack of oxygen or reduced flow of oxygen.

Other Encephalopathies: damage to the brain caused by infections (e.g., meningitis, encephalitis), tumors, and metabolic disorders.

Every 21 seconds, one person in the US sustains a TBI

1.5 million Americans will sustain an TBI this year

80,000-90,000 people annually experience the onset of long-term disabilities following TBI

An estimated 5.3 million Americans-a little more than 2% of the US population-currently live with disabilities resulting from TBI

Each year 500,000 Americans are hospitalized and over 200,000 will demonstrate persistent cognitive, physical and/or emotional deficits that will prevent functioning at pre-injury levels

Males aged 15-24 and persons older than 75 years of age have the highest incidence of TBI

5

Source: ISDH, Epidemiology Resource Center, DAT

6

Source: ISDH, Epidemiology Resource Center

* According to the Centers for Disease Control and Prevention  

Measure Mild Moderate Severe

Glasgow Coma Scale 13 –15 9 – 12 3 – 8

Loss of consciousness < 20 min 20 min – 36 hr > 36 hr

Posttraumatic amnesia < 24 hr 1 – 7 days 7 days

An estimated 15% of persons who sustain a mild brain injury continue to experience negative consequences one year after injury

Repeated mild brain injuries occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits

Repeated mild brain injuries occurring within a short period of time (i.e., hours, day, or weeks) can be catastrophic or fatal

Sleep◦ Sleeping more, Sleep less, difficulty falling to

sleep Emotion/ Mood

◦ Irritability, Sadness, Anxiety Physical

◦ Headache, Nausea, Sensitivity to light Feeling tired

Thinking/ Remembering ◦ Difficulty thinking, Feeling slowed, Difficulty

concentrating, Difficulty remembering

Mild A B I

ER Home

Hospital if medical or physical

complications

Short-term Residential

Outpatient

Moderate A B I

ER

Hospitalization for medical stabilization

Acute Rehab

Inpatient

Subacute Inpatient

Home Residential

Severe A B I

ER

Hospitalization for medical stabilization

Acute Rehab

Inpatient

Subacute Inpatient

Long Term Care

Facility

Residential Programs

Home

Mobility Cognition Communication Health Self-help skills Household management Community skills Leisure skills Vocational

Short-term memory loss Long-term memory loss Slowed ability to process information Trouble concentrating or paying attention

for periods of time Difficulty keeping up with a conversation;

other communication difficulties such as word finding problems

Spatial disorientation Organizational problems and impaired

judgment Unable to do more than one thing at time

(multi-task) A lack of initiating activities, or once

started, difficulty in competing tasks without reminders

Safety-awareness deficits

Receptive - ability to understand others

Expressive - ability to express one’s self to others

Muscle spasticity or flacidity Mobility Contractures Coordination/Dexterity Fatigue/endurance Balance problems

Aggressive behavior/verbal outrages Increased Anxiety Depression and mood swings Impulsive behavior More easily agitated Egocentric behaviors; difficulty seeing how

behaviors can affect others Withdrawal/lack of engagement Depression

Motor functioning

Vision & Hearing

Taste & Smell

Swallowing

Endurance

Urinary Disorders Seizures Disorders Sleep Disorders Headaches or migraines Pain Arthritis Aspiration pneumonia

“The development of the person to the fullest physical, psychological, social, vocational, avocational and educational potential consistent with his or her physiological or anatomical impairments and environmental limitations.”

Whyte & Rosenthal (1988)

The development of a means for measuring and predicting functional outcome post-brain injury is of critical importance if realistic goals are to be formulated to assist the person to resume independence to the maximum level possible.

Outcome is defined as: “The adequacy with which a patient’s lifestyle is resumed including the efficiency with which he performs the activities of daily life” (Levin, Benton, & Grossman, 1982).

Pre-injury Factors: Pre-injury History

General Health Prior history of brain injury

Age at Time of Onset Psychosocial Issues Educational Level Employment History

Injury Factors: Severity of Injury Etiology and Location Type of Injury

Anoxic, Traumatic, Etc. Coma Depth and Duration Post-traumatic Amnesia Complicating Medical Factors Access to Acute Care

Post-injury Factors: Time Elapsed Since Injury Socio-economic Status Nature and Extent of Financial Resources Motivation Level of Self Awareness, Self Control and Coping

Skills Religious and Spiritual Beliefs Psychosocial Issues Access to a Continuum of Care

Examples of Services Available in the Continuum of Care

Hospital-Based ServicesTrauma System/ERAcute Rehabilitation

After-Hospital ServicesSkilled Nursing Facility (Sub-Acute)Post-Acute TreatmentTransitional Treatment (Short Term)Long-Term Rehabilitation (6-12 months)Outpatient Treatment

Supported Living Programs

Occurs in naturalistic settings.

Integrated into common daily routines.

Offers a structure within which learning can occur

and through which autonomy and self-reliance

is fostered.

Designed and carried out by trained staff

Intended to empower the individual.

1. Identify important skills individual can do independently,

with assistance, and those that cannot be done.2. Based on abilities and disabilities identified, assist

individual to develop realistic long-term plan (include specification of discharge environment).3. Determine abilities or outcomes individual will need to achieve the plan.4. Identify long-term goals that must be met to acquire the

necessary abilities.5. Break long-range goals into specific short term objectives.6. Design a plan for assisting individual to meet objectives.7. Evaluate progress on basis of measurable outcome criteria.8. Based on regular reviews, revise Steps 1-7 as necessary.

Person-centered: individual should be included in identification and design of the treatment plan.

Supportive: plan’s design should make it very likely that the individual will succeed (especially in the early stages).

Simplicity: plan should be easy for staff and individual to understand.

Consistency: plan must be implemented as consistently as possible.

Flexibility: plan must be flexible enough to adapt to changes in the individual.

Positive: staff should discuss the person’s successes.

1. Ability of the family to listen.2. Shared and common perceptions of reality

within the family.3. Spirituality of the family.4. Ability of the family to realize the

redemptive power of a seemingly tragic event.

5. Ability of family members to take responsibility for disability-related problems.

6. Ability of family members to use negotiation in family problem solving.

7. Family members’ willingness to take good care of themselves.

8. Family’s ability to focus on present, rather than on past events.

9. Ability of family members to provide reinforcements for each other.

10. Ability of family members to discuss concerns.

11. Ability of family members to provide an atmosphere of belonging.

12. Family’s effective trans generational coping strategies

Brain Injury Association of Indiana◦ BIAI.ORG

Defense and Veterans Center for Brain Injury

DVBIC.GOV

Contact your local VAVA.GOV

Robbie Schmidt, LCSWProgram Director317-771-1875