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Fd gray matters_051817final

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This 90-minute webinar will provide participants with a basic awareness of Traumatic Brain Injury and the potential impact on daily life including work, family, and relationships. Participants will learn about signs, symptoms, and helpful interventions when working with individuals and families dealing with TBI.

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Fd gray matters_051817final

  1. 1. FD SMS icons 1 https://learn.extension.org/events/3010 This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Military Family Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368. Gray Matters: Understanding Traumatic Brain Injury’s Impact on Families
  2. 2. Connecting military family service providers and Cooperative Extension professionals to research and to each other through engaging online learning opportunities militaryfamilies.extension.org MFLN Intro Sign up for webinar email notifications at militaryfamilies.extension.org/webinars
  3. 3. Heidi Knock, Psy.D • Staff Psychologist- Polytrauma Unit at Richard L. Roudebush VA Medical Clinic • Provides individual, marital, and group psychotherapy to veterans and their families • Conducts presentations on PTSD and Traumatic Brain Injury to organizations to help facilitate veteran focused care and integration Today’s Presenter 3
  4. 4. We want to know about YOU! 4 https://pixabay.com/en/group-team-feedback-confirming-1825510/
  5. 5. Facts about Mild Traumatic Brain Injury (MTBI) ✓ Approximately 80% of all brain injuries are mild ✓ Males outnumber females 2:1 ✓ 5.3 million people are estimated to have ongoing problems related to MTBI ✓ Direct care costs are estimated at $5.3 billion 5 https://pixabay.com/en/thought-idea-innovation-imagination-2123971/
  6. 6. Traumatic Brain Injury (TBI) 6 • Occurs when an external force causes injury to the brain. Can be closed or penetrating (open) head injury. o Motor vehicle crash- Closed Head Injury o Gun shot wound- Penetrating Head Injury https://pixabay.com/en/abstract-brain-stylistic-top-1293337/
  7. 7. Traumatic Brain Injury (TBI) Diffuse Axonal Injury (DAI) • Occurs when the axon of the neuron is stretched, twisted, or torn (sheared) • Can result from acceleration/deceleration injuries or other similar mechanisms • Can lead to microscopic injury all over the brain 7 https://pixabay.com/en/neuron-nerve-cell-dendrites-axon-29147/
  8. 8. TBI from Blast Injury • Leading cause of TBI in veterans • Not well understood • Causes organs and different densities to shift at different rates leading to shearing and tearing of brain tissue 8 Primary • Direct injury to brain via rapid shifts in air pressure Secondary • Impact from fragments or objects propelled by explosion Tertiary • Structure collapse or being thrown from blast wind Quaternary • Burns; crush injuries; other illnesses or diseases not caused by the other mechanisms
  9. 9. Average Annual Percentages 9 Average annual percentages, 1995-2001; ED visits, hospitalizations, and deaths combined (CDC, 2004)
  10. 10. Frequency of Diagnoses among OEF/OIF/OND Veterans 10 1Includes both provisional and confirmed diagnoses. aThese are cumulative data since FY 2002, with data on hospitalizations and outpatient visits as of September 30, 2011; Veterans can have multiple diagnoses with each health care encounter. A Veteran is counted only once in any single diagnostic category but can be counted in multiple categories, so the above numbers and percentages add up to greater than 741,954. bPercentages reported are approximate due to rounding. Data obtained from Office of the Assistant Deputy Under Secretary for Health for Policy and Planning, http://vaww4.va.gov/vhaopp/vast2.asp
  11. 11. Frequency of Mental Disorders among OEF/OIF/OND Veterans since 2002 11 Cumulative from 1st Quarter FY 2002 through 4th Quarter FY 2011 1 Includes both provisional and confirmed diagnoses. 2 These are cumulative data since FY 2002. ICD-9 diagnoses used in these analyses are obtained from computerized administrative data. Although diagnoses are made by trained health care providers, up to one-third of initial diagnostic codes may not be confirmed because the diagnosis is provisional, pending further evaluation. aThe total will be higher than the 385,711 unique patients who received a diagnosis of a possible mental health disorder. A Veteran may have more than one mental health disorder diagnosis and each diagnosis is entered separately in this table. bThis row of data does not include a) information on PTSD from VA’s Vet Centers , b) data from Veterans not enrolled for VA health care, or c) Veterans with a diagnoses of adjustment reaction (ICD-9 309) but not PTSD (ICD-9 309.81). cThis category currently excludes Veterans who have a diagnosis of a) tobacco use disorder only, ICD-9 305.1 (n=103,905); b) alcohol abuse only, ICD-9 305.0, (n=26,293); or both tobacco use disorder and alcohol abuse, ICD-9 305.0 and 305.1 ,(n=20,947).
