Brain Injury
        Elizabeth Bilderback, MA

   Elizabet.bilderback@healthsouth.com
Types of Brain Injury

• Traumatic- blow to head or
  penetrating injury that disrupts the
  functioning of the brain.
   ...
Types of Brain Injury (continued)

 – Aneurysms
 – Tumors
 – Strokes
 – Encephalopathies
Types of Brain Injury (continued)

• Concussions
  – A type of brain injury that disrupts
    functioning of the brain
  –...
What We Hear About

• 795,000 strokes every year in the U.S.
  – Every 40 seconds, 1 person has a stroke


• 1.2 million c...
Did You Know….

• According to the World Health
  Organization TBI is the leading
  cause of death and disability
  in chi...
Brain Injury by the Numbers

• 1.4 million new traumatic brain
  injuries (TBI) each year in the U.S.
  – Every 23 seconds...
TBI by the Numbers

• TBIs in the U.S.
  –   50,000 die
  –   235,000 are hospitalized
  –   1.1 million treated and relea...
TBI in Australia

• Use the term Acquired Brain Injury
  which includes accidents, strokes,
  infections, degenerative,
  ...
TBI in Australia

• An individual with an ABI has an 80%
  chance of developing a
  diagnosable mental illness

• About 1/...
TBI in Canada

• TBI is the number one killer and
  disabler of Canadians under age 40
  – More than half are under age 20...
TBI in Canada

• Every year 50,000 Canadians sustain
  brain injuries
  – Every 5 minutes someone is injured
  – Every 7 h...
Brain Injury

• Traumatic brain injury can happen
  to ANYONE
  – Highest risk
    • Males 1.5x to 2x as likely as females...
Brain Injury

• Cost
  – $60 billion in the U.S. in 2000 for direct
    medical costs and indirect costs such
    as lost ...
Brain Injury

• Range in Severity
  – Mild with transient symptoms to Severe
    with lengthy loss of consciousness and
  ...
Brain Injury

• Long term Consequences of
  Physical Damage to the brain
  –   Physical Skills
  –   Sensation
  –   Think...
Brain Injury
• Most frequent unmet needs
  according to one study
  – Improving memory and problem
    solving
  – Improvi...
TBI and Law Enforcement

• Not all brain injury survivors will be a
  problem for law enforcement
  – Brain Injury Causing...
TBI and Aggression
• One 1996 study on a military
  population found TBI ↑ the risk of
  behavioral discharge 4x and
  cri...
TBI and Aggression

• Focal frontal lesions in an aggressive
  TBI group vs. a more diffuse lesion in
  a nonaggressive TB...
TBI and Insight

• A 1993 study found poor insight
  regarding behavioral impairment at
  6 months post injury

• A 2006 s...
TBI Causes Physical Problems
 – Loss of Motor Control and Coordination
   • Hemiparesis
   • Ataxia
   • Balance
   • Stre...
Physical Problems Continued

• Sensory Problems
    • Diplopia
    • Blindness
    • Visual Field Cut
    • Sensitivity to...
Physical Problems Continued

• Speaking and Swallowing Disorders
    • Dysarthria
    • Dysphagia
• Fatigue
• Headaches
• ...
Brain Injury

• Our cognition or thought processes
  guide behavior and lead to feelings
  or emotions

• Brain Injuries C...
TBI Causes Cognitive Problems

• Attention/Concentration
• Visual Spatial Skill
  – Understanding and manipulating things
...
Cognitive Problems Continued

• Memory
   • Recognition
   • Recall
   • Prospective
   • Auditory
   • Visual
   • Immedi...
Cognitive Problems Continued

• Slowed Speed of Information
  Processing and Slowed Reaction
  Time
  –   Especially with ...
Cognitive Problems Continued

• Communication
 – Reading/Writing
 – Expressive Language
   • Verbal Fluency
 – Receptive L...
Cognitive Problems Continued

