Traumatic Brain Injury:Traumatic Brain Injury: The Basics of TBI

Betsy Johnson, MA, CCC-SLPBrain Injury Association of Kansas and Greater Kansas City

Learning Objectives

Causes and consequences of TBI Causes and consequences of TBI How TBI can affect behavior,

relationships and the community How community resources can How community resources can

assist persons with brain injury and ftheir families

Definitions

Traumatic Brain Injury (TBI) is an insult to the Traumatic Brain Injury (TBI) is an insult to the brain caused by an external physical force or trauma; does not refer to the emotional ;trauma the injury causes for the person and family membersy

Acquired Brain Injury (ABI) is an injury to the brain that has occurred after birth. Includes: TBI, stroke, near suffocation, infections in the brain, tumor, etc.

The “Silent Epidemic”

TBI is a largely unrecognized major TBI is a largely unrecognized major public health problemM l d ’t d t d th Many people don’t understand the consequences of TBI or how it affects people

Some brain injuries are not perceived j pas a brain injury For example: A concussion is a type of TBI For example: A concussion is a type of TBI

Scope of the Problem

1.4 million people sustain a brain injury every1.4 million people sustain a brain injury every year as reported in ER visits

TBI is the leading cause of death and gdisability among children and young adults

TBI is the 4th leading cause of death overall CDC estimates 3.17 million people live with

disability from TBI Direct and indirect costs of TBI are about $60

million per year

Approximately 1 in 10 people is touched by

the effects of TBI

Other Stats

Blasts are the leading cause ofBlasts are the leading cause of TBI for active duty military personnel in war zones

More than 50% of all motor vehicle crashes resulting in TBI involve alcoholinvolve alcohol

40% of those hospitalized with TBI had at least 1 unmet needTBI had at least 1 unmet need for services one year post injury

Comparison of Annual Incidence

1400000

1000000

1200000

1400000

600000

800000

1000000

200000

400000

600000

0

200000

MS Spinal CordInjury

HIV/AIDS Breast Cancer TBIInjury

Causes of Traumatic Brain Injury

9%

Falls

28%

13%

9%

MVA

Struck by/against

AssaultAssault

Other

Unknown11%

20%19%

Survival Rates are Increasing

Reasons Reasons Improved medical technology Mandated safety features such as seatbelts child Mandated safety features such as seatbelts, child

safety seats and airbags Resulting ing More people living with the affects of TBI Long term affects are being discoveredg g

Those that have sustained a TBI are at higher risk for Alzheimer’s disease and Parkinson’s disease

Sports Concussions

Research suggests that although there may Research suggests that although there may not be damage to the brain anatomy, there is a disturbance to the brain metabolism

It is estimated that 1.6 to 3.8 million sports related concussions occur yearlyrelated concussions occur yearly

If a player returns to play too soon, could result in Second Impact Syndromeresult in Second Impact Syndrome

From presentation by Jamie Pardini, PhD University of Pittsburgh Medical Center

Risk Factors for TBI

Males are 1 5 times more likely than females Males are 1.5 times more likely than females to sustain a TBI

Age groups at highest risk for TBI are 0-4 Age groups at highest risk for TBI are 0-4 year olds and 15-19 year olds

Certain military duties have a higher risk of Certain military duties have a higher risk of sustaining TBI (i.e. paratroopers)

African Americans have the highest death African Americans have the highest death rate from TBI

No one is immune from sustaining a TBI!

Things to Consider About Brain Injury

Brain injury can change everything about us Brain injury can change everything about us in a matter of seconds

It affects who we are the way we think act It affects who we are, the way we think, act and feel

A person with a brain injury is a person first A person with a brain injury is a person first No two injuries to the brain are alike

N t l th No two people recover the same Effects are complex and vary for each person

Severity Ratings for TBI

Mild Mild Brief or no loss of consciousness; concussion

Moderate Moderate Loss of consciousness that can last a few hours

Severe Severe Prolonged loss of consciousness

S i f TBI d diSeverity of TBI does not predict long-term outcomes!!long term outcomes!!