  12. 12. Research Neurological Rehabilitation Institute at Brookhaven Hospital (August 2011) (General population, not veteran specific) 12 53% of individuals who sustain a TBI will suffer a major depressive episode within the first year after injury 23% experienced suicidal ideation after their injury 17% actually had a suicide attempt after their injury
  13. 13. TBI and Rates of Suicide Suicide rates for individuals who sustained a TBI was 3 times greater than the general population 13J Neuro/Neurosurg Psychiatry, 2001, 71: 436-440
  14. 14. TBI & Loss Sense of significant loss of who they were and their functioning related to the injury 14 ▪ Frustration over small tasks being too big ▪ Simply can’t think the way they used to ▪ Change of personality and functioning https://pixabay.com/en/despair-emotion-feeling-unhappy-2019938/ ▪ Often cannot continue employment ▪ May lose basic independence skills ▪ Relationships suffer
  15. 15. Caregiving & TBI The partner becomes more of a caregiver and less of a spouse 15 ▪ Typically causes a great deal of conflict ▪ Spouse experiences loss and frustration too ▪ Spouse shoulders a great deal of the responsibility ▪ Spouse often take symptoms personally https://pixabay.com/en/thoughtful-thinking-person-pensive-2031866/
  16. 16. Military Life & TBI ▪ Forced medical boarding/discharge from the military due to TBI ▪ Pervasive sense of loss; sudden isolation ▪ Sense of betrayal by the military ▪ Often wanted to be “lifers” ▪ Lack of marketable work skills ▪ Joined the military to have a real family 16 https://pixabay.com/en/african-american-sadness-man-sad-883376/
  17. 17. MTBI • Focal neurological deficits that may or may not be transient • Loss of consciousness is not more than 30 minutes • Post-traumatic amnesia does not exceed 24 hours • Glasgow Coma Scale of 13-15 after 30 minutes • Any alteration in mental state at the time of the accident 17 https://pixabay.com/en/time-clock-watches-wave-time-of-2132452/
  18. 18. Altered Mental State • Headache • Nausea • Vomiting • Dizziness • Fatigue • Trouble sleeping • Drowsiness • Sensitivity to light/noise • Blurred vision • Difficulty remembering • Difficulty concentrating 18 https://pixabay.com/en/trees-away-nature-eddy-turn-dizzy-358418/
  19. 19. TBI Severity 19 Kay et al., 1993; Snyder & Nussbaum, 2000
  20. 20. Course of Recovery of MTBI • In the majority of individuals, symptoms resolve in 6 months or less after the injury • In some cases, symptoms can persist longer (12-18 months) and even life-long • The majority of people with moderate to severe TBI do not return to their full pre-injury status and will have ongoing cognitive and behavioral issues 20 https://pixabay.com/en/day-planner-calendar-organizer-828611/
  21. 21. Overview of Diffuse Symptoms of MTBI • Cognitive memory, attention, processing speed & intelligence • Psychological depression, anxiety, irritability, sleep & personality change • Physical light/sound sensitivity, dizziness & fatigue 21
  22. 22. Post-Concussive Symptoms 22 If symptoms last: >2 weeks: Post-Concussion Syndrome >6 weeks: Persistent Post-Concussion Syndrome http://dvbic.dcoe.mil/
  23. 23. What can be injured? Anything the brain can do! • Problem solving • Personality • Planning and organizing • Emotional lability • Understanding concepts • Understanding verbal language • Speech • Visual recognition 23
  24. 24. Co-Morbid Conditions • Sleep deprivation • Sleep apnea • Depression and anxiety • Substance use • Trauma issues/ PTSD • Medical issues/Chronic pain • Multiple stressors 24 https://pixabay.com/en/depressed-depression-sadness-sad-83006/
  25. 25. 25Vanderploeg, 2007 25Vanderploeg, 2007 + PTSD Re-experiencing Avoidance Social withdrawal Memory gaps Apathy ? Mild TBI Residual Difficulty with decisions Mental slowness Concentration Headaches Dizzy Appetite changes Fatigue Sadness Arousal Sensitive to noise Concentration Insomnia Irritability + Depression
  26. 26. Rehabilitation Team • Neuropsychologist/Clinical Psychologist • Speech Language Pathologist • Cognitive Therapist • Physiatrist • Physical Therapist • Occupational Therapist • Recreational Therapist • Neurologist • Neuropsychiatrist 26 https://pixabay.com/en/group-work-personal-group-458653/
  27. 27. Dealing with TBI as a Professional • What signs to look for: 27 ✓ Distractibility ✓ Difficulties focusing on what is being said ✓ Answering slowly or answering questions that are not asked ✓ Long pauses in speech ✓ Talking very loud/yelling ✓ Difficulty following directions ✓ Easily agitated/irritable and appear disinhibited ✓ Significant coordination issues and involuntary movements that are neurologically based ✓ Visual field cuts ✓ Flat affect and apathetic ✓ Poor initiation of conversations
  28. 28. Interventions • One thing at a time • Repeat slowly and clearly • Keep questions simple • Maintain eye contact • Include support person in session • Ask them to reflect on what you have said • Minimize distractions (noise, lights, movements, clutter) 28 https://pixabay.com/en/talk-dialogue-discussion-together-2076968/
  29. 29. Interventions • Write down any follow-up (and encourage the use of Smart Phones for reminders) • For those who are anxious or agitated, encourage breathing and grounding skills (stress ball, sensory loaded modality) • Allow a time-out if necessary • Structure/Routine • Marker Board • Take notes in session • Involve Family 29 https://pixabay.com/en/postit-memos-notes-colorful-1726554/ What works for YOU?