• Executive Skills
  –   Plan, Direct, Execute and Monitor Activities
  –   Initiation
  –  ...
TBI Causes
Behavioral/Psychosocial Problems
• Disinhibition/Impulsivity/Impatience/
  Restlessness
  – May be unaware of t...
Behavioral/Psychosocial
       Problems continued
• Egocentricity/Self-centeredness
  – How does my behavior impact you?
 ...
Behavioral/Psychosocial
       Problems continued
• Rigidity/Inflexibility/Stubbornness
  – I‟m right and don‟t argue with...
Behavioral/Psychosocial
       Problems continued
• Oversensitivity/Suspiciousness
• Irritability
  – Easily annoyed/bothe...
Behavioral/Psychosocial
         Problems continued
• Reactionary Disturbances
  –   Denial
  –   Depression
  –   Anxiety...
Brain Injury as an excuse…

   Is brain injury an excuse for
           inappropriate or
         illegal behavior?

   Pe...
2 Situations
       you will encounter:



      You will be informed of an injury
                      OR
          You ...
At HEALTHSOUTH

        We tell the patient/family
      to inform Police of the injury
if they call the Police for ANY re...
No CLUE?...Things to Look for:

• Suture Lines on the head (surgery)
• Subtle Dents on head (surgery or monitors)
• Asymme...
No Clue, cont…things to look for

• “FLK” & “FLA”
  -Dressed Inappropriately
  -Odd, Broad Based Gait
  -Arm that Hangs in...
Do‟s & Don‟ts
           with Brain Injured Citizens
• Do not Over-Stimulate
   – Brain injured individuals can only proce...
Do‟s & Don‟ts
          with Brain Injured Citizens
• Do not lecture or argue with the individual,
  it will only escalate...
Thank You!
      Elizabeth Bilderback, MA

 Elizabet.bilderback@healthsouth.com
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Brain Injury- by Elizabeth Bilderback

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Elizabeth Bilderback
Brain Injury

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Brain Injury- by Elizabeth Bilderback

