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Dealing with TBI An Overview of Behavioral Symptoms and Interventions.

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Presentation on theme: "Dealing with TBI An Overview of Behavioral Symptoms and Interventions."— Presentation transcript:

1 Dealing with TBI An Overview of Behavioral Symptoms and Interventions

2 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 annually, with indirect care estimated at 37.8 billion dollars annually

3 Diagnostic Criteria for MTBI Traumatically induced physiological disruption of the brain (an injury occurs) Any period of loss of consciousness not to exceed 30 minutes Loss of memory for events immediately before of after the accident Any alteration in mental state at the time of the accident

4 MTBI Focal neurological deficits that may or may not be transient Post-traumatic amnesia does not exceed 24 hours Glasgow Coma Scale of 13-15 after 30 minutes –Eyes open spontaneously –Oriented to place/time (Verbal output) –Obeys Commands (Motor output)

5 Assessment Questions Have you ever been told you have suffered a brain injury or concussion? Have you ever hit your head hard enough that you saw stars or had a headache that lasted the rest of the day? Have you ever been knocked unconscious? If so, for how long? Did you seek medical treatment?

6 Assessment Questions When you hit your head, did you feel nauseated or dizzy afterwards? Did you have any speech or coordination problems? Is there any part of the incident you cannot remember? Did you have any visual problems?

7 Assessment Questions Currently- –Do you have any memory problems? –Do you have problems keeping up with conversations or what people are saying? –Do you have problems concentrating or staying on task? –Are you sensitive to light? Does it cause you to have headaches? –Do you have problems pulling up words (are they on the tip of your tongue?)

8 Assessment Questions Are you more irritable than before the incident? Do people often say you act before you think? Do you have problems multi-tasking? Are you having any current balance or coordination issues? Are you having any sensory problems (hearing, smell, taste, etc.) ? Are there any changes you have noticed since the incident that I did not ask you about?

9 Frontal Lobe Injury Higher cognitive functioning or “executive functioning” Focusing attention Generating and following through on decisions Poor judgment Self-awareness of deficits self-monitoring Planning and carrying out activities (maintaining a job, grocery shopping, completing household duties, repairs, etc.)

10 Frontal Lobe TBI Concrete thinking Trouble staying on task Possible disinhibition and immaturity Possible decreased energy, motivation and spontaneity Possible speech and motor problems

11 Temporal Lobe TBI Storing NEW memories –Right: Visual memory –Left: Verbal memory Behavioral problems –Irritability –Aggression –Modulating behavior Word-finding and naming

12 Parietal Lobe TBI Processing sensory information –Right: Visual-spatial information –Left: Comprehension of spoken/written words Get lost in familiar surroundings Confused by multi-step instructions

13 Occipital Lobe TBI Processing of visual information Visual deficits –Field cuts –Blindness –Inability to know objects

14 Cerebellum TBI Coordination of movement –Walking and control of upper extremities for day-to-day tasks –Possible tremors associated with injury

15 Course of Recovery of MTBI In the majority of individuals symptoms of MTBI resolve in 6 months or less after 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

16 Overview of Diffuse Symptoms of MTBI Cognitive –Memory, Attention, Processing Speed & Intelligence Psychological –Depression, Anxiety, Irritability, and Sleep & Personality change Physical –Light/sound sensitivity, dizziness & fatigue

17 Dealing with Impaired Attention/Concentration Work slowly Break your work down into small, manageable increments Double check your work Prepare all materials for tasks prior to starting Take regular breaks to minimize fatigue

18 Attention and Concentration Con’t. When reading and studying, read small passages, take a break, and then read them again Clear away any materials not needed for tasks/work Maintain a quiet environment with minimal distractions when focus is needed

19 Learning and Memory Difficulties Daily organizer/calendar to record appointments and important tasks Multiple modalities to learn new material –Read it aloud (hearing) –Picture it (visual) Set realistic goals –It will take longer to learn new things –Break material down into smaller portions –Allow breaks between studying to allow material to consolidate into memory –Be patient with yourself!