  30. 30. Treatment Considerations • Possibility of missed appointments • Follow-through on assigned tasks may be weak • May be fearful of expressing that they do not understand • May come across as agitated (anxiety, overstimulation, impulsivity, distractibility) • May self-medicate (problems coping with loss associated with injury, sleep issues, self-esteem issues) • May make poor choices (difficulties considering outcomes, difficulties making decisions, irritability) • May not remember what happened in previous session 30 https://pixabay.com/en/questions-demand-doubts-psychology-1922477/
  31. 31. Accommodations • Write follow-up instructions in bullet point style (assists in breaking down tasks) • Reduce stimulation in room to minimize distractions • Reduce rate of speech to adjust for processing • Allow for a time out if agitation is present. Continuing to talk will only escalate frustration 31
  32. 32. Employment and Academic Accommodations Employment • may need a job with repetition/job coaching • may need structure • may need job coaching initially until task is solidified 32 Academic • Extended time limit on tasks • Testing in private room • Open note tests when feasible • Sunglasses or hates in classroom • Class notes from instructor or peers • Record classes • Allow absences to be made up • Allow to leave classroom as needed https://pixabay.com/en/hands-writing-diary-journal-pen-1369316/
  33. 33. Family Involvement (Intervention) Family or case manager will need to strongly advocate for medical care… What families can do with medical interventions: ✓Keep a symptom notebook ✓Have providers write down recommendations ✓Keep medication list 33 WHY?
  34. 34. Interventions at Home • Daily structure • Marker boarding for cueing • Basket of commonly misplaced items • Common tasks broken down into 5 steps • Assistance with finances/bills • Find a brain injury support group 34 https://pixabay.com/en/to-do-list-task-list-notes-written-734587/
  35. 35. Energy Management • Set up a daily schedule, consider energy demands for the day • Rest when tired- pushing can lead to a “melt down” • Take breaks- stop for lunch/coffee, go for walks • Cognitive breaks- find a non-stimulating place • Take a nap- 30-60 minutes (longer will interfere with sleep at night) 35 https://pixabay.com/en/break-rest-relaxation-recovery-1736072/
  36. 36. Resources • Veterans Crisis Line: Phone Number: 1-800-273-8255 (press 1) Website: https://www.veteranscrisisline.net/ Text: 838255 • Military OneSource: Phone Number: 1-800-342-9647 Website: http://www.militaryonesource.mil/ 36
  37. 37. Resources • www.brainlinemilitary.org: Help for service members, veterans, national guard, reserve, and families • www.dvbic.org: Defense and Veterans Brain Injury Center for service members and veterans, family and caregivers, and medical providers • www.braininjuryeducation.org: The Brain Injury Guide and Resources 37
  38. 38. Resources • Dayton, OH VAMC and Lexington, KY VAMC: Offer inpatient TBI programs and/or combined PTSD/TBI programs • NeuroRestorative Care : Offers residential programs throughout the country • Wounded Warrior Project: offers an “Independent Living Program” • Project Victory (Texas): A grant-driven facility that offers residential treatment for TBI • Assisted Living (VA): TBI funding program to pay for care outside of the VA for veterans with TBI/brain injuries 38
  39. 39. Connect with MFLN Family Development Online! MFLN Family Development MFLN Family Development @mflnfd To subscribe to our MFLN Family Development newsletter send an email to: MFLNfamilydevelopment@gmail.com with the Subject: Subscribe FD SMS icons 39
  40. 40. MFLN Intro 40 We invite MFLN Service Provider Partners to our private LinkedIn Group! https://www.linkedin.com/groups/8409844 DoD Branch Services Reserve Guard Cooperative Extension
  41. 41. Evaluation and Continuing Education Credits/Certificate MFLN Family Development is offering 1.5 NASW and GAMFT CEUs for today’s webinar. Please complete the evaluation and post-test if available at:https://vte.co1.qualtrics.com/jfe/form/SV_bIRCg6i9CdIb0QB Must pass post-test with an 80% or higher to receive certificate. 41
  42. 42. MFLN Family Development Upcoming Event Unintended Consequences: What We Now Know about Spanking and Child Development • Date: June 1, 2017 • Time: 11:00 am Eastern • Location: https://learn.extension.org/events/3017 For more information on MFLN Family Development, go to: https://militaryfamilies.extension.org/family-development 42
  43. 43. militaryfamilies.extension.org/webinars 43This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Military Family Readiness Policy, U.S. Department of Defense under Award Number 2015-48770-24368.

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