Traumatic brain injury (TBI) The Centers for disease Control and Prevention have identified Traumatic brain injury (TBI) as a serious public health problem in the United States. Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. Recent data shows that, on average, approximately 1.7 million people sustain a traumatic brain injury annually.1 References 1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
Costs of TBI The Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated $76.5 billion in the United States in 2000.1,2 References 1. Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006. 2. Coronado, McGuire, Faul, Sugerman, Pearson. The Epidemiology and Prevention of TBI (in press) 2012.
Potential Affects of TBI A TBI may lead to a wide range of short- or long-term issues affecting: Cognitive Function (e.g., attention and memory) Motor function (e.g., extremity weakness, impaired coordination and balance) Sensation (e.g., hearing, vision, impaired perception and touch) Emotion (e.g., depression, anxiety, aggression, impulse control, personality changes) Approximately 5.3 million Americans are living with a TBI-related disability and the consequences of TBI can affect all aspects of an individual’s life.1 This can include relationships with family and friends, as well as their ability to work or be employed, do household tasks, drive, and/or participate in other activities of daily living. References 1. Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil 1999;14(6):602-615.
Conversations with TBI Survivors We attended 3 separate TBI support groups and talked to 15 survivors and 5 family members who were their primary care providers. We asked the survivors what were the largest challenges they faced after the TBI. Answers included difficulties with attention and memory, balance, hearing, and vision. The most prevalent challenges stated were related to Emotions, including; depression, anxiety, anger, aggression, impulse control and changes in personality.
Conversations with Family Family members of survivors of TBI often point to the Survivors emotions as being the most challenging. They referred to the survivor as having a "short fuse," "flying off the handle" easily, being irritable or having a quick temper. Family members mentioned anger or temper outbursts because they can be quite startling, and can overshadow other more serious difficulties, such as physical or cognitive deficits.
Handling Emotions after A Traumatic Brain Injury (TBI)In our conversations with survivors and family, we found that emotional outbursts were often experienced “out of nowhere”. The survivor would have an outburst without realizing that they were even getting angry. All respondents wished that this situation could be controlled and stated that they would be happy to pay for a solution to this problem.Our Proposal is to utilize existing technology and research on physiology and emotion to give the survivor a “heads up "to an impending outburst. This would allow the survivor to utilize strategies to control their emotions.
The What: An application that starts when the user puts on a Zephyr BioHarness or shirt and is in the Bluetooth proximity of an Android or IOS device that is compatible. The app receives real-time sensor data indicating, recording, and analyzing physiological conditions of the user. The BioHarness transmits measurements of the users heart rate, respiration, skin temperature, activity and posture continuously. A baseline of measurements is established for the user. When the app identifies a change in heart rate, respiration, or skin temperature without a corresponding change in activity or posture, an event is triggered that notifies the user (and optionally a remote monitor family) and gives them a set of options (apps) to mediate the physiological changes, or gets help.
The Why: Survivors of TBI are often less aware of changes to their emotions and experiences (such as stress) and are often frustrated and angered by others that would point out the changes. These factors can lead to expressions of their emotions in socially unacceptable and sometimes damaging ways. It is also well documented that long-term stress has adverse effects on a person’s physical and mental well-being. By informing the user of physiological changes before the event that is causing them has gotten out of hand, the user is able to affect the changes in the environment (earplugs, sunglasses, time out, or relocate to a less stressful area). The user can also get suggestions from the associated apps i.e. “Have you taken your meds?”, “would you like to do a breathing exercise or meditate?”. If the user’s measurements go uncontrolled and the user does not acknowledge the alerts, an app can be triggered to contact a family member, care provider, monitoring station, or emergency service as would be the case with a posture of prone indicated with other measurements out of range.
Zephyr Bioharness connects to IOS / Android Device
What: Posture indication Green Circle: Within Red Circle: Exceeds parameters parameters The user must press the red “ALERT” button to acknowledge the event within a certain time frame, otherwise Central Monitoring is notified, or a 911 call is initiated.
If the user acknowledges the event within the alloted time frame, a selection screen is presented. Emergency: I need help NOW! I am OK I want assistance
Selecting “Panic” sends SMS messages to notify emergency contacts. The messagesinclude the current GPS location. Audio and video monitoring may also be initiated. The user must respond to the Yes/No question, otherwise Central Monitoring will be notified. If there is no Central Monitoring, then a 911 call will be initiated. If the users selects “YES”, a 911 call is initiated. A medical emergency app is launched giving responders vital information such as emergency contacts, allergies, and medical conditions.
Selecting “OK” sends SMS messages to theemergency contacts, letting them know the user is alright and providing current vitals, and asks if the user would like to call someone. The alert will temporarily be suspended for a predefined amount of time. If the alert occurs again, the same process will be repeated. The user can temporarily disable the allert based on a selectable amount of time. This would be convinient if the alert is a false positive based on activities or a malfunction. An SMS will then be sent to the emergency contacts letting them know the user has disabled the alert.
Selecting “Advice” prompts the user to make other selections Phone or Texting app Breathing apps, relaxing sound apps, meditation apps Medication, anxiety, depression, and emotional assessment apps