The document provides information about brain injuries and their effects. It begins by introducing Kimmie, an elementary school teacher who suffered a brain injury in a car accident. Her brain injury resulted in damage to her brainstem and diffuse brain damage. It then discusses the importance for professionals to understand brain injuries as consumers and coordinators may deal with individuals who have brain injuries. It provides communication strategies for coordinators, such as giving clear, short directives and written instructions. Finally, it outlines physical, cognitive and other challenges that brain injury survivors may face and why they need assistance, including issues with memory, communication, perception and cognitive impairments.

1. Brain Injury 101Brain Injury 101
The Independent Living Center, April 20, 2010
Andrea Buening, IL Special Projects Coordinator

2. Brain InjuryBrain Injury
A complex disabilityA complex disability
This is Kimmie, from “A Miracle for Kimmie”
http://www.discoverhiddensecrets.com/Ki
mberlyAnne.html

3. WhoWho isis Kimmie?Kimmie?
 Kimmie is an elementary teacherKimmie is an elementary teacher
 June 2001 Kimmie wasJune 2001 Kimmie was thethe passengerpassenger in a car which wasin a car which was
broadsided by a loaded logging truck. The passenger side receivedbroadsided by a loaded logging truck. The passenger side received
the full force of the impactthe full force of the impact
 Kimmie’s brain injury resulted in a sheared brainstem and diffuseKimmie’s brain injury resulted in a sheared brainstem and diffuse
damage to her braindamage to her brain
 October 2003, Kimmie returned to the elementary classroomOctober 2003, Kimmie returned to the elementary classroom
Kimmie’s story is one of many. There are many who do not fare soKimmie’s story is one of many. There are many who do not fare so
well.well.

4. Brain Injury 101Brain Injury 101
 The Importance of Learning About Brain InjuryThe Importance of Learning About Brain Injury
 You may have Consumers who have to deal with Brain InjuryYou may have Consumers who have to deal with Brain Injury
 Consumers look to professionals for helpConsumers look to professionals for help
 Professionals need to be informedProfessionals need to be informed
 As Coordinators then you also have to deal with Brain InjuryAs Coordinators then you also have to deal with Brain Injury
 What areWhat are youryour ExpectationsExpectations
 How can youHow can you bestbest communicate your needs such thatcommunicate your needs such that
the consumer understands them?the consumer understands them?
 How can you expect them to “remember” what you haveHow can you expect them to “remember” what you have
talked with them about?talked with them about?

5. Brain Injury 101Brain Injury 101
 Who do you know that has a BrainWho do you know that has a Brain Injury?Injury?
 Do you know an athlete who has had multiple concussions?Do you know an athlete who has had multiple concussions?
 Do you have a consumer who has had a stroke?Do you have a consumer who has had a stroke?
 Do you know a child who has been abused?Do you know a child who has been abused?
 Do you know a person who had spousal abuse?Do you know a person who had spousal abuse?
Then you probably know someone with a brain injuryThen you probably know someone with a brain injury

6. Brain Injury 101Brain Injury 101
 Communication Strategies for Coordinators working withCommunication Strategies for Coordinators working with
Consumers who have brain injuriesConsumers who have brain injuries
 Coordinators need to learn effective communication strategiesCoordinators need to learn effective communication strategies
 Survivors need people to have EXTREME patience with themSurvivors need people to have EXTREME patience with them
 Survivors process information and respond slower thanSurvivors process information and respond slower than
most people domost people do
 Give clear, short directivesGive clear, short directives
 Give concrete examplesGive concrete examples
 Ask questions then listen patientlyAsk questions then listen patiently
 Give written instructions for survivors who need writtenGive written instructions for survivors who need written
remindersreminders
 Give verbal instructions for othersGive verbal instructions for others
 Survivors deal in absolutes and are not usually verySurvivors deal in absolutes and are not usually very flexibleflexible

