Introduction to Traumatic Brain Injury

1. Introduction to Traumatic Brain Injury Training for Human Service and Behavioral Health Professionals

2. Match the Person to the Disability They are Living With • George Clooney • Montel Williams • Justin Timberlake • Catherine Zeta Jones • Tom Cruise • Multiple Sclerosis • Traumatic Brain Injury • Bipolar Disorder • Dyslexia • Obsessive Compulsive Disorder

3. Following Today’s Training, you should be able to: • Identify the leading causes of TBI in the United States • Name three common physical impairments after TBI • Name three common impairments after TBI • Name three common behavioral health impairments after TBI • Describe three compensatory strategies or supports individuals living with brain injury can use to enhance independence and functioning at home, work and community

4. According to data published by the Centers for Disease Control and Prevention 2010: • At least 1.7 million Americans sustain a TBI each year • 275,000 are hospitalized • 52,000 die of their injuries • 75% of all TBI’s are concussions • For every age group, TBI rates are higher for males than females

5. Leading Causes of TBI • Falls-35.2% • Motor Vehicle Accidents-17.3% • Struck by/Against-16.5% • Assault-10%

6. TBI Definitation“A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain”

9. Executive Skills:The ability to look a problem or situation, develop a plan or approach to solve or manage the problem or situation, execute the plan, and here is the critical component that can be affected after TBI; the ability to modify or change the plan if it isn’t working. In other words, to be able to efficiently develop and go to Plan B if Plan A is not working

10. Common Areas of Physical Changes & Challenges • Motor skills/Balance • Vision • Spasticity/Tremors • Speech • Fatigue • Seizures • Taste/Smell

11. Common Areas of Cognitive Changes & Challenges • Memory • Attention • Concentration • Processing • Aphasia/receptive & expressive language • Problem solving • Organization • Perception • Perception • Persistence • Inflexibility

12. Common Areas of Emotional and Behavioral Consequences of TBI • Depression • Anxiety • Emotional Lability • Difficulty Reading Verbal & Nonverbal Social Cues • Reduced Frustration Tolerance • Substance Abuse

13. “Depression diagnosed postinjury is thought to be a product of multiple biopsychosocial factors, including neuroanatomical or pathophysical changes (i.e., brain lesions and specific location of lesions) and psychosocial factors such as concerns about disability or poor functional status” Guillamondegui et. al. Traumatic Brain Injury and Depression. Comparative Effectiveness Review No. 25. AHRQ Publication No. 11-EHC017. Rockville MD: Agency for Healthcare Research and Quality. March 2011

15. TBI and Alcohol • Alcohol may negatively affect the process of dendrite profusion thus impede ability of the remaining neurons to compensate for the neurons that have been damaged (Corrigan, NASHIA Webcast 2003) • Alcohol use after TBI may increase the risk of seizure • Increased brain atrophy observed in patients with a positive BAL and or history of moderate to heavy pre-injury use (Bigler et al. (1996) . Traumatic brain injury, alcohol and quantitative neuroimaging: preliminary findings. Brain Injury, 10 (3), 197-206

16. TBI and Alcohol • Between 37-51% of individuals hospitalized for TBI were intoxicated at the time of injury & have a history of alcohol misuse • Individuals with a history of pre-injury alcohol use have a more complicated course of recovery and generally poor rehabilitation and social outcomes • Parry-Jones BL., Vaughan FL., Miles Cox w. (2006) Traumatic Brain Injury and Substance Misuse: a systematic review of prevalence and outcomes research (1994-2004) Neuropsychological Rehabilitation October;16(5):537-60

17. Strategies to Support Individuals Living with Brain Injury • Use of a journal/calendar • Create a daily schedule • “To do” lists and shopping lists • Labeling items • Use of a high lighter (RED) • Alarms (on phone, watch, smart device) • Use of a digital recorder

18. Strategies to Support Individuals Living with Brain Injury • Break tasks into small manageable steps (AKA “chunking”) • Use of rest and low activity periods, naps are to be encouraged! • Work on accepting feedback or coaching from others, consult and collaborate with trusted individuals • Rehearse Review and Practice! (facilitates procedural memory) • Encourage individuals to paraphrase back to others what they understood them to say, in their own words

19. What it Might Feel Like

20. Procedural Learning In Action!

21. Break into Groups of 4-6You have three minutes to generate 2 closed answer questions and 1 open question based on what you have learned so farPut your notes/handouts face downQuiz round robinAdapted from Dr. SivasailamThiagaraianPh.D, aka “Thiagi “Interactive Techniques for Instructor-Led Training” October 5, 2012 workshop at University of Baltimore Maryland, Baltimore County

22. Strengths, Strategies and Barriers, Diagnosing “The Lookout”

23. Evaluation

24. Evaluation & Closure

25. For Information Regarding the Maryland Mental Hygiene Administration’s TBI Initiatives and Training Opportunities for Behavioral Health Professionals,Please contact Anastasia Edmonston MS CRCanastasia.edmonston@maryland.gov