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Traumatic Brain Injury

Traumatic Brain Injury. What is Traumatic Brain Injury (TBI)?. Two types of brain injury occur. Closed brain injury Open brain injury. Closed Head Injury. Resulting from falls, motor vehicle crashes, etc. Focal damage and diffuse damage to axons Effects tend to be broad (diffuse)

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Traumatic Brain Injury

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  1. Traumatic Brain Injury

  2. What is Traumatic Brain Injury (TBI)?

  3. Two types of brain injury occur • Closed brain injury • Open brain injury

  4. Closed Head Injury • Resulting from falls, motor vehicle crashes, etc. • Focal damage and diffuse damage to axons • Effects tend to be broad (diffuse) • No penetration to the skull

  5. Open Head Injury • Results from bullet wounds, etc. • Largely focal damage • Penetration of the skull • Effects can be just as serious

  6. What Happens Immediately After TBI?

  7. TBI: A biological event within the brain • Tissue damage • Bleeding • Swelling

  8. TBI: Changes in functioning • Loss of consciousness/coma • Other changes due to the TBI • Post-traumatic amnesia (PTA)

  9. Injured Brain • Does not mend fully • Leads to problems in functioning

  10. What Do We Mean by Severity of Injury • Amount of brain tissue damage

  11. How to measure “severity”? • Duration of loss of consciousness • Initial score on Glasgow Coma Scale (GSC) • Length of post-traumatic amnesia • Rancho Los Amigos Scale (1 to 10)

  12. Mild injury 0-20 minute loss of consciousness GCS = 13-15 PTA < 24 hours Moderate injury 20 minutes to 6 hours LOC GCS = 9-12 Severe injury > 6 hours LOC GCS = 3-8

  13. What Happens as the Person with Moderate or Severe Injury Begins to Recover After Injury?

  14. Recovery • A multi-stage process • Continues for years • Differs for each person

  15. What is the Long-term Impact of a Moderate or Severe TBI in the Person’s Functioning?

  16. Impact depends on • Severity of initial injury • Rate/completeness of physiological recovery • Functions affected • Meaning of dysfunction to the individual • Resources available to aid recovery • Areas of function not affected by TBI

  17. Areas of function affected • Cognition

  18. Cognitive functions • Attention • Concentration • Memory • Speed of Processing • Confusion • Perseveration • Impulsiveness • Language Processing • “Executive functions”

  19. Areas of function affected • Cognitive • Sensory/Perceptual

  20. Sensory/perceptual functions • Vision • Hearing • Smell • Vestibular • Taste • Touch • Balance

  21. Areas of function • Cognitive • Sensory/perceptual • Seizures

  22. Areas of function affected • Cognitive • Sensory/perceptual • Seizures • Other physical changes

  23. Other physical changes • Physical paralysis/spasticity • Chronic pain • Control of bowel and bladder • Sleep disorders • Loss of stamina • Appetite changes • Regulation of body temperature • Menstrual difficulties

  24. Areas of function affected • Cognitive • Sensory/perceptual • Seizures • Other physical changes • Social-emotional

  25. Social-emotional • Dependent behaviors • Emotional lability • Lack of motivation • Irritability • Aggression • Depression • Disinhibition • Denial/lack of awareness

  26. Recovery vs. “improvement”

  27. Permanence of change? • Physical recovery • Reeducation of the individual • Environmental modifications

  28. What Happens With Mild (or Minor) TBI?

  29. Mild TBI • Lesser levels of brain damage • Brief or no loss of consciousness • Often referred to as ‘concussion’

  30. Mild injury is important to discuss • Long-term impact for 15% • Don’t see that TBI is cause of deficits • Repeated injury leads to problem emergence-”second impact syndrome” • 300,000 sports and recreational injuries • CT, MRI and EEG are usually normal

  31. Effects of mild TBI: outcomes • Problems disappear on their own in about 85% of cases • Compensatory skills acquired • Education prevents emotional upset (“shattered sense of self”)

  32. Effects of mild TBI: outcomes • Problems are not attributed to TBI • Compensatory skills are not learned • Best approach is early education and information • Best rehab assessment is neuropsychology

  33. How is TBI Different (or the Same) for Those Injured as Children.

  34. Children • Brain still developing • Brain more flexible than adult’s • Fewer educational “building blocks” • Effects may not emerge immediately • Follow the child over time

  35. How Common is TBI, and Who is the Typical Person with TBI?

  36. Who is the typical person with TBI? • 4:1 ratio, males to females • 15 to 25 years of age • 1.5 million brain injuries per year in US • Alcohol is the leading risk factor

  37. Adolescents and young adults: highest rate Aged: second highest

  38. What is the Course of Treatment for Those with TBI?

  39. Integrated System of Care • Inpatient Rehabilitation Programs • Coma Recovery Programs (rarely used) • Extended Care Programs ( typically inappropriate) • Outpatient Programs • Community Support Services

  40. Community/Post Acute Services • Outpatient In clinic At home/work/community

  41. Community/Post Acute Services • Residential • neurorehabilitation/transitional living • neurobehavioral intensive • long-term supported living

  42. Brain Injury Association of PA • Biapa.org • Brain Injury Resource Line 1-866-635-7097 • biausa.org

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