7. What is a Brain Injury?What is a Brain Injury?
What is your definition of disability?What is your definition of disability?
 For starters, no brain injury is alikeFor starters, no brain injury is alike
 ““The Consumer is NOT the disability”The Consumer is NOT the disability”
 A brain injuryA brain injury can becan be a permanent disabling condition.a permanent disabling condition.
 Most brain injury survivors improve over timeMost brain injury survivors improve over time
 How much and how long is determined by MULTIPLE factorsHow much and how long is determined by MULTIPLE factors
 Most people with MILD brain injuries look and act like everyone else. While someMost people with MILD brain injuries look and act like everyone else. While some
mild injuries have tremendous impairmentsmild injuries have tremendous impairments ..
 Brain injury may result in mild, moderate, or severe impairments in one or more areasBrain injury may result in mild, moderate, or severe impairments in one or more areas
 Physical function ImpairmentPhysical function Impairment
 Cognition ImpairmentsCognition Impairments
 Speech-language communicationSpeech-language communication
 MemoryMemory
 Attention and concentrationAttention and concentration
 ReasoningReasoning
 Abstract thinkingAbstract thinking
 Psychosocial behavior ImpairmentPsychosocial behavior Impairment
 Information processing ImpairmentInformation processing Impairment

8. How impairments affect the individual’s ability toHow impairments affect the individual’s ability to
function in daily lifefunction in daily life
 Classifications of brain injuries are largely given to trauma survivorsClassifications of brain injuries are largely given to trauma survivors
 Mild traumatic brain injury or concussionMild traumatic brain injury or concussion
o Loss of consciousness not to exceed 30 minutesLoss of consciousness not to exceed 30 minutes
o Post traumatic amnesia lasts less than 24 hoursPost traumatic amnesia lasts less than 24 hours
o Glasgow Coma scale is 13 – 15Glasgow Coma scale is 13 – 15
 ModerateModerate
o Loss of consciousness is at least 30 minutes but not more than 24 hoursLoss of consciousness is at least 30 minutes but not more than 24 hours
o Post Traumatic Amnesia lasts at least 24 hours but not more than 7 daysPost Traumatic Amnesia lasts at least 24 hours but not more than 7 days
o Glasgow Coma scale 9 – 13Glasgow Coma scale 9 – 13
 SevereSevere
o Loss of consciousness exceeds 24 hoursLoss of consciousness exceeds 24 hours
o Post Traumatic Amnesia lasts longer than 7 daysPost Traumatic Amnesia lasts longer than 7 days
o Glasgow Coma Scale 8 or lessGlasgow Coma Scale 8 or less

9. Why do Brain Injury Survivors need Assistance?Why do Brain Injury Survivors need Assistance?
 Physical ChallengesPhysical Challenges – some, all, or none of the following may– some, all, or none of the following may
be experiencedbe experienced
 Lack of Muscle movementLack of Muscle movement – paralysis causes muscle atrophy– paralysis causes muscle atrophy
 SpasticitySpasticity – requires ongoing medication and intervention– requires ongoing medication and intervention
 Loss of TasteLoss of Taste – damaged olfactory nerves can create eating– damaged olfactory nerves can create eating
disordersdisorders
 Loss of BalanceLoss of Balance – increasing falls and secondary head injuries– increasing falls and secondary head injuries
 Loss of Muscle coordinationLoss of Muscle coordination – increasing falls and bumping into– increasing falls and bumping into
objectsobjects
 Loss of SmellLoss of Smell – affects taste and can increase hazards concerning– affects taste and can increase hazards concerning
firefire
 Loss of SpeechLoss of Speech – lessens ability to communicate needs– lessens ability to communicate needs
 Inability to SleepInability to Sleep – Chronic sleep deprivation– Chronic sleep deprivation
 Loss of sensationLoss of sensation – Touch or being touched– Touch or being touched
 Acquisition of seizure disorderAcquisition of seizure disorder – Common among those with brain– Common among those with brain
injuriesinjuries
 Loss of HearingLoss of Hearing – one or both sides or diminished hearing– one or both sides or diminished hearing
 FatigueFatigue – resulting from cognition and processing difficulty– resulting from cognition and processing difficulty
 Disrupted Sexual FunctioningDisrupted Sexual Functioning – Medications, or neural damage– Medications, or neural damage
 Double VisionDouble Vision – visual pathway damage, or damage to the occiptal– visual pathway damage, or damage to the occiptal
lobelobe
 WeaknessWeakness - motor cortex damage or cerebellum damage - motor cortex damage or cerebellum damage

