Brain Injury

Elizabeth Bilderback, MA

Elizabet.bilderback@healthsouth.com

Types of Brain Injury

• Traumatic- blow to head or penetrating injury that disrupts the functioning of the brain.– Falls (28%)– MVA’s (20%)– Struck by/against events

(19%)– Assaults (11%)– Soldiers (blasts)

Types of Brain Injury (continued)

– Aneurysms– Tumors– Strokes– Encephalopathies

Types of Brain Injury (continued)

• Concussions– A type of brain injury that

disrupts functioning of the brain– Do not need to lose

consciousness to have a concussion

– Multiple concussions can cause cumulative and long lasting problems

What We Hear About

• 795,000 strokes every year in the U.S.– Every 40 seconds, 1 person has a

stroke

• 1.2 million coronary attacks every year in the U.S.

Did You Know….

• According to the World Health Organization TBI is the leading cause of death and disability in children and young adults around the world and is involved in nearly half of all trauma deaths.

Brain Injury by the Numbers

• 1.4 million new traumatic brain injuries (TBI) each year in the U.S.– Every 23 seconds, 1 person

sustains a TBI

• 360,000 active duty soldiers have sustained TBIs in Iraq and Afghanistan

TBI by the Numbers

• TBIs in the U.S.– 50,000 die– 235,000 are hospitalized– 1.1 million treated and released

from ER– 75% are mild TBI or concussions– 1.6-3.8 million sports and

recreation-related concussions in U.S. each year

TBI in Australia

• Use the term Acquired Brain Injury which includes accidents, strokes, infections, degenerative, neurological disease and traumas

• “Common” in Australia- 432,700 Australians (2.2% of population) in 2003 had an ABI– 1 in 50 have an ABI

TBI in Australia

• An individual with an ABI has an 80% chance of developing a diagnosable mental illness

• About 1/3 of clients of mental health services have an underlying ABI

TBI in Canada

• TBI is the number one killer and disabler of Canadians under age 40– More than half are under age 20– Majority are young men ages 15-

30– Highest incidence rate is 15-19

year age group– MVAs account for half of all TBIs– 75% of all cycling deaths involve

TBIs

TBI in Canada

• Every year 50,000 Canadians sustain brain injuries– Every 5 minutes someone is

injured– Every 7 hours someone dies

Brain Injury

• Traumatic brain injury can happen to ANYONE– Highest risk

•Males 1.5x to 2x as likely as females•Highest risk age groups: 0-4 years

and 15-19 years with 15-24 years most likely to be hospitalized

•Certain military duties or other jobs increase risk

Brain Injury

• Cost– $60 billion in the U.S. in 2000 for

direct medical costs and indirect costs such as lost wages

Brain Injury

• Range in Severity– Mild with transient symptoms to

Severe with lengthy loss of consciousness and amnesia for the event (plus amnesia before and after event)

• More recent and worse brain injuries are easier for you to spot

Brain Injury

• Long term Consequences of Physical Damage to the brain– Physical Skills– Sensation– Thinking – Learning– Academics– Behavior– Personality– Social Skills

Brain Injury

• Most frequent unmet needs according to one study– Improving memory and problem

solving– Improving job skills– Managing stress and emotional

upsets– Controlling temper

• 40% of individuals who had been hospitalized had 1 or more unmet need at 1 year post

TBI and Law Enforcement

• Not all brain injury survivors will be a problem for law enforcement– Brain Injury Causing:

•Anger Management issues • Impulsivity•Poor Judgment

– Brain Injury Plus:•Substance Abuse•PTSD•Premorbid Personality•Lack of Family/Social Support

TBI and Aggression

• One 1996 study on a military population found TBI ↑ the risk of behavioral discharge 4x and criminal conviction 5x

• A 2003 study found 33.7% of individuals in a TBI group met the criteria for aggressive behavior in the first 6 months post injury. Major Depression also more frequent in TBI group.

TBI and Aggression

• Focal frontal lesions in an aggressive TBI group vs. a more diffuse lesion in a nonaggressive TBI group

TBI and Insight

• A 1993 study found poor insight regarding behavioral impairment at 6 months post injury

• A 2006 study found their TBI group less able to recognize emotion in others.

TBI Causes Physical Problems

– Loss of Motor Control and Coordination•Hemiparesis•Ataxia•Balance•Strength•Endurance•Spasticity

Physical Problems Continued

• Sensory Problems•Diplopia•Blindness•Visual Field Cut•Sensitivity to Hot/Cold•Taste•Hearing•Sensation•Smell •Proprioception

Physical Problems Continued

• Speaking and Swallowing Disorders

•Dysarthria•Dysphagia

• Fatigue• Headaches• Bladder/Bowel Incontinence• Seizures

Brain Injury

• Our cognition or thought processes guide behavior and lead to feelings or emotions

• Brain Injuries Cause Cognitive Problems.