  1. 1. Brain Injury Elizabeth Bilderback, MA Elizabet.bilderback@healthsouth.com
  2. 2. Types of Brain Injury • Traumatic- blow to head or penetrating injury that disrupts the functioning of the brain. – Falls (28%) – MVA‟s (20%) – Struck by/against events (19%) – Assaults (11%) – Soldiers (blasts)
  3. 3. Types of Brain Injury (continued) – Aneurysms – Tumors – Strokes – Encephalopathies
  4. 4. Types of Brain Injury (continued) • Concussions – A type of brain injury that disrupts functioning of the brain – Do not need to lose consciousness to have a concussion – Multiple concussions can cause cumulative and long lasting problems
  5. 5. What We Hear About • 795,000 strokes every year in the U.S. – Every 40 seconds, 1 person has a stroke • 1.2 million coronary attacks every year in the U.S.
  6. 6. Did You Know…. • According to the World Health Organization TBI is the leading cause of death and disability in children and young adults around the world and is involved in nearly half of all trauma deaths.
  7. 7. Brain Injury by the Numbers • 1.4 million new traumatic brain injuries (TBI) each year in the U.S. – Every 23 seconds, 1 person sustains a TBI • 360,000 active duty soldiers have sustained TBIs in Iraq and Afghanistan
  8. 8. TBI by the Numbers • TBIs in the U.S. – 50,000 die – 235,000 are hospitalized – 1.1 million treated and released from ER – 75% are mild TBI or concussions – 1.6-3.8 million sports and recreation- related concussions in U.S. each year
  9. 9. TBI in Australia • Use the term Acquired Brain Injury which includes accidents, strokes, infections, degenerative, neurological disease and traumas • “Common” in Australia- 432,700 Australians (2.2% of population) in 2003 had an ABI – 1 in 50 have an ABI
  10. 10. TBI in Australia • An individual with an ABI has an 80% chance of developing a diagnosable mental illness • About 1/3 of clients of mental health services have an underlying ABI
  11. 11. TBI in Canada • TBI is the number one killer and disabler of Canadians under age 40 – More than half are under age 20 – Majority are young men ages 15-30 – Highest incidence rate is 15-19 year age group – MVAs account for half of all TBIs – 75% of all cycling deaths involve TBIs
  12. 12. TBI in Canada • Every year 50,000 Canadians sustain brain injuries – Every 5 minutes someone is injured – Every 7 hours someone dies
  13. 13. Brain Injury • Traumatic brain injury can happen to ANYONE – Highest risk • Males 1.5x to 2x as likely as females • Highest risk age groups: 0-4 years and 15- 19 years with 15-24 years most likely to be hospitalized • Certain military duties or other jobs increase risk
  14. 14. Brain Injury • Cost – $60 billion in the U.S. in 2000 for direct medical costs and indirect costs such as lost wages
  15. 15. Brain Injury • Range in Severity – Mild with transient symptoms to Severe with lengthy loss of consciousness and amnesia for the event (plus amnesia before and after event) • More recent and worse brain injuries are easier for you to spot
  16. 16. Brain Injury • Long term Consequences of Physical Damage to the brain – Physical Skills – Sensation – Thinking – Learning – Academics – Behavior – Personality – Social Skills
  17. 17. Brain Injury • Most frequent unmet needs according to one study – Improving memory and problem solving – Improving job skills – Managing stress and emotional upsets – Controlling temper • 40% of individuals who had been hospitalized had 1 or more unmet need at 1 year post
  18. 18. TBI and Law Enforcement • Not all brain injury survivors will be a problem for law enforcement – Brain Injury Causing: • Anger Management issues • Impulsivity • Poor Judgment – Brain Injury Plus: • Substance Abuse • PTSD • Premorbid Personality • Lack of Family/Social Support
  19. 19. TBI and Aggression • One 1996 study on a military population found TBI ↑ the risk of behavioral discharge 4x and criminal conviction 5x • A 2003 study found 33.7% of individuals in a TBI group met the criteria for aggressive behavior in the first 6 months post injury. Major Depression also more frequent in TBI group.
  20. 20. TBI and Aggression • Focal frontal lesions in an aggressive TBI group vs. a more diffuse lesion in a nonaggressive TBI group
  21. 21. TBI and Insight • A 1993 study found poor insight regarding behavioral impairment at 6 months post injury • A 2006 study found their TBI group less able to recognize emotion in others.
  22. 22. TBI Causes Physical Problems – Loss of Motor Control and Coordination • Hemiparesis • Ataxia • Balance • Strength • Endurance • Spasticity
  23. 23. Physical Problems Continued • Sensory Problems • Diplopia • Blindness • Visual Field Cut • Sensitivity to Hot/Cold • Taste • Hearing • Sensation • Smell • Proprioception
