Brain Injury 101Brain Injury 101

The Independent Living Center, April 20, 2010Andrea Buening, IL Special Projects Coordinator

Brain InjuryBrain InjuryA complex disabilityA complex disability

This is Kimmie, from “A Miracle for Kimmie”http://www.discoverhiddensecrets.com/

KimberlyAnne.html

Who Who isis Kimmie? Kimmie? Kimmie is an elementary teacher Kimmie is an elementary teacher

June 2001 Kimmie was June 2001 Kimmie was the the passengerpassenger in a car which was in a car which was broadsided by a loaded logging truck. The passenger side broadsided by a loaded logging truck. The passenger side received the full force of the impactreceived the full force of the impact

Kimmie’s brain injury resulted in a sheared brainstem and Kimmie’s brain injury resulted in a sheared brainstem and diffuse damage to her braindiffuse damage to her brain

October 2003, Kimmie returned to the elementary October 2003, Kimmie returned to the elementary classroomclassroom

Kimmie’s story is one of many. There are many who do not Kimmie’s story is one of many. There are many who do not fare so well.fare so well.

Brain Injury 101Brain Injury 101

The Importance of Learning About Brain InjuryThe Importance of Learning About Brain Injury You may have Consumers who have to deal with Brain You may have Consumers who have to deal with Brain

InjuryInjury Consumers look to professionals for helpConsumers look to professionals for help Professionals need to be informedProfessionals need to be informed

As Coordinators then you also have to deal with Brain As Coordinators then you also have to deal with Brain InjuryInjury

What are What are youryour Expectations Expectations How can you How can you bestbest communicate your needs such communicate your needs such

that the consumer understands them?that the consumer understands them? How can you expect them to “remember” what you How can you expect them to “remember” what you

have talked with them about?have talked with them about?

Brain Injury 101Brain Injury 101

Who do you know that has a Brain Who do you know that has a Brain Injury?Injury? Do you know an athlete who has had multiple concussions?Do you know an athlete who has had multiple concussions?

Do you have a consumer who has had a stroke?Do you have a consumer who has had a stroke?

Do you know a child who has been abused?Do you know a child who has been abused?

Do you know a person who had spousal abuse?Do you know a person who had spousal abuse?

Then you probably know someone with a brain injuryThen you probably know someone with a brain injury

Brain Injury 101Brain Injury 101 Communication Strategies for Coordinators working with Communication Strategies for Coordinators working with

Consumers who have brain injuriesConsumers who have brain injuries Coordinators need to learn effective communication strategiesCoordinators need to learn effective communication strategies

Survivors need people to have EXTREME patience with themSurvivors need people to have EXTREME patience with them Survivors process information and respond slower than Survivors process information and respond slower than

most people domost people do Give clear, short directivesGive clear, short directives Give concrete examplesGive concrete examples Ask questions then listen patientlyAsk questions then listen patiently Give written instructions for survivors who need written Give written instructions for survivors who need written

remindersreminders Give verbal instructions for othersGive verbal instructions for others Survivors deal in absolutes and are not usually very Survivors deal in absolutes and are not usually very flexibleflexible

What is a Brain Injury?What is a Brain Injury?What is your definition of disability?What is your definition of disability?

For starters, no brain injury is alikeFor starters, no brain injury is alike ““The Consumer is NOT the disability”The Consumer is NOT the disability” A brain injury A brain injury can becan be a permanent disabling condition. a permanent disabling condition.

Most brain injury survivors improve over timeMost brain injury survivors improve over time How much and how long is determined by MULTIPLE factorsHow much and how long is determined by MULTIPLE factors

Most people with MILD brain injuries look and act like everyone else. While Most people with MILD brain injuries look and act like everyone else. While some mild injuries have tremendous impairmentssome mild injuries have tremendous impairments..

Brain injury may result in mild, moderate, or severe impairments in one or more Brain injury may result in mild, moderate, or severe impairments in one or more areasareas

Physical function ImpairmentPhysical function Impairment Cognition ImpairmentsCognition Impairments

Speech-language communicationSpeech-language communication MemoryMemory Attention and concentrationAttention and concentration ReasoningReasoning Abstract thinkingAbstract thinking

Psychosocial behavior ImpairmentPsychosocial behavior Impairment Information processing ImpairmentInformation processing Impairment

How impairments affect the individual’s How impairments affect the individual’s ability to function in daily lifeability to function in daily life

Classifications of brain injuries are largely given to trauma survivorsClassifications of brain injuries are largely given to trauma survivors Mild traumatic brain injury or concussionMild traumatic brain injury or concussion

o Loss of consciousness not to exceed 30 minutesLoss of consciousness not to exceed 30 minuteso Post traumatic amnesia lasts less than 24 hoursPost traumatic amnesia lasts less than 24 hourso Glasgow Coma scale is 13 – 15Glasgow Coma scale is 13 – 15

