Traumatic Brain Injury Overview

Successful completion of this training meets one hour of the four hour annual training requirement for Personal Attendant Services direct care staff as provided through the TBI Waiver

Program

• Information included in this presentation was current at the time it was developed.

• Presentation materials are reviewed on an annual basis.

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Disclaimer

Christopher J George, MSW, LGSW, CBISKaylynn Shepherd, LICSW, CBISJeanette Motsch, MS, CBISAmanda M Wilson, M.A.Ashley Young, CBIS

Traumatic Brain Injury Services at the Center for Excellence in Disabilities

Contact information:www.cedwvu.org/programs/tbi

Toll Free: 1-877-724-8244

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Authors

Upon completion of this training participantswill be able to:

• Define Traumatic Brain Injury (TBI)

• Describe the basic anatomy of the brain

• Identify three impairments as a result of Traumatic Brain Injury (TBI)

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Learning Objectives

Traumatic Brain Injury (TBI) isan insult to the brain not of a degenerative or congenital nature caused by an external physical force, that may produce a diminished or altered state of consciousness resulting in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning, may be temporary or permanent and cause partial or total functional disability or psychosocial maladjustment

National Head Injury Foundation(now the Brain Injury Association of America)

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Overview of Traumatic Brain Injury

Medicaid TBI Waiver definition

A non-degenerative, non-congenital insult to thebrain caused by an external physical force resulting

in total or partial functional disability and/or psychosocial impairment

WV TBI Waiver Manual 512.7.2.C. page 19

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• Every 23 seconds, one person in the United States sustains a traumatic brain injury

• Each year, an estimated 1.7 million people sustain a TBI

Centers for Disease Control and Prevention

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Overview of Traumatic Brain Injury

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What are the Causes of TBI ?

Centers for Disease Control and Prevention

The following estimated averages are based annually for the

United States from 2002-2006:

• 1.7 million people will sustain a TBI

• 52,000 people will die resulting from a TBI

• 80,000 people annually experience the onset of long-term disabilities following TBI

• 1.365 million (80%) are treated and released from emergency departments

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How Often Does Brain Injury Occur ?

• TBI by Age• Adults aged 75 years and older have the highest rates of

TBI-related hospitalization and death

• TBI by Gender• In every age group, TBI rates are higher for males than

for females• Males aged 0 to 4 years have the highest rates of TBI-

related emergency department visits, hospitalizations, and deaths

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Who Experiences TBI the Most ?

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By Any Other Name

Traumatic Brain Injury (TBI) is often referred to as some of the following:

• The “Silent Epidemic”

• The “Signature Wound” of returning veterans

• Having your bell rung

Watch the following video“Relearning Everything”

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Real Lives, Real People

http://www.youtube.com/watch?v=-DXKS9uCIc0

2013

Primary Injuries of TBI: The following are some injuries that may occur at the time of

traumatic injury:

• Axonal Shearing (diffuse axonal injury): damage to individual nerve cells (neurons)

o Often seen in car accidents as a result from the brain bouncing against the wall of the skull

• Contusion: bruising of the brain tissueo Often caused by small blood vessel leaks as a result from a fall or car

accident

• Coup-Contrecoup: shaking of the brain back and forth within the confines of the skull

o Often caused when the head slams into a dashboard then jerked back hitting the headrest during a car accident

• Skull Fracture: break in one or more of the bones that make up the skull

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Axonal Shearing (Diffuse Axonal Injury)

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Coup-Contrecoup

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Skull Fracture

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Secondary Injuries of TBI:

The following are some injuries that may occur after the trauma:

• Hematomas: Accumulation of blood or a collection of blood trapped in the tissue of the brain.

• Increased Intracranial Pressure: Pressure inside the skull that builds as the brain swells.

• Seizure Disorder: Disorderly discharge or electrical activity in the nerve cells of the brain.

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Brain Anatomy

• The Brain is comprised of nerve cellso Consistency similar to spaghetti

• The Brain fits tightly within the skullo Surrounded by fluid called cerebrospinal

• The Brain is divided into four lobeso Frontalo Occipitalo Parietalo Temporal

The following link will explain the four lobes of the brain and their functions

Please take a minute and review each lobe provided on the link below

Brain Basics - 3D Model of Brain Injury | BrainLine.org

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Lobes of the Brain

• Frontal o Impaired social behavior o Decrease in problem solving abilitieso Difficulty controlling emotionso Decision making: Often can not see long-term consequences of actions o Memory

• Occipital o Double Vision o Vision field cut

-Part of what a person may see might be cut offExample: When looking at a flower a person may only see the

bottom half of the flower

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Problems Associated with Lobe Damage

• Parietalo Impaired body sensation on affected body partso Decreased awareness of a person’s own body partso Problems judging distances and deptho Trouble controlling eye movements

• Temporalo Impaired sensory information

-Hearingo Can cause problems with communication, comprehension, and memoryo Difficulty with speech

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Problems associated with Lobe Damage

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The Connector : Brain Stem

The Brain Stem is located deep inside the brain and leads to the Spinal Cord

The Brain Stem controls many arousal and basic life functions like the following:

• Respiratory and Cardiac Centerso Breathingo Heart Rateo Swallowing

• Autonomic Nervous Systemo Sweatingo Blood Pressureo Digestiono Body Temperature

• Reflexes to Seeing and Hearing

• Ability to Sleep

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Brain Stem

When someone has experienced damage to the brain stem they may experience

some of the following:

• Dizziness and Nauseao May also be known as Vertigo

• Insomnia

• Difficulty swallowingo May also be known as Dysphagia

• Difficulty with organization/perception of the environment

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Damaged Brain Stem

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Cerebellum: “Little Brain”

Located towards the back of the brain, underneath the occipital and temporal lobes

The Cerebellum is also known as “little brain” because it controls many of the following:

• Movemento Directiono Rateo Forceo Steadiness

• Muscle Tone

• Posture

• Hand/Eye Movement

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Cerebellum

When someone has experienced damage to the cerebellum they may experience trouble with

some of the following:

• Walkingo May appear “drunk” when walking

• Balance

• Fine Motor Movement

• Coordination

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Damaged Cerebellum

• Learning to work with those who have a Traumatic Brain Injury (TBI) takes time

• Recovery time will vary from person to person

• Change and improvement can continue for many years

• Continued communication and consistency will assist with the recovery process

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Remember

U.S. Department of Health and Human ServicesCenters for Disease Control and Prevention, http://www.cdc.gov/TraumaticBrainInjury/

Brain Injury Association of America: The Essential Brain Injury Guide 4.0. Academy of Certified Brain Injury Specialist (2009)

BrainLinehttp://www.brainline.org

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References and Resources

Here are some additional resources that you may want to explore:

• TBI Survivors View• Centers for Disease Control and Prevention: TBI• Center for Excellence in Disabilities at West Virginia University

CDC Injury and Violence Prevention and Controlhttp://www.cdc.gov/injury/index.html Shepherd Center Learning Connections

http://myvitalconnections.org/webmanuals.nsf/3478d43e5c5c8dcb85256ae60061f897/1B910B089562F1EB85257164006D34A7

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Additional Resources and Readings

• To receive your certificate of successful completion you must first pass the test and complete an online evaluation

• A score of 80% or higher is required

• Once you have successfully completed this training module you will receive an email with your certificate of completion

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