1. The Face of Traumatic Brain Injury Gale Whiteneck, Ph.D. Director of Research Craig Hospital

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12. 12 The Face of Traumatic Brain Injury More young than old More male than female More cognitive than physical disabilities

13. 13 Invisibility of TBI If disabilities have been too invisible to society If cognitive disabilities are invisible in the word of disability Then TBI may be a relatively invisible cognitive disability But the troupes returning from Iraq and Bob Woodward may change all that

14. 14 The Numbers of TBI Each year in the US, CDC estimates: 50,000 people die from TBI 235,000 people are hospitalized with TBI 1,100,000 people with TBI are treated and released from Emergency Departments A large but unknown number are either seen in physicians’ offices or clinics or do not seek medical attention

15. 15 The Severity Spectrum of TBI The depth of alteration of consciousness (Glasgow Coma Scale) The length of loss of consciousness The length of Post Traumatic Amnesia (PTA) Imaging of the brain (CT, MRI) Severity measures are not necessarily consistent The initial severity is not necessarily a good predictor of long-term outcome

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17. 17 The Face of TBI in this Audience Have you ever been injured? –Car crash, sports, falls, violence, abuse Was your head or neck injured? –Blow to the head or whiplash Did you experience any alteration of consciousness? –Dazed or confused Did you experience loss of consciousness? –Knocked out or blacked out

18. 18 Have you ever had a TBI? A: Never had an injury to the head resulting in even being dazed or confused B: Have had one or more injuries to the head with altered consciousness, but never experienced loss of consciousness C: Have had one or more head injuries with loss of consciousness, but never more than 30 minutes D: One loss of consciousness greater than 30 min E: More than one loss of consciousness > 30 min

19. 19 Pathways of TBI Care Hospitalization Seen in Emergency Department and released Seen in physicians office or clinic No medical care sought

20. 20 Consequences of TBI Of all the people that are hospitalized (for even one night) after a TBI (even if it wasn’t the reason for the hospitalization), what proportion will have life-time cognitive deficits resulting in the need for assistance from others? A: 1/10 B: 1/5 C: 1/4 D: 1/3 E: 1/2

21. 21 Consequences of TBI 5.3 million people are living in the US with significant disability after being hospitalized with TBI It is unknown what percentage of people with non-hospitalized TBI have significant life-time disability

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25. 25 Types of TBI Focal Diffuse (increasing disruption of axonal fibers) –Mild concussion –Classic cerebral concussion –Diffuse axonal injury –Diffuse white matter injury

26. 26 Common Cognitive Impairments Attention/Concentration Speed of Information Processing Problem solving/judgment Short Term Memory Lack of self awareness

27. 27 Common Emotional Psychosocial Impairments Anxiety Mood disorders, depression Emotional dysfunction, impulsivity, anger Impaired social skills, loneliness

28. 28 Common ADL/Participation Difficulties Meal planning, preparation, cleanup Hygiene, dressing, grooming Money management, budgeting Time management Driving, public transportation Work, school, volunteer

30. 30 Technology Applications to TBI Cognitive rehabilitation PDA-based memory aids AT for independent living, working, QOL Advanced cognitive prostheses Aids in increasing social capital The NIDRR-funded TBI Model Systems as a research laboratory

31. 31 After Thinking About TBI Briefly A: I never knew much about TBI and it doesn’t interest me B: I have never focused on TBI in my work, but see that it is an important disability C: I have never focused on TBI in my work, but think it might be relevant to TBI D: TBI has been one of the focuses of my work E: TBI has been the primary focus of my work, or soon will be

32. Questions? Thank you! Gale Whiteneck, Ph.D. 303-789-8204 gale@craig-hospital.org

33. 33 Craig Hospital Specializing in Spinal Cord Injury and Traumatic Brain Injury Rehabilitation since 1956

34. 34 ___________________________________________________________ Craig Hospital ___________________________________________________________ “A Century of Rebuilding Lives” 1907-2007