10. Why ELSE do Brain Injury Survivors need Assistance?Why ELSE do Brain Injury Survivors need Assistance?
 Cognitive impairmentsCognitive impairments or Thinking Changesor Thinking Changes
 MemoryMemory – the most common issue reported– the most common issue reported
 CommunicationCommunication – inability to be understood and inability TO– inability to be understood and inability TO
understandunderstand
 PerceptionPerception – of objects, of the spoken word, of their place in– of objects, of the spoken word, of their place in
space, you name it!space, you name it!
 Decision makingDecision making – processing ability has a great amount to do– processing ability has a great amount to do
with this as well as fearwith this as well as fear
 Reading and writing skillsReading and writing skills – loss of skills relating to motor– loss of skills relating to motor
functions and memoryfunctions and memory
 Thought flexibilityThought flexibility – rigidity of relearned schedules and skills– rigidity of relearned schedules and skills
 PrioritizationPrioritization
 PlanningPlanning
 SequencingSequencing – a huge problem– a huge problem
 JudgmentJudgment
 OrganizationOrganization

11. More Cognitive ImpairmentsMore Cognitive Impairments
 Thought processing speedThought processing speed – difficulty hearing, then finding meaning– difficulty hearing, then finding meaning
and responding to new informationand responding to new information
 Safety awarenessSafety awareness – relating to safety, abilities, limitations, and– relating to safety, abilities, limitations, and
challenging themselveschallenging themselves
 Problem solving skillsProblem solving skills – Loss of seeing the “big picture,” focusing on– Loss of seeing the “big picture,” focusing on
the treesthe trees
 New learningNew learning – must find old memories to attach new information to– must find old memories to attach new information to
be able to retrieve.be able to retrieve.
 JudgmentJudgment – Decision-making skills– Decision-making skills
 AttentionAttention – Can be selective, and can be affected by distraction– Can be selective, and can be affected by distraction
 Self-perceptionSelf-perception – related to Self-Awareness– related to Self-Awareness

12. Personality Changes in People with Brain InjuriesPersonality Changes in People with Brain Injuries
 Personality and Behavioral ChangesPersonality and Behavioral Changes
 Dual Diagnoses, Mental Health IssuesDual Diagnoses, Mental Health Issues
 Emotional control and mood swingsEmotional control and mood swings
 DepressionDepression
 Lack of Social skillsLack of Social skills
 Lack of Self-monitoring which leads to inappropriate remarks orLack of Self-monitoring which leads to inappropriate remarks or
actionsactions
 Extreme Appropriateness or inappropriateness of behaviorExtreme Appropriateness or inappropriateness of behavior
 Excessive laughing or cryingExcessive laughing or crying
 Stress and AnxietyStress and Anxiety
 FrustrationFrustration
 Irritability or agitationIrritability or agitation
 Lack ofLack of Coping skillsCoping skills
 Reduced self-esteemReduced self-esteem
 Lack of MotivationLack of Motivation
 DenialDenial
 Self-centerednessSelf-centeredness
 Lack of Anger management Lack of Anger management

13. What TILC can do for Brain Injury SurvivorsWhat TILC can do for Brain Injury Survivors
 Offer human support if the survivor meets DA1 minimumOffer human support if the survivor meets DA1 minimum
scores and CDS requirements, or offer In-Home if morescores and CDS requirements, or offer In-Home if more
appropriateappropriate
 Offer IL Support and IL Skills TrainingOffer IL Support and IL Skills Training
 Ask survivors questions and learn what the survivor “thinks” theyAsk survivors questions and learn what the survivor “thinks” they
can and can’t do. Survivors often do not fully understand theircan and can’t do. Survivors often do not fully understand their
limitations in relation to their brain injury. Assess the survivor’slimitations in relation to their brain injury. Assess the survivor’s
needs and help in goal planningneeds and help in goal planning
 Brain Injury survivors isolate themselves because they cannotBrain Injury survivors isolate themselves because they cannot
process multiple conversations or stimulation of light, sound,process multiple conversations or stimulation of light, sound,
colors, and movement. Offer IL Support to help them reducecolors, and movement. Offer IL Support to help them reduce
isolationisolation
 Provide social and peer supportProvide social and peer support

