1. Traumatic Injuries: Traumatic Brain Injury KNR 279

2. TRAUMATIC BRAIN INJURY  Insult to brain, not of degenerative or congenital nature, but caused by an external force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive or physical functioning  Open or closed injury  Mild (concussion) to severe (coma)

3. INCIDENCES OF TBI  Over 2-5 million in US  1 injury every 15 seconds  Many result in life long disability  56,000 killed annually  Leading cause of death among Americans under 45  Males 14-24 have highest rate

4. CAUSES OF TBI  50% Motor vehicle crashes  21% Falls  12% Violence  10% Sports & recreation  7% Other

6. Symptoms: Frontal Lobe/Forehead www.braininjury.com  Paralysis  Problems sequencing for multi-step task  Persistence of a single thought  Inability to focus on task  Mood changes/emotional liability  Changes in personality  Difficulty with problem solving  Inability to express language

7. Parietal Lobe/ Near back & top of head  Inability to attend to more than 1 object at a time  Inability to name an object  Inability to locate words for writing  Problems reading  Difficulty with drawing tasks  Difficulty to distinguish left from right  Difficulty with math  Difficulty with eye-hand coordination

8. Occipital Lobes: Back of head  Defects in vision (visual field cuts)  Difficulty locating objects in the environment  Problems identifying colors  Difficulties with reading & writing  Visual illusions (inaccurately seeing objects)

9. Temporal Lobes: Side of head above ears  Difficulty recognizing faces  Difficulty in understanding spoken words  Short term memory loss  Interference with long term memory  Inability to categorize objects  Right lobe can cause persistent talking  Increased aggressive behavior

10. Brain stem: Deep within brain  Difficulty swallowing food & water  Problems with balance & movement  Dizziness & nausea  Sleeping difficulties  Decreased vital capacity in breathing needed for speech

11. Cerebellum: Base of skull  Loss of ability to coordinate fine movements  Loss of ability to walk  Tremors  Slurred speech  Inability to make rapid movements

12. EFFECTS OF TBI  Balance or equilibrium  Behavior / emotion  Cognitive  Physical  Seizures  Speech / language

13. Glasgow Coma Scale

14. Ranchos Los Amigos Scale Level of Cognitive Functioning / Recovery  I = No response, comatose  II = Generalized response, nonpurposeful, inconsistent  III = Localized response, inconsistent reaction to specific stimuli  IV = Confused, agitated, nonpurposeful behavior, inability to process information

15. Ranchos Los Amigos Scale Level of Cognitive Functioning / Recovery  V = Confused, inappropriate, nonagitated behavior, alert, highly distractible, responds to simple commands  VI = Confused but appropriate behavior, goal-directed, uses external input for direction

16. Ranchos Los Amigos Scale Level of Cognitive Functioning / Recovery  VII = Automatic, appropriate behavior, robot like compliance with routine, shallow recall, increased awareness of others  VIII = Purposeful, appropriate behavior, alert, oriented, independent functioning

17. Recommended TR Interventions  I, II, III = Sensory stimulation, passive stretching, art, movement to music, cognitive retraining, reality orientation  IV, V, VI = Aquatic therapy, expressive arts, leisure education, horticulture, behavior management, stretching & flexibility exercises, table & board games  Carter, Van Andel, & Robb, 2003

18. Recommended TR Interventions  VII, VIII = Computer games, Community integration, expressive arts, social skills training Carter, Van Andel, & Robb, 2003

19. Considerations/Accommodations  Decrease distractions in environment  Provide repetition & consistency  Demonstrate new tasks & provide examples  Help with planning  Behavior management  Guidance with appropriate behavior in social situations  May not remember that just asked question

20. Considerations/Accommodations  Structure  Start with simple tasks & small steps  Give clear, concrete directions  Supervise, may not know own limitations