ModerateModerateo Loss of consciousness is at least 30 minutes but not more than 24 hoursLoss of consciousness is at least 30 minutes but not more than 24 hourso Post Traumatic Amnesia lasts at least 24 hours but not more than 7 daysPost Traumatic Amnesia lasts at least 24 hours but not more than 7 dayso Glasgow Coma scale 9 – 13Glasgow Coma scale 9 – 13

SevereSevereo Loss of consciousness exceeds 24 hoursLoss of consciousness exceeds 24 hourso Post Traumatic Amnesia lasts longer than 7 daysPost Traumatic Amnesia lasts longer than 7 dayso Glasgow Coma Scale 8 or lessGlasgow Coma Scale 8 or less

Why do Brain Injury Survivors need Assistance?Why do Brain Injury Survivors need Assistance? Physical ChallengesPhysical Challenges – some, all, or none of the following may – some, all, or none of the following may

be experiencedbe experienced

Lack of Muscle movementLack of Muscle movement – paralysis causes muscle atrophy – paralysis causes muscle atrophy SpasticitySpasticity – requires ongoing medication and intervention – requires ongoing medication and intervention Loss of TasteLoss of Taste – damaged olfactory nerves can create eating – damaged olfactory nerves can create eating

disordersdisorders Loss of BalanceLoss of Balance – increasing falls and secondary head injuries – increasing falls and secondary head injuries Loss of Muscle coordinationLoss of Muscle coordination – increasing falls and bumping into – increasing falls and bumping into

objectsobjects Loss of SmellLoss of Smell – affects taste and can increase hazards concerning – affects taste and can increase hazards concerning

firefire Loss of SpeechLoss of Speech – lessens ability to communicate needs – lessens ability to communicate needs Inability to SleepInability to Sleep – Chronic sleep deprivation – Chronic sleep deprivation Loss of sensationLoss of sensation – Touch or being touched – Touch or being touched Acquisition of seizure disorderAcquisition of seizure disorder – Common among those with brain – Common among those with brain

injuriesinjuries Loss of HearingLoss of Hearing – one or both sides or diminished hearing – one or both sides or diminished hearing FatigueFatigue – resulting from cognition and processing difficulty – resulting from cognition and processing difficulty Disrupted Sexual FunctioningDisrupted Sexual Functioning – Medications, or neural damage – Medications, or neural damage Double VisionDouble Vision – visual pathway damage, or damage to the – visual pathway damage, or damage to the

occiptal lobeocciptal lobe WeaknessWeakness  - motor cortex damage or cerebellum damage  - motor cortex damage or cerebellum damage

Why ELSE do Brain Injury Survivors need Why ELSE do Brain Injury Survivors need Assistance?Assistance?

Cognitive impairmentsCognitive impairments or Thinking Changes or Thinking Changes MemoryMemory – the most common issue reported – the most common issue reported

CommunicationCommunication – inability to be understood and inability TO – inability to be understood and inability TO understandunderstand

PerceptionPerception – of objects, of the spoken word, of their place – of objects, of the spoken word, of their place in space, you name it!in space, you name it!

Decision makingDecision making – processing ability has a great amount to – processing ability has a great amount to do with this as well as feardo with this as well as fear

Reading and writing skillsReading and writing skills – loss of skills relating to motor – loss of skills relating to motor functions and memoryfunctions and memory

Thought flexibilityThought flexibility – rigidity of relearned schedules and – rigidity of relearned schedules and skillsskills

PrioritizationPrioritization PlanningPlanning SequencingSequencing – a huge problem – a huge problem JudgmentJudgment OrganizationOrganization  

More Cognitive ImpairmentsMore Cognitive Impairments Thought processing speedThought processing speed – difficulty hearing, then finding – difficulty hearing, then finding

meaning and responding to new informationmeaning and responding to new information

Safety awarenessSafety awareness – relating to safety, abilities, limitations, and – relating to safety, abilities, limitations, and challenging themselveschallenging themselves

Problem solving skillsProblem solving skills – Loss of seeing the “big picture,” focusing – Loss of seeing the “big picture,” focusing on the treeson the trees

New learningNew learning – must find old memories to attach new information – must find old memories to attach new information to be able to retrieve.to be able to retrieve.

Judgment Judgment – Decision-making skills – Decision-making skills

AttentionAttention – Can be selective, and can be affected by distraction – Can be selective, and can be affected by distraction

Self-perceptionSelf-perception – related to Self-Awareness – related to Self-Awareness

Personality Changes in People with Brain Personality Changes in People with Brain InjuriesInjuries

Personality and Behavioral ChangesPersonality and Behavioral Changes Dual Diagnoses, Mental Health IssuesDual Diagnoses, Mental Health Issues

Emotional control and mood swingsEmotional control and mood swings DepressionDepression

Lack of Social skillsLack of Social skills Lack of Self-monitoring which leads to inappropriate Lack of Self-monitoring which leads to inappropriate

remarks or actionsremarks or actions Extreme Appropriateness or inappropriateness of behaviorExtreme Appropriateness or inappropriateness of behavior Excessive laughing or cryingExcessive laughing or crying

