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Ann Tarpy, M.Ed. Acting Executive Director Arizona Governor's Council on Spinal and Head Injuries

“Understanding Traumatic Brain Injury” Southern Arizona Disability Rights and Resources Conference Saturday April 4, 2009 Session l Workshops 9:15 a.m. – 10:45 a.m. Windemere Hotel and Convention Center Sierra Vista, Arizona. Ann Tarpy, M.Ed. Acting Executive Director

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Ann Tarpy, M.Ed. Acting Executive Director Arizona Governor's Council on Spinal and Head Injuries

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  1. “Understanding Traumatic Brain Injury”Southern Arizona Disability Rights and Resources ConferenceSaturday April 4, 2009 Session l Workshops 9:15 a.m. – 10:45 a.m.Windemere Hotel and Convention CenterSierra Vista, Arizona Ann Tarpy, M.Ed. Acting Executive Director Arizona Governor's Council on Spinal and Head Injuries 10640 N. 28th Drive Ste. B-102 Phoenix, AZ 85029 602.863.0484 atarpy@azdes.gov Arizona Governor’s Council on Spinal and Head Injury

  2. Objectives • By the end of this Session, the participant will: • Comprehend the brain behavior relationships and the impact of brain injury. • Describe the impact of brain injury on the family system. Arizona Governor’s Council on Spinal and Head Injury

  3. Agenda • Opening activities • Part 1 - Understanding brain injury • Part 2 – Understanding brain behavior relationships and what happens when these relationships are interrupted from brain injury • Part 3 - Impacts on the Family System • Part 4 – Brain Injury Association of Arizona (BIAAZ) • Closing activities and evaluation Arizona Governor’s Council on Spinal and Head Injury

  4. Understanding Brain Injury • Traumatic brain injury is: • A condition with potential life-long implications that may require ongoing services and supports • A multidimensional syndrome affecting a wide variety of areas of function including: • Cognitive • Sensory • Motor • Social • Emotional • Physical Arizona Governor’s Council on Spinal and Head Injury

  5. Part 1 Understanding Brain Injury Arizona Governor’s Council on Spinal and Head Injury

  6. Understanding Brain Injury • Individuals can sustain brain injuries from medical conditions such as: • Infectious disease (e.g., meningitis, encephalitis) • Brain tumor and their treatments (chemotherapy and radiation can cause diffuse brain damage) • Neurological disease (e.g. multiple sclerosis) • Cerebrovascular disorders (e.g. stroke) • Toxic chemical or drug reactions (e.g., lead poisoning, carbon monoxide poisoning) • Hydrocephalus • Substance abuse Arizona Governor’s Council on Spinal and Head Injury

  7. Understanding Brain Injury • Hypoxia/Anoxia are other forms of brain injury. Examples are: • Suffocation • Suicide attempts • Near drowning • Other injuries (cardio or pulmonary) can reduce blood flow to the brain Arizona Governor’s Council on Spinal and Head Injury

  8. Understanding Brain Injury A traumatic brain injury (TBI) is a result of: • Blunt or penetrating trauma to the head such as a gunshot wound. • Coup – contrecoup injury from acceleration - deceleration forces such as motor vehicle crashes. Arizona Governor’s Council on Spinal and Head Injury

  9. Understanding Brain Injury • Mild, moderate, and severe brain injury are the clinical terms used to describe the “type” of brain injury the person sustained. • However, these same descriptors often fail to tell us about the “functional outcome” of the injury. Arizona Governor’s Council on Spinal and Head Injury

  10. Part 2 • Understanding brain behavior relationships and what happens when these relationships are interrupted from brain injury Arizona Governor’s Council on Spinal and Head Injury

  11. Part 2Understanding Brain Behavior Relationships Brain Function Arizona Governor’s Council on Spinal and Head Injury

  12. Understanding Brain Behavior Relationships • The brain is a very complex and delicate structure with pathways that determine such things as memories, emotions, and basic motor functions. In sum – who we are. Arizona Governor’s Council on Spinal and Head Injury

  13. Understanding Brain Behavior Relationships It is through our brains that we: • Experience ourselves and the environment • Understand our relationships to others. • Form our perceptions of our world. We don’t react to the world out there, but rather to our perception of it. Arizona Governor’s Council on Spinal and Head Injury

