Recognizing and Screening for Brain Injury

1. Recognizing and Screening for Brain Injury Peggy Reisher, MSW, Executive Director

2. Brain Injury 101

3. Nebraska Facts • An estimated 36,000 Nebraskans are living with disability due to TBI. • Over 8000 Nebraskans joined the Nebraska Brain Injury Registry July 2016 to Aug. 2017

4. Leading Causes of Brain Injury • 1st - Falls are the leading cause of TBI • Account for 55% of TBI in children 0-14 years old • Account for 81% of TBI in adults aged 65 and older. • 2nd -Being Struck by or Against an Object or Person • 3rd – Motor Vehicle Traffic Incidents • 4th – Assaults • Information shared by CDC

5. Interesting Comparisons

6. Brain Injury - Defined Acquired Brain Injury-ABI • Injury to the brain, which is not hereditary, congenital or degenerative, that has occurred after birth. These include brain tumors, anoxia/hypoxia, infections of the brain, stroke, aneurysm, ingestion of toxic substances. Traumatic Brain Injury-TBI • Injury caused by a bump, blow, or jolt to the head; or a penetrating head injury that disrupts the normal function of the brain. TBI includes concussion and shaken baby syndrome. This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-NC-ND

7. What This Might Look Like

8. Generalized Core Functions by Lobe

9. Oxygen deprivation The brain’s blood supply Hypoxic/Anoxic injury • 3 major sets of arteries • Areas of overlap between arteries are most susceptible to oxygen deprivation

10. Physical Effects of BI • Balance and walking problems because of dizziness. • Headaches • Fatigue • Sleep disturbance • Nausea/vomiting • Visual Disturbances • Sensitivity to light • Ringing in the ears • Disorders of taste and smell

11. Cognitive Effects of BI • Attention and concentration problems • Memory • Slowed thinking (feeling foggy) • Learning and memory problems • Executive Function problems • Processing problems • Planning • Insight and Awareness • Sequencing

12. Social-Emotional Effects of BI • Lack of motivation • Lack of inhibition • Aggression • Self centeredness • Social isolation Irritability Anxiety Depression Mood Swings Impulsivity Denial/lack of awareness This Photo by Unknown Author is licensed under CC BY-NC

13. Course of Recovery • Domains may resolve at different rates • Areas of recovery may effect one another

14. Distribution of Severity • Mild injuries = 80%(Loss of consciousness < 30 min, Post traumatic amnesia < 1 hour). May not show up for hours or days. • Moderate = 10%(LOC 30 min-24 hours, PTA 1-24 hours). Notice immediately and need urgent care. • Severe = 10%(LOC >24 hours, PTA >24 hours) Notice immediately and need urgent care.

15. Mild Brain Injury (AKA Concussion) • Mild TBI is often a preventable public health issue. • 80-90% recover in 1-4 weeks. • No obvious structural changes to the brain. • People may also be completely unaware. • Effects of TBI can have a significant effect on responsiveness/utilization of resources. • Recognition and management is key.

16. Populations at risk

17. Adult Incarceration • 60% of all individuals in the criminal justice system screen positive • Incarcerated Survivors of TBI: • Commit a far greater number of conduct violations and infractions. • Are often mistaken as noncompliant. • When engaged in therapy, require 2-3X the amount of services to achieve success. • Almost 2X as likely to be re-arrested within their first year. RHI Study done in IN

18. Juvenile Justice System • 32% to 72% of those in Juvenile Justice System have TBI. • Despite high rates of TBI, most facilities don’t screen therefore injured offenders go undiagnosed, unrecognized, and untreated. • Most common causes are 1) Assault, 2) Falls, 3) Sports related injuries, 4) MV crashes • Adolescents with a TBI: • Commit more criminal offenses • Higher rates of conduct disorder and substance abuse Journal of Head Trauma Rehabilitation, 2017

19. Brain Injury & ViolenceDomestic Violence • 58% screened positive for a possible brain injury. • 91% hit in the head or strangled. 65% no medical treatment for their injury. • 48% hit 1-3 times, 31% hit 6+ • What about their children?

20. Undiagnosed Brain Injuries • “Hidden” Disability can cause: • Drop out • Start misusing substances • Fail at relationships • Become victims • Become homeless • End up in mental health systems • Be unable to obtain or maintain employment • Get into trouble with the law

21. Can not vs. Will not • The relationship between disabilities and delinquency is not causal, however; • There is evidence to support that disabilities may increase an individuals susceptibility to engage in antisocial and delinquent behavior

22. Screening for brain injury

23. Why Screen for Brain Injury • Not a visible disorder • Some people may not know that they have had a brain injury • Documentation of a history of may not be found in medical records

24. H- Have you ever had a hit to your head or been strangled or choked? • If yes, when was your head hit or when were you strangled or choked? Was it: (check all that apply) • Within the year? • 1- 2 years ago? • 3-4 years ago? • Longer than 4 years ago? • As a child? • Please describe how it happened. Did it happen: • Playing sports? • Riding a bike? • Were you wearing a helmet? • From a fall? • From an assault or fight? • Were you pushed, punched, shaken, or strangled? • In a car accident? • Did you receive whiplash or have a violent shaking of your head or neck? • From almost drowning? • Did you experience lack of oxygen for a significant amount of time? • Given the questions above, how many times had your head been hit or you were strangled? • 1-3 • 4-6 • More than 6

25. E- Were you ever seen in the emergency room, hospital, or by a doctor because of a hit to your head or because of strangulation or choking? • If yes, were you seen by a: • Doctor • Nurse • Other medical professional • Were you given follow-up recommendations? • Yes • No • Did you follow the recommendations? • Yes • No

26. L- Did you ever lose consciousness or experience a period of being dazed and confused because of a hit to the head or due to strangulation or choking? • If yes, for how long did you feel dazed or confused: • Hours • Days • Months • How many times have you felt this way: • 1-3 • 4-6 • More than 6

27. P-Do you experience any of these problems in your daily life because of a hit your head or due to strangulation or choking? • If yes, since the injury, have you experienced or are you experiencing: (mark all that apply) • Headaches? • Dizziness? • Nausea? • Sensitivity to light? • Blurred or double vision? • Numbness or weakness in any of your limbs? • Insomnia, difficulty sleeping, or changes in your sleeping patterns? • Feeling irritable or impatient? • Feeling anxiety or depression? • Confusion? • Difficulty remembering? • Difficulty concentrating or focusing? • Challenges with going back to school or work and performing the tasks you used to? • Do you think any of the problems are related to a head injury? • Yes • No • Uncertain

28. Treatment and Support

29. Diagnosis Diagnosis begins with talking to a health care provider about: • How the injury happened • The area of the injury with the degree of force • Loss of consciousness or dazed; if so, how long • Any changes in behavior, awareness, speech, or coordination

30. Specialized Medically Based Treatment Hospital and Outpatient based treatment • Assessment (Mild TBI Clinic) • Interdisciplinary Therapy

31. Brain Injury Treatment Team

32. Beyond the hospital • Individuals and families need help in overcoming the adjustment to the new normal • Small environmental supports can make a big difference.

33. Brain Injury Specific Resources • Brain Injury Alliance of NE • Biane.org • CDC • cdc.gov/traumaticbraininjury • Brainline • brainline.org

34. Resource Facilitation • Provides brain injury education • Navigate brain injury-specific, community and vocational supports and services • Collaborates with providers and community-based resources.

35. Thank you! Peggy Reisher, MSW, Executive Director peggy@biane.org, 402-890-0606