20 Dealing with Executive Control Dysfunction Work on one task at a time Work slowly and carefully Check your work for errors Use a pocket organizer, smart phone or palm pilot Make a “to do” list and post it in a designated place Be willing to allow family members/friends provide reminders without being upset

21 How to detect brain injury There are often no outward physical signs of Injury – Invisible Wounds We need to focus on observable behavioral Indicators of TBI

22 Dealing with TBI Signs to look for: –Distractibility –Difficulties focusing on what is being said –Answering slowly or answering questions that are not asked (poor comprehension issues or low comprehension) –Long pauses in speech (word retrieval issues)

23 What to Look For Client’s with TBI are often very anxious, look for: –Restlessness –Face flushed –Sweatiness –Shakiness –Increased breathing rates

24 What to Look For cont. Talking very loud/yelling –Self-awareness and self-monitoring Staring –Inattentiveness Shakiness –Can be neurologically based Difficulty following orders –Delayed processing or comprehension problems

25 What to Look For cont. Have significant short-term memory issues –They seem to understand instructions, then minutes later cannot remember what you told them May become agitated/irritable very quickly and appear disinhibited due to frontal lobe injury May have significant coordination issues and involuntary movements that are neurologically based –Fail field test, NOT due to substance use/intoxication May have visual field cuts

26 What to Look For cont. Flat affect and seem apathetic Poor initiation of conversations Provide short & concrete answers to complex questions Suspect’s body language and poor verbal output (yes/no responses) suggests disinterest in what you are saying (flat affect) –Remember this is neurologically based

27 Interventions Tell individual one thing at a time; no multistep directions Be willing to repeat instructions slowly and clearly –Memory, Processing speed, and Comprehension Keep questions as simple as possible Make sure you have eye-contact with individual –Attention

28 Interventions Have them reflect what you have told them “Can you tell me what I ask you to do?” Loud speech does not always imply anger or opposition More likely confused or anxious; Inability to self- monitor

29 Interventions cont. Individuals with TBI often get overwhelmed with environments that are over-stimulating (too much noise, lights, movement around them), so: –When trying to talk to them or directing them, try to get them in quieter areas away from crowds, noise, lights, etc.

30 Interventions Write down any follow-up and encourage them to put in PDAs -Memory vs. non-compliance For anxious or agitated individuals, encourage breathing and grounding skills -Stress ball -Sensory loaded modalities Allow a time-out if necessary

31 Therapy Interventions- TBI Structure/routine –Pill reminder Marker board Symptom journal –Disorganization –Questions they want answered Take notes in session Involve family –Educational aspects –ADD-like aspects They often won’t admit deficits

32 TBI and PTSD: Overlapping and Differentiating symptoms TBI: –Concentration –Memory Commonly STM –Irritability –Fatigue Constant detours –Headaches Light sensitivity –Apathy Flat affect –Sexual inhibition or impulsivity PTSD –Concentration –Memory Dissociative or amnestic –Irritability triggers –Headaches SNS arousal –Apathy Secondary depression –Sexual aggression, heightened interest, or inhibition

33 TBI and PTSD: Overlapping and Differentiating Symptoms TBI: Sleep problems –REM cycle disruption Problems processing –Slowed –Word retrieval –Problems shifting focus Emotional lability –Without external triggers –Overly emotional to small events Personality changes –Flat –Lack of initiation –Loss of self-awareness/self- monitoring Lack of spontaneity PTSD: Problems sleeping –Nightmares –Hyperarousal –hypervigilance Problems processing –Scattered –Preoccupied Emotional Lability –Anxious, irritable, numbing, laughing Personality Changes –Self-esteem –Sense of damage Everything pre-planned Severe numbing

34 REFRENCES Brain Injury Association of Indiana PO Box 24167 Indianapolis, Indiana 46224 P: (317) 356-7722 F: (317) 481-1825 Brain Injury Association of America Inc. 1608 Spring Hill Rd Suite 110 Vienna, VA 22182

35 Reference Family Caregiver Alliance/National Center of Caregiving 180 Montgomery Street Suite 1100 San Francisco, CA 94104 Defense and Veterans Brain Injury Center

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