  14. The Role of the Neuron • The Messenger Arizona Governor’s Council on Spinal and Head Injury

  15. Understanding Brain Behavior Relationships • The brain is made up of billions of nerve cells (neurons) through which messages are transmitted. • Neurons of the brain connectand organize into functionalunits/networks with specific roles to sense, perceive, process and act on information from both outside of us and within us. • The units serve specific and important functions and are designed to work together. Arizona Governor’s Council on Spinal and Head Injury

  16. Interruption of Brain Behavior Relationships • During brain injury, these neurons/axons and networks can be damaged causing an interruption in the way that information flows through the networks within and between the functional units. Arizona Governor’s Council on Spinal and Head Injury

  17. Brain Functions Arizona Governor’s Council on Spinal and Head Injury

  18. Left Hemisphere – Logical Words (spelling) Verbal meaning Vocabulary in language Details – rules Analysis One-by-one selectivity Step-by-step instructions Sequential ordering Cause and effect relationships Learned facts Letter-symbol associations Abstract reasoning Academically-learned information Ideas Serial/ordered structures Self-verbalizations Selective attention Consciousness – reasoning Scientific logic Right Hemisphere – Aesthetic Images, pictures, and colors – spatial Music and feelings Gestalt – whole/relational Synthesis, comparisons Simultaneous patterning Whole process Whole units Analogies Creativity – new combinations Visual symbolism Concrete Practical – common sense knowledge Patterns of things/theory Random-without structure body language Facial expression, tone of voice Sustained attention Meditation, spontaneous ideas, subconscious Spiritual – mythical Patterns of logical associations Cognitive Skills/Functions Associated with Hemispheres of the Brain Arizona Governor’s Council on Spinal and Head Injury

  19. Arizona Governor’s Council on Spinal and Head Injury

  20. Interruption of Brain Behavior Relationships Areas of Impact • Functional / Physical • Cognitive • Personality / Emotional • Psychological / Behavioral Arizona Governor’s Council on Spinal and Head Injury

  21. What Happens during Cognitive Development? Arizona Governor’s Council on Spinal and Head Injury

  22. Understanding Brain Behavior Relationships • Cognitive development: • Is a dynamic and interactive process of the development of skills gross motor, fine motor, language, cognitive, and social. • Causes maturation in thinking ability, behavior, emotional regulation, and social capabilities. Arizona Governor’s Council on Spinal and Head Injury

  23. Interruption of Brain Behavior Relationships • Injury during cognitive development… • Results in an underdevelopment of the brain functions of the areas impacted by the injury, • Impacts further cognitive development, • Impacts how those working with the individual set realistic expectations regarding behavior and accomplishments. Arizona Governor’s Council on Spinal and Head Injury

  24. Understanding Brain Behavior Relationships • Role of the Information Processing Model Arizona Governor’s Council on Spinal and Head Injury

  25. Understanding Brain Behavior Relationships When the brain is functioning normally- • It receives messages/information through our senses and interprets them; filters out irrelevant information. • It puts together the messages in a way that has meaning for us, • Stores that information in our memory; • Uses that memory and retrieves the information timely and accurately. Arizona Governor’s Council on Spinal and Head Injury

  26. Interruption of Brain Behavior Relationships • If an individual is unable to receive (input) information or • If they receive inaccurate or unreliable sensory input, and/or • If their ability to process information or filter out irrelevant information is disrupted from injury… Arizona Governor’s Council on Spinal and Head Injury

  27. Interruption of Brain Behavior Relationships • A person’s behavior, ability to function, and ability to communicate change. Arizona Governor’s Council on Spinal and Head Injury

  28. Interruption of Brain Behavior Relationships • Sensory information may not be able to get into the brain or may not be able to get in accurately; • Different parts of the brain may no longer be able to communicate with one another; • Processing speed (receptive and expressive) may be slowed. Arizona Governor’s Council on Spinal and Head Injury

  29. Interruption of Brain Behavior Relationships • Changes in the way they are able to process information may interfere with the individual’s ability to control emotions, benefit from experience, and be sensitive to the emotional needs of others. Arizona Governor’s Council on Spinal and Head Injury

  30. Interruption of Brain Behavior Relationships • It is the complex neurobehavioral problems that may cause the greatest disruption in the survivor’s and family’s life. Arizona Governor’s Council on Spinal and Head Injury

  31. Interruption of Brain Behavior Relationships Behavior following brain injury is likely to be influenced by or an interaction between the following factors: • Changes based on the parts of the brain that were injured (e.g. in personality, cognition and behavior) • Complications caused by emotional reactions to difficulties and changes from the injury • Pre-morbid characteristics • Family system/family functioning (pre/post injury) • Environment • Reaction to medication • History of substance abuse • Level of awareness and understanding of brain injury. Arizona Governor’s Council on Spinal and Head Injury