What Can Change after Brain Injury

CognitiveCognitive Attention, memory, executive function, processing

speed, perception, inflexibility; language skills Physical Motor coordination, spasticity, flaccidity, balance,

weakness changes in any of the 5 sensesweakness, changes in any of the 5 senses Can affect mobility and speech

Emotional/Behavioral Emotional/Behavioral Depression, anxiety, difficulty with relationships,

disinhibition, control of emotions, initiation

Recovery

Measured in weeks, months, yearsMeasured in weeks, months, years Survivors can face long periods of time without

sufficient services Community resources are needed to help fill gaps in

service

50

100

150

Pre-injury Status

Recovery of Skills0

0 3 6 9 12 15 18 21 24 27 30 33 36

Recovery of Skills

Months post-injury (based on FIM scores)Months post injury (based on FIM scores)

References

Specific referencing p gsources for previous slides can be found on Brain Injury Association of America’s website, www.biausa.org,

d h “Abunder the “About Brain Injury” tab.

More about “Attention”

Attention/concentration is considered a foundationAttention/concentration is considered a foundation skill of cognition

This is often impaired following TBI Impaired attention results in difficulties with memory Those with impaired attention can become easily

distracted which leads to frustration Increased frustration leads to decreased ability to

pay attentionpay attention So the cycle goes…

More about “Memory”

There are many types of memoryThere are many types of memory A person can have impairment for some

types of memory and not othersyp y Difficulty with memory can lead to difficulty in

higher level independent living skills Memory strategies can make a person

functional, but many are complex to learn Ability to remember can be different from day

to day – sometimes this is unpredictable

More about “Executive Function”

This is complex skill is found in the brain in the This is complex skill is found in the brain in the frontal lobe – the part behind the forehead

The frontal lobe is very susceptible to damage The frontal lobe is very susceptible to damage Executive Function consists of the highest

level of cognitive skillslevel of cognitive skills Includes: decision making, ability to

organize/prioritize error correction ability toorganize/prioritize, error correction, ability to predict in a novel situation, self regulation

Community Profile 1

Female, age 45 years, fell on the job whileFemale, age 45 years, fell on the job while walking too fast

She did not lose consciousness Scans of her brain came back “clean” Family reports sudden personality changey p p y g She cannot work more than an hour before

becoming very anxious, including panic attacks

She does not have obvious signs of injury

Impact on Family

Some family members have become Some family members have become alienated due to personality changes

Some family members consider her “lazy” Some family members consider her lazy and/or a hypochondriac

Family may have to move to smaller home Family may have to move to smaller home due to decrease in income

Strains on all relationships within family Strains on all relationships within family Roles within family have changed

Community Profile 2

Male age 23 was involved in motor vehicle Male, age 23, was involved in motor vehicle accident

He was in a coma for 2 weeks He was in a coma for 2 weeks Due to severe ataxia (tremors), he is not able

to control muscle movementto control muscle movement He is in an electric wheelchair

H i 24 h He requires 24 hour care He is not able to hold any type of job

Impact on Family

Family’s home had to have physical Family s home had to have physical accommodations made for wheelchair

Family fun activities have been affected Family fun activities have been affected, including annual vacations

One family member had to quit job in order to One family member had to quit job in order to be at home during the day to assist with activities of daily livingactivities of daily living

Strains on finances and family dynamics interfere with relationshipsinterfere with relationships

Community Profile 3

Male age 62 fell while riding a bike Male, age 62, fell while riding a bike Was found unconscious

Swelling of the brain resulted in diffuse Swelling of the brain resulted in diffuse damage affecting higher levels of cognitionN b i h i l i i t No obvious physical impairment

He easily becomes agitated in public places Becomes easily confused, requiring 24 hour

care for redirection purposes only

Impact on Family

His wife has taken on the additional role of His wife has taken on the additional role of primary caregiver, or mothering role

He requires one-on-one attention in public He requires one-on-one attention in public places due to confusion and agitation

Caregivers have been hired to assist with Caregivers have been hired to assist with supervision within the home, adding to his confusion by having strangers aroundconfusion by having strangers around

Friends have distanced themselves due to behavior changesbehavior changes

Community Resources

Profile 1 Profile 1 Family counselling at reduced rate Financial assistance Financial assistance

Profile 2 Respite services during family vacations Respite services during family vacations Assistance with building ramps

Profile 3 Profile 3 Respite services that will not increase agitation Assistance within the community public places Assistance within the community – public places

Contact Information

Brain Injury Association of Kansas and Brain Injury Association of Kansas and Greater Kansas City www.biaks.org www.biaks.org

State of Kansas TBI program website State of Kansas TBI program website www.tbikansas.org

Brain Injury Association of America www biausa org www.biausa.org