Traumatic Brain InjuryTraumatic Brain Injury

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Not degenerative

Case StudyCase Study

From a survivors perspective:From a survivors perspective:

“ “ after a car accident, I awoke in the after a car accident, I awoke in the hospital to a world I didn’t understand. I hospital to a world I didn’t understand. I had to learn to ask people to talk slower. had to learn to ask people to talk slower. Some stranger had taken over my body. Some stranger had taken over my body. She reacted in ways that were foreign to She reacted in ways that were foreign to me, like making obscene gestures and me, like making obscene gestures and saying things that I would never be saying things that I would never be caught dead saying.”caught dead saying.”

-Before her injury she had no emotional or -Before her injury she had no emotional or psychiatric problems. psychiatric problems.

2(Bryant, 2002)

PrevalencePrevalence

1.1. Main cause of death and disability in Main cause of death and disability in youth in U.S.youth in U.S.

a. fastest growing disability group in a. fastest growing disability group in U.S. due to increased survival ratesU.S. due to increased survival rates

b. 25% of all pediatric injuries are brain b. 25% of all pediatric injuries are brain injuriesinjuries

c. called “the silent epidemic”c. called “the silent epidemic”

2. 65-75 % mild in nature MTBI (missing a 2. 65-75 % mild in nature MTBI (missing a lot of these kids)lot of these kids)

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CONCEPT CONCEPT MAPMAP

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Environmental Etiologies

Family Factors

No Oxygen External ForceTypes of Damage

ConcussionContusionShearing

Child Biogenetic Factors

(Cognitive & Behavioral)

Child Risk FactorsChild Risk Factors

BEHAVIORAL FACTORSBEHAVIORAL FACTORS

Active & Risk –Active & Risk –Taking (e.g., Taking (e.g., ADHD)ADHD)

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COGNITIVE FACTORS

LD & MI/MH

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Family Factors

– Disorganized families

– 1/4 of TBI occur for children less than 2 yrs. Examples are:

• shaken babies

• tossed babies

Environmental Environmental EtiologiesEtiologies

Birthing Birthing processprocess

DrowningDrowning StrokesStrokes

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Environmental CAUSES

LACK Oxygen• External Force

10% from firearms but 9/10 of these die

Falls: younger than 5 & older than 75

• Opposing ForcesVehicles (car, bike, pedestrian)

account for ½ adolescent TBIsContact sports

External Forces

Contact sports in high Contact sports in high schoolschool

About 63,000 cases of MTBI annually in H.S. About 63,000 cases of MTBI annually in H.S. varsity athletesvarsity athletes

Football accounts for 63% of the cases. Football accounts for 63% of the cases.

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(Powell, 2000)

Look at this link Look at this link

http://www.hbo.com/docs/programs/coma/http://www.hbo.com/docs/programs/coma/index.htmlindex.html

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Types of Damage Types of Damage

1.1. ConcussionConcussion

2.2. ContusionContusion

3.3. ShearingShearing

1.1. bruising = focal bruising = focal effects that are effects that are recovered --no recovered --no damage of tissuedamage of tissue

2.2. bleeding and toxic bleeding and toxic effects to brain = focal effects to brain = focal damage to brain cellsdamage to brain cells

3.3. layers riding up on layers riding up on each other therefore each other therefore cutting of nerve cutting of nerve pathways = global pathways = global damagedamage

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Indicators of DamageIndicators of Damage

1.1. Seizures and types Seizures and types 2.2. Auras (warnings that Auras (warnings that

may be motor or may be motor or sensory)sensory)

3.3. ComaComa4.4. Secondary (co-Secondary (co-

occurring) disabilitiesoccurring) disabilities11

Physical OutcomesPhysical Outcomes

Physical stamina can by less (fatigue)Physical stamina can by less (fatigue)

Gross motor coordinationGross motor coordination--73% have good --73% have good recovery of these functions but recovery of these functions but (severe injury may require (severe injury may require wheelchairs)wheelchairs)

Fine motor speech impairmentsFine motor speech impairments

Headaches (even 1 year out)Headaches (even 1 year out)

Seizures (within 2 years of injury)Seizures (within 2 years of injury)

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Sensory & SomaticSensory & Somatic OutcomesOutcomes

DizzinessDizziness InsomniaInsomnia NauseaNausea Vision problems Vision problems

(e.g., blurred or (e.g., blurred or double, low double, low vision/blindness, vision/blindness, visual field cuts)visual field cuts)

Loss of smell or Loss of smell or tastetaste

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(CDC, 2003)

Possible Cognitive Possible Cognitive OutcomesOutcomes

Declines in general intelligence—especially Declines in general intelligence—especially nonverbal abilitiesnonverbal abilities

Slowed processing and response speed Slowed processing and response speed

Cognitive fatigue and Cognitive fatigue and attention/concentration deficitsattention/concentration deficits

Language and visual processing deficitsLanguage and visual processing deficits

Deficits in memory and new learningDeficits in memory and new learning

Problems with executive functions (e.g., Problems with executive functions (e.g., working memory)working memory)