TBI Causes Cognitive Problems

• Attention/Concentration• Visual Spatial Skill

– Understanding and manipulating things you see

• Perception/Judgment– Self Awareness– Deficit Awareness

• Goal Setting• Disordered/Slowed Learning

–↓ ability to learn from experience

Cognitive Problems Continued

• Memory•Recognition•Recall•Prospective•Auditory•Visual• Immediate•Long-term

Cognitive Problems Continued

• Slowed Speed of Information Processing and Slowed Reaction Time– Especially with decision making– Response Selection– Mental Transformations– Stressful Situations– Complex Situations

Cognitive Problems Continued

• Communication– Reading/Writing– Expressive Language

•Verbal Fluency

– Receptive Language•Auditory Comprehension

• Math Skills• Time Management

Cognitive Problems Continued

• Executive Skills– Plan, Direct, Execute and Monitor

Activities– Initiation– Planning/Organizing/Categorizing/

Sequencing– Reasoning– Abstract Thought– Flexibility of Thought– Problem Solving/Judgment– Learning from mistakes/ Thinking about

consequences

TBI Causes Behavioral/Psychosocial

Problems• Disinhibition/Impulsivity/

Impatience/ Restlessness– May be unaware of this and its

effects on others– May be related to less tolerance

for frustration/noise/problems– Verbal Outbursts– Physical Outbursts– “I’ll do it now and think about it

later”

Behavioral/Psychosocial Problems continued

• Egocentricity/Self-centeredness– How does my behavior impact

you?– I’m most important– With decreased empathy,

interpersonal sensitivity, self-reflectiveness, and/or self-critical attitudes

Behavioral/Psychosocial Problems continued

• Rigidity/Inflexibility/Stubbornness– I’m right and don’t argue with me

• Sexual Problems– Increase or decrease in

drive/interest

Behavioral/Psychosocial Problems continued

• Oversensitivity/Suspiciousness• Irritability

– Easily annoyed/bothered

• Apathy– I don’t care

• Silliness/Childishness

Behavioral/Psychosocial Problems continued

• Reactionary Disturbances– Denial– Depression– Anxiety– Frustration– Sleep Disturbances– Suicidal Thoughts– Loss of Self-Esteem– Loss of Self-Confidence– Anger– Mood Swings

Brain Injury as an excuse…

Is brain injury an excuse for inappropriate or

illegal behavior?

People are still responsible for their behavior,

injury or not

2 Situations you will encounter:

You will be informed of an injuryOR

You will have NO CLUE

At HEALTHSOUTH

We tell the patient/family to inform Police of the injury if they call the Police for ANY

reason

We also tell the patient to inform the Police Officer of their injury if they happen to be stopped or

detained for any reason

No CLUE?...Things to Look for:

• Suture Lines on the head (surgery)

• Subtle Dents on head (surgery or monitors)

• Asymmetrical Face – 1 side droops• Eyes that don’t seem to work

correctly• Struggle finding words• Disorganized Speech• Tangential or Verbose

No Clue, cont…things to look for

• “FLK” & “FLA”-Dressed Inappropriately-Odd, Broad Based Gait-Arm that Hangs in an Odd way-Arm Swing is off

• Braces / Splints

Do’s & Don’ts with Brain Injured Citizens

• Do not Over-Stimulate– Brain injured individuals can only process certain amounts of

information, and can lose behavioral control if over-stimulated

• Reduce Stimulation– Do this by removing spectators and personnel, having only 1 person

talk, reducing noise, and removing environmental objects that stimulate, such as music.

• Make Surrounding Environment Safe– Remove dangerous objects, if possible

• Allow the Individual to ‘walk off’ any agitation– Allow the individual to move

• Model Calm Behavior – Speak Quietly

• Direct the Individual away from the source of frustration– Reduce anger and frustration by changing the topic

Do’s & Don’ts with Brain Injured Citizens

• Do not lecture or argue with the individual, it will only escalate the situation

• Try to be consistent and predictable

• Be aware of Body Language, yours and theirs. Be aware of interpersonal space, posturing and speed of approach.

• Do not touch an agitated individual unless you are prepared for a physical alteration

• If possible, clearly and simply, state the consequences and impact of the individual’s behavior

• Do not take what they say personally

Elizabeth Bilderback, MA

Elizabet.bilderback@healthsouth.com

Thank You!