Stress and AnxietyStress and Anxiety FrustrationFrustration Irritability or agitationIrritability or agitation Lack of Lack of Coping skills Coping skills

Reduced self-esteemReduced self-esteem Lack of MotivationLack of Motivation DenialDenial Self-centerednessSelf-centeredness Lack of Anger management Lack of Anger management 

What TILC can do for Brain Injury SurvivorsWhat TILC can do for Brain Injury Survivors Offer human support if the survivor meets DA1 Offer human support if the survivor meets DA1

minimum scores and CDS requirements, or offer minimum scores and CDS requirements, or offer In-Home if more appropriateIn-Home if more appropriate

Offer IL Support and IL Skills TrainingOffer IL Support and IL Skills Training Ask survivors questions and learn what the survivor Ask survivors questions and learn what the survivor

“thinks” they can and can’t do. Survivors often do not “thinks” they can and can’t do. Survivors often do not fully understand their limitations in relation to their brain fully understand their limitations in relation to their brain injury. Assess the survivor’s needs and help in goal injury. Assess the survivor’s needs and help in goal planningplanning

Brain Injury survivors isolate themselves because they Brain Injury survivors isolate themselves because they cannot process multiple conversations or stimulation of cannot process multiple conversations or stimulation of light, sound, colors, and movement. Offer IL Support to light, sound, colors, and movement. Offer IL Support to help them reduce isolationhelp them reduce isolation

Provide social and peer supportProvide social and peer support

Article in St. Louis NewspaperArticle in St. Louis NewspaperBudget Cuts and Funding injury servicesBudget Cuts and Funding injury services

A traumatic brain injury is devastating to the individual and his family. A traumatic brain injury is devastating to the individual and his family. Recovery often is slow and painful. Missouri residents with brain injuries Recovery often is slow and painful. Missouri residents with brain injuries saw the elimination of physical therapy, occupational and speech therapy saw the elimination of physical therapy, occupational and speech therapy and comprehensive day rehabilitation a few years ago. The proposed and comprehensive day rehabilitation a few years ago. The proposed budget that passed the Missouri House last week eliminates all support and budget that passed the Missouri House last week eliminates all support and rehabilitation services in the Adult Head Injury Program in the Department rehabilitation services in the Adult Head Injury Program in the Department of Health and Senior Services. These vital services are one of the last of Health and Senior Services. These vital services are one of the last lifelines for people with brain injury and can make the difference between lifelines for people with brain injury and can make the difference between living in the community or in a nursing home.living in the community or in a nursing home.In 2009, 239 Missourians received paid support and rehabilitation services In 2009, 239 Missourians received paid support and rehabilitation services from the Adult Head Injury Program. Another 265 people are on a waiting from the Adult Head Injury Program. Another 265 people are on a waiting list for services. Among the services they receive are one-on-one home list for services. Among the services they receive are one-on-one home support and training, pre-vocational training and adjustment counseling. support and training, pre-vocational training and adjustment counseling. Many of the service providers who deliver these services are small Many of the service providers who deliver these services are small businesses. If these cost-effective services are eliminated, employees will businesses. If these cost-effective services are eliminated, employees will be laid off and some small businesses will close, increasing the be laid off and some small businesses will close, increasing the unemployment rate and reducing tax revenue.unemployment rate and reducing tax revenue.The human and financial impact of these cuts is significant, even though The human and financial impact of these cuts is significant, even though the dollar amount saved is modest. Our elected leaders in the state Senate the dollar amount saved is modest. Our elected leaders in the state Senate should reverse the proposed cuts to the Adult Head Injury Program when should reverse the proposed cuts to the Adult Head Injury Program when they consider the budget in the coming days. The budget should not be they consider the budget in the coming days. The budget should not be balanced on the backs of Missouri's most vulnerable citizens.balanced on the backs of Missouri's most vulnerable citizens.Timothy Imhoff — Maryland Heights Brain Injury Association of Timothy Imhoff — Maryland Heights Brain Injury Association of MissouriMissouri

For More Information and Skill Training in For More Information and Skill Training in communicating with a survivor of brain injury see communicating with a survivor of brain injury see

AndreaAndrea

ReferencesReferences http://www.biausa.org/education.htm#aninjuredbrain’http://www.biausa.org/education.htm#aninjuredbrain’ http://www.traumaticbraininjuryatoz.org/Moderate-to-http://www.traumaticbraininjuryatoz.org/Moderate-to-

Severe-TBI/DiagnosinSevere-TBI/Diagnosin http://cognitrn.psych.indiana.edu/busey/Q301/http://cognitrn.psych.indiana.edu/busey/Q301/

BrainStructure.htmlBrainStructure.html http://www.med.harvard.edu/AANLIB/home.htmlhttp://www.med.harvard.edu/AANLIB/home.html http://www.discoverhiddensecrets.com/KimberlyAnne.htmlhttp://www.discoverhiddensecrets.com/KimberlyAnne.html http://braininjury.wisconsin.gov/links.htmhttp://braininjury.wisconsin.gov/links.htm