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Cognitive Characteristics Cognitive Characteristics

Focal mild Focal mild attention/attention/

concentrationconcentration visual perceptualvisual perceptual

DifferentDifferent short term memoryshort term memory judgment judgment

loss of academic new loss of academic new learninglearning or languageor language (naming and (naming and receptive)receptive)

GlobalGlobal attention/attention/

concentrationconcentration visual perceptualvisual perceptual

DifferentDifferent long term memorylong term memory IQ--problem-solving/IQ--problem-solving/

disorganizationdisorganization

-- -- loss of old learningloss of old learning

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School and Vocational School and Vocational OutcomesOutcomes

1.1. Problems initiating and completing workProblems initiating and completing work

2.2. Slowed work paceSlowed work pace

3.3. Increased impulsivityIncreased impulsivity

4.4. Trouble navigating physical Trouble navigating physical surroundings, especially in new settings surroundings, especially in new settings (e.g., motor limitations, spatial deficits)(e.g., motor limitations, spatial deficits)

5.5. Decreased productivityDecreased productivity

6.6. Loss of employmentLoss of employment

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Social Social CharacteristicsCharacteristics

CommunicationCommunication May say inappropriate thingsMay say inappropriate things Difficulty understanding another’s Difficulty understanding another’s

perspectiveperspective Poor awareness of social environmentPoor awareness of social environment

Functioning losses Functioning losses Relationships: loss of friends, Relationships: loss of friends,

relationshipsrelationships Loss of the ability to manage home or Loss of the ability to manage home or

school environmentschool environment

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EmotionalEmotional

In general, the presence of an In general, the presence of an acquired brain injury places acquired brain injury places individuals at greater risk for individuals at greater risk for developing a new psychiatric developing a new psychiatric disorder (about 5 times disorder (about 5 times expectancies)expectancies)

DepressionDepressionAnxietyAnxietySleep disturbancesSleep disturbancesFrequent mood changes orFrequent mood changes ordifficulty regulating emotionsdifficulty regulating emotions18

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Which type of disability is more likely to have secondary psychiatric disorders?

Case Study IICase Study II A 15 year old girl with a history of anorexia nervosa. A 15 year old girl with a history of anorexia nervosa.

She sustained a head injury when she fell from her She sustained a head injury when she fell from her bicycle. bicycle.

Initially she was drowsy, slow to respond, and Initially she was drowsy, slow to respond, and disoriented in time but oriented in place and person.disoriented in time but oriented in place and person.

During the following 3 weeks, she was tired, lost During the following 3 weeks, she was tired, lost interest in activities, and had poor hygiene, slept interest in activities, and had poor hygiene, slept excessively, and worried about not being able to excessively, and worried about not being able to remember the accident. remember the accident.

Then difficulties in thinking, and hearing voices, but Then difficulties in thinking, and hearing voices, but was unable to elaborate on her thinking and hearing. was unable to elaborate on her thinking and hearing.

Finally diagnosed with Bipolar disorder from Finally diagnosed with Bipolar disorder from sustaining the head injury.sustaining the head injury.20

(Sayal, 2000)

InterventionsInterventions

Interventions may depend upon which area Interventions may depend upon which area of the brain was affected:of the brain was affected:

MemoryMemory ReviewingReviewing Consistent RoutineConsistent Routine

ComprehensionComprehension Repetition Repetition Emphasize Main PointsEmphasize Main Points

AttentionAttention Break down large assignments into Break down large assignments into

smaller taskssmaller tasks21

Interventions:Interventions:

May require changes in May require changes in instructional formatting:instructional formatting:

1. Advance Organizers1. Advance Organizers

Draw maps in planning the dayDraw maps in planning the day List solutions when giving them a List solutions when giving them a

problemproblem Use outlinesUse outlines

2. Groupings2. Groupings

Use groups with different disabilitiesUse groups with different disabilities

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Prevention of Mild Prevention of Mild TBITBI

SupervisionSupervision

Safety rules and education Safety rules and education Never drive while under the influenceNever drive while under the influence

Protective gear Protective gear Wear a seat belt.Wear a seat belt. Wear a helmet and make sure your Wear a helmet and make sure your

children wear helmets children wear helmets Avoid falling at home by: Avoid falling at home by:

using a step stool, using a step stool, installing handrails,installing handrails,installing window guards, installing window guards, and using safety gates.and using safety gates.

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(CDC,2003)

T or F in Response to T or F in Response to SeizureSeizure

1.1. put something soft put something soft under the person’s under the person’s headhead

2.2. put something in the put something in the person’s mouthperson’s mouth

3.3. hold onto the person’s hold onto the person’s tonguetongue

4.4. clear the floor around clear the floor around the personthe person

5. call for assistance if 5. call for assistance if the seizure is longer the seizure is longer than 5 minthan 5 min

6. try to revive the 6. try to revive the student and bring student and bring him/her aroundhim/her around

7. turn person onto their 7. turn person onto their sideside

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AnswersAnswers

1.1. TT

2.2. FF

3.3. FF

4.4. TT

5.5. TT

6.6. FF

7.7. TT

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