101 Exploration of Traumatic & Acquired Brain Injury by Success Rehabilitation

1.
An Exploration of Traumatic and Acquired Brain Injury
RCPA BI Committee Resources
September 2019

2. TBI and ABI – what’s the difference?
• Traumatic brain injury (TBI) happens when a
bump, blow, jolt, or other head injury causes
damage to the brain. Examples may be a
motor vehicle accident, physical assault,
gunshot wound, sports injury/concussion.
• Acquired brain injury (ABI) occurs when a
person who was born with a normal brain
“acquired” a disability from injuring their
brain through physical trauma, disease, or
illness.
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3. WHO CAN “GET” AN ABI/TBI?
ANYONE
…any time, any place, any where.
Traumatic brain injury is one of the major causes of
death and disability in the United States.
Approximately 1.7 million Americans sustain a
traumatic brain injury each year, and 52,000 of those
Americans die. Traumatic brain injuries make up
nearly a third of all injury-related deaths. (Psychology
Today, April 2016)
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4. Do they have a brain injury?
• Common deficits may impact cognitive
functioning like memory and executive skills,
physical functioning, behavioral functioning,
and emotional functioning/regulation.
• Anosagnosia, which means lack of awareness
of deficits, is common and prevents individuals
from recognizing or being able to
communicate their needs.
• May be difficult to know – brain injury or
manipulation? Get all the facts before
deciding. Use team approach to review all the
data.
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5. Mental Health and Brain Injury
• Depression and Anxiety is more common than not
in those who have experienced brain injury.
• In 2013, a group of Danish scientists found that
individuals with TBI (including concussions)
were four times more likely to develop a mental
illness. People who had received a TBI were 65
percent more likely to develop schizophrenia, 59
percent more likely to develop depression and 28
percent more likely to develop bipolar disorder.
This study is the largest of its kind and involved
following 1.4 million Danish citizens born between
the years 1977 and 2000. (Psychology Today, 2016)
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6. Mental Health Intervention for those
with brain injury
• Psychiatry – medication management
• Psychology – talk therapy and behavioral
therapy (individual and group)
• Case Management support
How these services are delivered – remembering
that memory, processing, decoding and other
cognitive challenges – may get in the way of the
client being able to take full advantage of the
service.
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7. Substance Use/Abuse post-BI
• There is often a "honeymoon" after the injury when the
amount of drinking (compared to pre-injury) stops or
reduces (Bombardier, Temkin, Machamer & Dikmen, 2003;
Corrigan, Lamb-Hart & Rust, 1995; Kreuzer, Doherty, Harris
& Zasler, 1990; Krueutzer, Witol, Sander, Cifu, Marwitz &
Delmonico, 1996).
• Some studies have indicated that between 10% and 20% of
persons with traumatic brain injury develop a substance
use problem for the first time after their injury (Corrigan
et al., 1995; Kreutzer et al., 1996).
• People who are able to access structure and supervision by
residential staff or family/friends may have a longer
‘honeymoon period’ and with other supports such as AA/NA
and therapy, can continue their sobriety for much longer.
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8. What is a cognitive impairment
• Cognitive Impairments can include difficulties
with a variety of cognitive skill areas like
attention, memory, impulsivity, problem solving
or decision-making, that can impair a person’s
ability to perform ADL’s, IADL’s or function
successfully in their environment.
• These impairments can stem from injury,
disease, aging or disease related cognitive
decline.
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9. What is a Cognitive Impairment? (cont.)
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The thinking process is disrupted by cognitive impairments
and can result in the inability to:
• Focus on the important information, thoughts, and actions.
• Pay attention to a task or activity for a long period of
time.
• Predict what may happen, plan, and solve problems.
• Take in new information and understand information
in an appropriate amount of time.
• Understand and communicate by speaking or writing.
• Learn and remember new information.

