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