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Update on Closed Head Injuries Sponsored by

Update on Closed Head Injuries Sponsored by. Barss Residential Long Term Care January 15, 2009 Fort Gratiot, MI www.barssresidential.com. Goals. Appreciate impact Improve care Encourage prevention. Objectives. Describe primary causes Describe how the brain works Utilize strategies

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Update on Closed Head Injuries Sponsored by

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  1. Update on Closed Head InjuriesSponsored by Barss Residential Long Term Care January 15, 2009 Fort Gratiot, MI www.barssresidential.com

  2. Goals • Appreciate impact • Improve care • Encourage prevention

  3. Objectives • Describe primary causes • Describe how the brain works • Utilize strategies • Discuss prevention

  4. Outline • What they are • Why important • Who is at risk • How brain injury impacts function • What you can do

  5. 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

  6. Prevalence

  7. In Michigan... 200,000 citizens live with disabilities 2,500 new citizens per year 1,500 fatalities in 2004

  8. Major Causes of TBI in Michigan Falls – primarily among elderly and children. Motor Vehicle – cars, motorcycle, recreational vehicles. Violence – substance abuse related, domestic, and shaken baby syndrome. Blast - "Signature Wound"

  9. In Michigan...

  10. Severity • Mild (75%) • 1-3 months • Moderate (10-30%) • 1 year • Severe (5-10%) • higher risk for long term disability

  11. Post acute care should be based on assessment of current functioning rather than on diagnosis of severity made immediately after injury

  12. What happens

  13. Primary events • Axonal shearing • Contusion • Bruising • Bleeding • Depressed skull fracture

  14. Secondary events • Swelling (cerebral edema) • Hematoma • Increased intracranial pressure • Anoxia

  15. Consequences • No two are alike • Minority of survivors have long-term, physical signs • Cognitive/Behavioral/Emotional

  16. Physical Consequences • Pain • Swallowing and speech • Sensory • Fatigue • Body movement

  17. Behavioral Consequences • Emotional dyscontrol • Social inappropriateness • Difficulty with relationships • Lack of response to social cues • Mood swings

  18. Cognitive consequences • Slower processing • Language difficulties • Inattention • Poor concentration • Memory deficits

  19. Brain Behavior Relationships

  20. Brain-behavior relationships • Right • The big picture • Visuospatial relationships • Self-awareness • Creativity • Visual memory

  21. Brain-Behavior Relationships • Left • Language • Emotional regulation • Verbal memory • Logic • Sequencing

  22. Brain-Behavior Relationships • Frontal • Parietal • Occipital • Temporal • Brain stem • Hippocampus • Amygdala

  23. Frontal lobe • Executive function • Purposeful behavior • Complex reasoning • Organization • Problem solving • Flexibility • Speaking

  24. Frontal lobe • Initiation • Self-monitoring • Inhibition • Judgment

  25. Temporal Lobe • Memory • Understanding language • Organizing and sequencing • Hearing

  26. Standing in the Shoes... • Susan Wehry

  27. Standing in the Shoes...

  28. Standing in the Shoes...

  29. Complex Mild to severe Different areas Multiple areas Recovery varies

  30. Recovery • Weeks Years • Lifelong • Unique • Pre-injury personality • Learning style • Location and severity • Psychological reaction • Family involvement

  31. Rehabilitation • Functional assessment • Targeted to specific strengths, deficits • Family involvement and support critical

  32. Rehabilitation • Cognitive • Speech • Occupational • Physical • Social

  33. Primary Prevention • Causes • Seat belts • Environmental hazards • Conflict resolution • Risk factors • Age • Gender • Alcohol

  34. Secondary Prevention • Physical deficits may  further injury • Attend to risk of falls, choking • Cognitive deficits  further disability • Target rehabilitation towards strengths

  35. What you can do • Personal prevention • Share what you've learned • Act as an advocate • Become involved • Brain Injury Association of Michigan

  36. References and Resources • www.cdc.gov/ncipc/tbi/TBI.htm • www.mitbitraining.org/ • http://www.bianys.org/veterans/BeyondTheInvisible320x240.wmv

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