  32. Interruption of Brain Behavior Relationships • Environment is the one variable over which family members, caregivers, and service providers have the most control. • Changing the expectations of the individual in the environment can change/improve the behavior. Arizona Governor’s Council on Spinal and Head Injury

  33. Interruption of Brain Behavior Relationships Arizona Governor’s Council on Spinal and Head Injury

  34. Interruption of Brain Behavior Relationships Comments about Medications • Side-effects of medications can be enhanced after brain injury making compliance problematic. • Typical medication regimens may not produce the desired result and may have the opposite reaction. • Individuals with brain injuries are likely to need assistance managing their medications. • Due to the fragmented nature of care following brain injury, the survivor may end up with multiple medications that they may or may not need. They may not have a physician monitoring all of the medication and may be over-medicated. Arizona Governor’s Council on Spinal and Head Injury

  35. Interruption of Brain Behavior Relationships • A person with a brain injury may engage in behaviors (adaptive and maladaptive) as a means of communication… Arizona Governor’s Council on Spinal and Head Injury

  36. Interruption of Brain Behavior Relationships They may be trying to communicate – • That a basic need is not met • That others are not listening • That they need more assistance to do the task or activity • All other efforts have failed • Frustration due to other impairments associated with the injury (e.g., delaying information processing speed, memory impairments, physical limitations, etc.) Arizona Governor’s Council on Spinal and Head Injury

  37. By understanding that behavior may be a manifestation of the brain injury or a means of communication - family members, caregivers, and service providers can begin to interpret the behavior differently - not as volitional or a demonstration of a lack of interest. Interruption of Brain Behavior Relationships Arizona Governor’s Council on Spinal and Head Injury

  38. Interruption of Brain Behavior Relationships • Important for the family member, caregiver, and/or service provider to be aware of his/her perception of what the behavior means. Arizona Governor’s Council on Spinal and Head Injury

  39. Interruption of Brain Behavior Relationships • Stress is a common reaction when living or working with individuals with a brain injury. • The stress reaction generally occurs in situations where the demands of the environment exceed an individual’s (perceived) resources to handle the situation. • The stress reaction can occur in the individual with the brain injury, the caregiver, family member and/or service provider. Arizona Governor’s Council on Spinal and Head Injury

  40. Part 3 • Impacts on the Family System Arizona Governor’s Council on Spinal and Head Injury

  41. Impacts on the Family System Understanding brain injury and the impact of the brain injury on the individual and the family is really about understanding grief and loss – at many levels. Arizona Governor’s Council on Spinal and Head Injury

  42. Impacts on the Family System • For the individual – (depending on their level of awareness) s/he may mourn the loss of: • Memories of experiences that connect them with family and friends • Sense of self – who they were before the injury • His/her role and status in the family, at work, with friends • Physical functioning • Changes in thinking and behavior • Ability to do some of the things they did before • The life they had before the injury Arizona Governor’s Council on Spinal and Head Injury

  43. Impacts on the Family System • For the family, they are mourning the loss of: • Who the individual was before the injury - connection to the individual through memories of shared experiences. • Hopes, dreams, and plans for the future they had for the individual. • Their way of life and now facing the reality that life may never be returning to the way it was before. • The role the individual played in the family • For a spouse, they may be mourning the loss of their companion, their support, their partner. Arizona Governor’s Council on Spinal and Head Injury

  44. Impacts on the Family System • Families members, individually and as a unit, experience an ongoing journey filled with challenges and changes through the recovery period and then adjusting to life after brain injury. • In many cases, recovery becomes a lifelong process of adjustments and accommodations for the individual and the family as they deal with acceptance and understanding of the injury and subsequent limitations and consequence. Arizona Governor’s Council on Spinal and Head Injury

  45. Impacts on the Family System • For the individual with a brain injury, survivorship is about understanding the “new person” who is developing. • For the family, it is understanding the new family that is emerging. Arizona Governor’s Council on Spinal and Head Injury

  46. Resources • Brain Injury Association of Arizona will now provide you with information about their services. Arizona Governor’s Council on Spinal and Head Injury

  47. Questions Arizona Governor’s Council on Spinal and Head Injury

  48. Closing activities and evaluation Thank You for attending this session today. Arizona Governor’s Council on Spinal and Head Injury

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