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Traumatic Brain Injury
Presented by:David L Strauss, Ph.D.
ReMed
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)
• No penetration to the skull
Open Head Injury
• Results from bullet wounds, etc.
• Largely focal damage
• Penetration of the skull
• Effects can be just as serious
What Happens Immediately After TBI?
TBI: A biological event within the brain
• Tissue damage
• Bleeding
• Swelling
TBI: Changes in functioning
• Loss of consciousness/coma
• Other changes due to the TBI
• Post-traumatic amnesia (PTA)
Injured Brain
• Does not mend fully
• Leads to problems in functioning
What Do We Mean by Severity of Injury
• Amount of brain tissue damage
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)
Mild injury0-20 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
What Happens as the Person with Moderate or Severe Injury Begins to Recover After Injury?
Recovery
• A multi-stage process
• Continues for years
• Differs for each person
What is the Long-term Impact of a Moderate or Severe TBI in the
Person’s Functioning?
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
Areas of function affected
• Cognition
Cognitive functions
• Attention• Concentration• Memory• Speed of Processing• Confusion
• Perseveration• Impulsiveness• Language Processing• “Executive functions”
Areas of function affected
• Cognitive
• Sensory/Perceptual
Sensory/perceptual functions
• Vision• Hearing• Smell• Vestibular
• Taste• Touch• Balance
Areas of function
• Cognitive
• Sensory/perceptual
• Seizures
Areas of function affected
• Cognitive
• Sensory/perceptual
• Seizures
• Other physical changes
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
Areas of function affected
• Cognitive
• Sensory/perceptual
• Seizures
• Other physical changes
• Social-emotional
Social-emotional
• Dependent behaviors
• Emotional lability
• Lack of motivation
• Irritability
• Aggression
• Depression
• Disinhibition
• Denial/lack of awareness
Recovery vs. “improvement”
Permanence of change?
• Physical recovery
• Reeducation of the individual
• Environmental modifications
What Happens With Mild (or Minor) TBI?
Mild TBI
• Lesser levels of brain damage
• Brief or no loss of consciousness
• Often referred to as ‘concussion’
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
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”)
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
How is TBI Different (or the Same) for Those Injured as
Children.
Children
• Brain still developing
• Brain more flexible than adult’s
• Fewer educational “building blocks”
• Effects may not emerge immediately
• Follow the child over time
How Common is TBI, and Who is the Typical Person with TBI?
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
Adolescents and young adults: highest rate
Aged: second highest
What is the Course of Treatment for Those with TBI?
Integrated System of Care
• Inpatient Rehabilitation Programs
• Coma Recovery Programs (rarely used)
• Extended Care Programs ( typically inappropriate)
• Outpatient Programs
• Community Support Services
Community/Post Acute Services
• OutpatientIn clinic
At home/work/community
Community/Post Acute Services
• Residential– neurorehabilitation/transitional living– neurobehavioral intensive– long-term supported living
Brain Injury Association of PA
• Biapa.org
• Brain Injury Resource Line 1-866-635-7097
• biausa.org