Update on Closed Head Injuries Sponsored by Barss Residential Long Term Care January 15, 2009 Fort Gratiot, MI
Goals Appreciate impact Appreciate impact Improve care Improve care Encourage prevention Encourage prevention
Objectives Describe primary causes Describe primary causes Describe how the brain works Describe how the brain works Utilize strategies Utilize strategies Discuss prevention Discuss prevention
Outline What they are What they are Why important Why important Who is at risk Who is at risk How brain injury impacts function How brain injury impacts function What you can do What you can do
Traumatic brain injury (TBI) An injury to the brain caused by external trauma to the head or violent movement of the head Thurman et al., 1994 Thurman et al., 1994
Prevalence
In Michigan ,000 citizens live with disabilities 2,500 new citizens per year 1,500 fatalities in 2004
Major Causes of TBI in Michigan Motor Vehicle – cars, motorcycle, recreational vehicles. Violence – substance abuse related, domestic, and shaken baby syndrome. Falls – primarily among elderly and children. Blast - "Signature Wound"
In Michigan...
Severity Mild (75%) Mild (75%) 1-3 months 1-3 months Moderate (10-30%) Moderate (10-30%) 1 year 1 year Severe (5-10%) Severe (5-10%) higher risk for long term disability higher risk for long term disability
Post acute care should be based on assessment of current functioning rather than on diagnosis of severity made immediately after injury
What happens
Primary events Axonal shearing Axonal shearing Contusion Contusion Bruising Bruising Bleeding Bleeding Depressed skull fracture Depressed skull fracture
Secondary events Swelling (cerebral edema) Swelling (cerebral edema) Hematoma Hematoma Increased intracranial pressure Increased intracranial pressure Anoxia Anoxia
Consequences No two are alike No two are alike Minority of survivors have long-term, physical signs Minority of survivors have long-term, physical signs Cognitive/Behavioral/Emotional Cognitive/Behavioral/Emotional
Physical Consequences Pain Pain Swallowing and speech Swallowing and speech Sensory Sensory Fatigue Fatigue Body movement Body movement
Behavioral Consequences Emotional dyscontrol Emotional dyscontrol Social inappropriateness Social inappropriateness Difficulty with relationships Difficulty with relationships Lack of response to social cues Lack of response to social cues Mood swings Mood swings
Cognitive consequences Slower processing Slower processing Language difficulties Language difficulties Inattention Inattention Poor concentration Poor concentration Memory deficits Memory deficits
Brain Behavior Relationships
Brain-behavior relationships Right Right The big picture The big picture Visuospatial relationships Visuospatial relationships Self-awareness Self-awareness Creativity Creativity Visual memory Visual memory
Brain-Behavior Relationships Left Left Language Language Emotional regulation Emotional regulation Verbal memory Verbal memory Logic Logic Sequencing Sequencing
Brain-Behavior Relationships Frontal Parietal Occipital Temporal Brain stem Hippocampus Amygdala
Frontal lobe Executive function Purposeful behavior Complex reasoning Organization Problem solving Flexibility Speaking
Frontal lobe Initiation Initiation Self-monitoring Self-monitoring Inhibition Inhibition Judgment Judgment
Temporal Lobe Memory Understanding language Organizing and sequencing Hearing
Standing in the Shoes... Susan Wehry
Complex Mild to severe Different areas Multiple areas Recovery varies
Recovery Weeks Years Weeks Years Lifelong Lifelong Unique Pre-injury personality Learning style Location and severity Psychological reaction Family involvement
Rehabilitation Functional assessment Functional assessment Targeted to specific strengths, deficits Targeted to specific strengths, deficits Family involvement and support critical Family involvement and support critical
Rehabilitation Cognitive Cognitive Speech Speech Occupational Occupational Physical Physical Social Social
Primary Prevention Causes Causes Seat belts Seat belts Environmental hazards Environmental hazards Conflict resolution Conflict resolution Risk factors Risk factors Age Age Gender Gender Alcohol Alcohol
Secondary Prevention Physical deficits may further injury Physical deficits may further injury Attend to risk of falls, choking Attend to risk of falls, choking Cognitive deficits further disability Cognitive deficits further disability Target rehabilitation towards strengths Target rehabilitation towards strengths
What you can do Personal prevention Personal prevention Share what you've learned Share what you've learned Act as an advocate Act as an advocate Become involved Become involved Brain Injury Association of Michigan Brain Injury Association of Michigan
References and Resources wmv 40.wmv 40.wmv 40.wmv