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Learn about the two types of traumatic brain injury, the immediate effects, severity, recovery stages, long-term impacts, and differences in children. Discover the common treatment methods and resources available for those affected.
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Two types of brain injury occur • Closed brain injury • Open brain injury
Closed Head Injury • Resulting from falls, motor vehicle crashes, etc. • Focal damage and diffuse damage to axons • Effects tend to be broad (diffuse) • No penetration to the skull
Open Head Injury • Results from bullet wounds, etc. • Largely focal damage • Penetration of the skull • Effects can be just as serious
TBI: A biological event within the brain • Tissue damage • Bleeding • Swelling
TBI: Changes in functioning • Loss of consciousness/coma • Other changes due to the TBI • Post-traumatic amnesia (PTA)
Injured Brain • Does not mend fully • Leads to problems in functioning
What Do We Mean by Severity of Injury • Amount of brain tissue damage
How to measure “severity”? • Duration of loss of consciousness • Initial score on Glasgow Coma Scale (GSC) • Length of post-traumatic amnesia • Rancho Los Amigos Scale (1 to 10)
Mild injury 0-20 minute loss of consciousness GCS = 13-15 PTA < 24 hours Moderate injury 20 minutes to 6 hours LOC GCS = 9-12 Severe injury > 6 hours LOC GCS = 3-8
What Happens as the Person with Moderate or Severe Injury Begins to Recover After Injury?
Recovery • A multi-stage process • Continues for years • Differs for each person
What is the Long-term Impact of a Moderate or Severe TBI in the Person’s Functioning?
Impact depends on • Severity of initial injury • Rate/completeness of physiological recovery • Functions affected • Meaning of dysfunction to the individual • Resources available to aid recovery • Areas of function not affected by TBI
Areas of function affected • Cognition
Cognitive functions • Attention • Concentration • Memory • Speed of Processing • Confusion • Perseveration • Impulsiveness • Language Processing • “Executive functions”
Areas of function affected • Cognitive • Sensory/Perceptual
Sensory/perceptual functions • Vision • Hearing • Smell • Vestibular • Taste • Touch • Balance
Areas of function • Cognitive • Sensory/perceptual • Seizures
Areas of function affected • Cognitive • Sensory/perceptual • Seizures • Other physical changes
Other physical changes • Physical paralysis/spasticity • Chronic pain • Control of bowel and bladder • Sleep disorders • Loss of stamina • Appetite changes • Regulation of body temperature • Menstrual difficulties
Areas of function affected • Cognitive • Sensory/perceptual • Seizures • Other physical changes • Social-emotional
Social-emotional • Dependent behaviors • Emotional lability • Lack of motivation • Irritability • Aggression • Depression • Disinhibition • Denial/lack of awareness
Permanence of change? • Physical recovery • Reeducation of the individual • Environmental modifications
Mild TBI • Lesser levels of brain damage • Brief or no loss of consciousness • Often referred to as ‘concussion’
Mild injury is important to discuss • Long-term impact for 15% • Don’t see that TBI is cause of deficits • Repeated injury leads to problem emergence-”second impact syndrome” • 300,000 sports and recreational injuries • CT, MRI and EEG are usually normal
Effects of mild TBI: outcomes • Problems disappear on their own in about 85% of cases • Compensatory skills acquired • Education prevents emotional upset (“shattered sense of self”)
Effects of mild TBI: outcomes • Problems are not attributed to TBI • Compensatory skills are not learned • Best approach is early education and information • Best rehab assessment is neuropsychology
How is TBI Different (or the Same) for Those Injured as Children.
Children • Brain still developing • Brain more flexible than adult’s • Fewer educational “building blocks” • Effects may not emerge immediately • Follow the child over time
Who is the typical person with TBI? • 4:1 ratio, males to females • 15 to 25 years of age • 1.5 million brain injuries per year in US • Alcohol is the leading risk factor
Adolescents and young adults: highest rate Aged: second highest
Integrated System of Care • Inpatient Rehabilitation Programs • Coma Recovery Programs (rarely used) • Extended Care Programs ( typically inappropriate) • Outpatient Programs • Community Support Services
Community/Post Acute Services • Outpatient In clinic At home/work/community
Community/Post Acute Services • Residential • neurorehabilitation/transitional living • neurobehavioral intensive • long-term supported living
Brain Injury Association of PA • Biapa.org • Brain Injury Resource Line 1-866-635-7097 • biausa.org