10. Unique Characteristics
of Cognitive Disability
• No two individuals with a cognitive disability are alike
• Impacts physical, cognitive, behavioral and
psychosocial functions
• Often results in chronic disability
• Individuals with cognitive disabilities often have
difficulties recognizing their limitations:
– Individuals may not be aware that they are not
aware of their own deficits
– Individuals may not remember that they don’t
remember
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11. Cognitive functions may include:
• Attention
• Concentration
• Learning & Memory
• Speed of Processing
• Social Perception
• Impulsiveness
• Decision Making/Judgment
• “Executive functions” (plan/
organize, initiate,
follow-through)
• Self-awareness
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12. Communication functions may include:
• Expressive Communication
– Speaking
– Writing
– Pragmatics (social skills)
• Receptive Communication
– Reading
– Listening Comprehension
• Aphasia: difficulty comprehending and
expressing language
• Dysarthria: difficulty pronouncing words clearly
• Dysphagia: feeding / swallowing difficulty
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13. Social - Emotional
With cognitive impairments:
• Dependent behaviors
• Emotional lability (rapid, exaggerated changes in mood)
• Lack of motivation
• Irritability
• Aggression
• Depression
• Disinhibition(say & do what they feel without regard for
the social impact/consequences)
• Denial / lack of awareness
• Egocentricity/ lack of empathy
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14. Evaluating Functional Abilities/
Limitations
• Need to obtain corroborative/consistent
information about strengths and limitations from
another knowledgeable party (family or staff)
• Determine whether participant is capable of
functional tasks & whether they actually initiate the
performance of these tasks
• Determine if participant is receiving assistance for
any part of a task (or needs an initiation cue) for a
task that they say they can do
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15. Evaluating Functional Abilities/Limitations
• Ask about “red flag” issues; e.g., problems with paying bills,
remembering to take medications, keeping appointments,
making impulsive purchases/excessive spending
• Ask probing questions related to safety awareness, such as
how to respond during power outage, when a stranger is at
door, or how to get out in the event of a fire
• Ask about at risk behaviors; e.g., going into unsafe
neighborhoods, excessive or unsafe sexual activities,
alcohol or drug use, providing personal information over
phone or online
• Ask about any difficulties with police, other authority figures,
legal problems, aggressive or disruptive behaviors
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16. Tips for interacting with
persons with cognitive disabilities
When speaking with an individual with cognitive disability:
• Keep statements and questions short (Yes/No questions may be helpful)
• Use concrete terminology
• Speak slowly & clearly (but not like you’re speaking to a young child)
• Give adequate time for responses (may be slow to process information)
• Give options rather than telling them what to do
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17. Cognitive Rehabilitation Therapy
• NOT Cognitive Behavioral Therapy (CBT) . Cognitive
behavioral therapy (CBT) is a short-term, goal-oriented
psychotherapy treatment that takes a hands-on,
practical approach to problem-solving. Its goal is to
change patterns of thinking or behavior that are behind
people's difficulties, and so change the way they feel.
• CRT-provides education about cognitive functioning to
improve self-awareness and to help individuals
understand, accept and manage their strengths and
weaknesses
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18. What is Cognitive Rehabilitation Therapy?
The Brain Injury Interdisciplinary Special Interest Group (BI-
ISIG) of the American Congress of Rehabilitation Medicine
defines cognitive rehabilitation therapy to be a:
"systematic, functionally-oriented service of therapeutic
cognitive activities, based on an assessment and
understanding of the person's brain-behavior deficits."
"Services are directed to achieve functional changes by (1)
reinforcing, strengthening, or reestablishing previously
learned patterns of behavior, or (2) establishing new
patterns of cognitive activity or compensatory mechanisms
for impaired neurological systems" (Harley, et al., 1992, p.
63).
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19. Cognitive Rehabilitation Therapy
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CRT- provides the development of skills through direct
retraining or practicing the underlying cognitive skills to
resolve or better manage the individual’s weaknesses
CRT - provides strategy training involving the use of
environmental, internal and external strategies to develop
strategies to compensate rather than resolving
weaknesses.
CRT – provides functional activities training. This involves
the application of the other three components in everyday
life to make real life improvements.

20. Resource
• BIAA Brain Injury Association of America - http://
www.biausa.org/
Brain Injury Association of Pennsylvania (BIAPA) -
http://www.biapa.org;
or phone 866-635-7097
The mission of BIAPA is to prevent brain injury and
improve the quality of life for people who have
experienced brain injury and their family
members through support, education, advocacy,
and research. Information on educational
materials, support groups and various other topics
can be found at BIAPA.
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