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Learn about traumatic brain injuries, their causes, effects on brain function, and strategies for prevention. Explore the brain-behavior relationships, consequences of TBI, and the importance of rehabilitation and prevention. Discover what you can do to support those affected by closed head injuries.
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Update on Closed Head InjuriesSponsored 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 • Discuss prevention
Outline • What they are • Why important • Who is at risk • How brain injury impacts function • What you can do
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
In Michigan... 200,000 citizens live with disabilities 2,500 new citizens per year 1,500 fatalities in 2004
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"
Severity • Mild (75%) • 1-3 months • Moderate (10-30%) • 1 year • Severe (5-10%) • higher risk for long term disability
Post acute care should be based on assessment of current functioning rather than on diagnosis of severity made immediately after injury
Primary events • Axonal shearing • Contusion • Bruising • Bleeding • Depressed skull fracture
Secondary events • Swelling (cerebral edema) • Hematoma • Increased intracranial pressure • Anoxia
Consequences • No two are alike • Minority of survivors have long-term, physical signs • Cognitive/Behavioral/Emotional
Physical Consequences • Pain • Swallowing and speech • Sensory • Fatigue • Body movement
Behavioral Consequences • Emotional dyscontrol • Social inappropriateness • Difficulty with relationships • Lack of response to social cues • Mood swings
Cognitive consequences • Slower processing • Language difficulties • Inattention • Poor concentration • Memory deficits
Brain-behavior relationships • Right • The big picture • Visuospatial relationships • Self-awareness • Creativity • Visual memory
Brain-Behavior Relationships • Left • Language • Emotional regulation • Verbal memory • Logic • Sequencing
Brain-Behavior Relationships • Frontal • Parietal • Occipital • Temporal • Brain stem • Hippocampus • Amygdala
Frontal lobe • Executive function • Purposeful behavior • Complex reasoning • Organization • Problem solving • Flexibility • Speaking
Frontal lobe • Initiation • Self-monitoring • Inhibition • Judgment
Temporal Lobe • Memory • Understanding language • Organizing and sequencing • Hearing
Standing in the Shoes... • Susan Wehry
Complex Mild to severe Different areas Multiple areas Recovery varies
Recovery • Weeks Years • Lifelong • Unique • Pre-injury personality • Learning style • Location and severity • Psychological reaction • Family involvement
Rehabilitation • Functional assessment • Targeted to specific strengths, deficits • Family involvement and support critical
Rehabilitation • Cognitive • Speech • Occupational • Physical • Social
Primary Prevention • Causes • Seat belts • Environmental hazards • Conflict resolution • Risk factors • Age • Gender • Alcohol
Secondary Prevention • Physical deficits may further injury • Attend to risk of falls, choking • Cognitive deficits further disability • Target rehabilitation towards strengths
What you can do • Personal prevention • Share what you've learned • Act as an advocate • Become involved • Brain Injury Association of Michigan
References and Resources • www.cdc.gov/ncipc/tbi/TBI.htm • www.mitbitraining.org/ • http://www.bianys.org/veterans/BeyondTheInvisible320x240.wmv