  24. 24. Physical Problems Continued • Speaking and Swallowing Disorders • Dysarthria • Dysphagia • Fatigue • Headaches • Bladder/Bowel Incontinence • Seizures
  25. 25. Brain Injury • Our cognition or thought processes guide behavior and lead to feelings or emotions • Brain Injuries Cause Cognitive Problems.
  26. 26. TBI Causes Cognitive Problems • Attention/Concentration • Visual Spatial Skill – Understanding and manipulating things you see • Perception/Judgment – Self Awareness – Deficit Awareness • Goal Setting • Disordered/Slowed Learning – ↓ ability to learn from experience
  27. 27. Cognitive Problems Continued • Memory • Recognition • Recall • Prospective • Auditory • Visual • Immediate • Long-term
  28. 28. Cognitive Problems Continued • Slowed Speed of Information Processing and Slowed Reaction Time – Especially with decision making – Response Selection – Mental Transformations – Stressful Situations – Complex Situations
  29. 29. Cognitive Problems Continued • Communication – Reading/Writing – Expressive Language • Verbal Fluency – Receptive Language • Auditory Comprehension • Math Skills • Time Management
  30. 30. Cognitive Problems Continued • Executive Skills – Plan, Direct, Execute and Monitor Activities – Initiation – Planning/Organizing/Categorizing/Sequencing – Reasoning – Abstract Thought – Flexibility of Thought – Problem Solving/Judgment – Learning from mistakes/ Thinking about consequences
  31. 31. TBI Causes Behavioral/Psychosocial Problems • Disinhibition/Impulsivity/Impatience/ Restlessness – May be unaware of this and its effects on others – May be related to less tolerance for frustration/noise/problems – Verbal Outbursts – Physical Outbursts – “I‟ll do it now and think about it later”
  32. 32. Behavioral/Psychosocial Problems continued • Egocentricity/Self-centeredness – How does my behavior impact you? – I‟m most important – With decreased empathy, interpersonal sensitivity, self-reflectiveness, and/or self-critical attitudes
  33. 33. Behavioral/Psychosocial Problems continued • Rigidity/Inflexibility/Stubbornness – I‟m right and don‟t argue with me • Sexual Problems – Increase or decrease in drive/interest
  34. 34. Behavioral/Psychosocial Problems continued • Oversensitivity/Suspiciousness • Irritability – Easily annoyed/bothered • Apathy – I don‟t care • Silliness/Childishness
  35. 35. Behavioral/Psychosocial Problems continued • Reactionary Disturbances – Denial – Depression – Anxiety – Frustration – Sleep Disturbances – Suicidal Thoughts – Loss of Self-Esteem – Loss of Self-Confidence – Anger – Mood Swings
  36. 36. Brain Injury as an excuse… Is brain injury an excuse for inappropriate or illegal behavior? People are still responsible for their behavior, injury or not
  37. 37. 2 Situations you will encounter: You will be informed of an injury OR You will have NO CLUE
  38. 38. At HEALTHSOUTH We tell the patient/family to inform Police of the injury if they call the Police for ANY reason We also tell the patient to inform the Police Officer of their injury if they happen to be stopped or detained for any reason
  39. 39. No CLUE?...Things to Look for: • Suture Lines on the head (surgery) • Subtle Dents on head (surgery or monitors) • Asymmetrical Face – 1 side droops • Eyes that don‟t seem to work correctly • Struggle finding words • Disorganized Speech • Tangential or Verbose
  40. 40. No Clue, cont…things to look for • “FLK” & “FLA” -Dressed Inappropriately -Odd, Broad Based Gait -Arm that Hangs in an Odd way -Arm Swing is off • Braces / Splints
  41. 41. Do‟s & Don‟ts with Brain Injured Citizens • Do not Over-Stimulate – Brain injured individuals can only process certain amounts of information, and can lose behavioral control if over-stimulated • Reduce Stimulation – Do this by removing spectators and personnel, having only 1 person talk, reducing noise, and removing environmental objects that stimulate, such as music. • Make Surrounding Environment Safe – Remove dangerous objects, if possible • Allow the Individual to „walk off‟ any agitation – Allow the individual to move • Model Calm Behavior – Speak Quietly • Direct the Individual away from the source of frustration – Reduce anger and frustration by changing the topic
  42. 42. Do‟s & Don‟ts with Brain Injured Citizens • Do not lecture or argue with the individual, it will only escalate the situation • Try to be consistent and predictable • Be aware of Body Language, yours and theirs. Be aware of interpersonal space, posturing and speed of approach. • Do not touch an agitated individual unless you are prepared for a physical alteration • If possible, clearly and simply, state the consequences and impact of the individual‟s behavior • Do not take what they say personally
  43. 43. Thank You! Elizabeth Bilderback, MA Elizabet.bilderback@healthsouth.com
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