14. Article in St. Louis NewspaperArticle in St. Louis Newspaper
Budget Cuts and Funding injury servicesBudget Cuts and Funding injury services
A traumatic brain injury is devastating to the individual and his family. Recovery oftenA traumatic brain injury is devastating to the individual and his family. Recovery often
is slow and painful. Missouri residents with brain injuries saw the elimination ofis slow and painful. Missouri residents with brain injuries saw the elimination of
physical therapy, occupational and speech therapy and comprehensive dayphysical therapy, occupational and speech therapy and comprehensive day
rehabilitation a few years ago. The proposed budget that passed the Missouri Houserehabilitation a few years ago. The proposed budget that passed the Missouri House
last week eliminates all support and rehabilitation services in the Adult Head Injurylast week eliminates all support and rehabilitation services in the Adult Head Injury
Program in the Department of Health and Senior Services. These vital services areProgram in the Department of Health and Senior Services. These vital services are
one of the last lifelines for people with brain injury and can make the differenceone of the last lifelines for people with brain injury and can make the difference
between living in the community or in a nursing home.between living in the community or in a nursing home.
In 2009, 239 Missourians received paid support and rehabilitation services from theIn 2009, 239 Missourians received paid support and rehabilitation services from the
Adult Head Injury Program. Another 265 people are on a waiting list for services.Adult Head Injury Program. Another 265 people are on a waiting list for services.
Among the services they receive are one-on-one home support and training, pre-Among the services they receive are one-on-one home support and training, pre-
vocational training and adjustment counseling. Many of the service providers whovocational training and adjustment counseling. Many of the service providers who
deliver these services are small businesses. If these cost-effective services aredeliver these services are small businesses. If these cost-effective services are
eliminated, employees will be laid off and some small businesses will close,eliminated, employees will be laid off and some small businesses will close,
increasing the unemployment rate and reducing tax revenue.increasing the unemployment rate and reducing tax revenue.
The human and financial impact of these cuts is significant, even though the dollarThe human and financial impact of these cuts is significant, even though the dollar
amount saved is modest. Our elected leaders in the state Senate should reverse theamount saved is modest. Our elected leaders in the state Senate should reverse the
proposed cuts to the Adult Head Injury Program when they consider the budget in theproposed cuts to the Adult Head Injury Program when they consider the budget in the
coming days. The budget should not be balanced on the backs of Missouri's mostcoming days. The budget should not be balanced on the backs of Missouri's most
vulnerable citizens.vulnerable citizens.
Timothy Imhoff — Maryland Heights Brain Injury Association of MissouriTimothy Imhoff — Maryland Heights Brain Injury Association of Missouri

15. For More Information and Skill Training in communicatingFor More Information and Skill Training in communicating
with a survivor of brain injury see Andreawith a survivor of brain injury see Andrea
ReferencesReferences
 http://www.biausa.org/education.htm#aninjuredbrain’http://www.biausa.org/education.htm#aninjuredbrain’
 http://www.traumaticbraininjuryatoz.org/Moderate-to-Severe-http://www.traumaticbraininjuryatoz.org/Moderate-to-Severe-
TBI/DiagnosinTBI/Diagnosin
 http://cognitrn.psych.indiana.edu/busey/Q301/BrainStructure.htmlhttp://cognitrn.psych.indiana.edu/busey/Q301/BrainStructure.html
 http://www.med.harvard.edu/AANLIB/home.htmlhttp://www.med.harvard.edu/AANLIB/home.html
 http://www.discoverhiddensecrets.com/KimberlyAnne.htmlhttp://www.discoverhiddensecrets.com/KimberlyAnne.html
 http://braininjury.wisconsin.gov/links.htmhttp://braininjury.wisconsin.gov/links.htm