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2. What is the Brain? 3. Centers for Disease Control and Prevention Dept. of Health and Human Services Childrens Health Act of 2000 4. Centers for Disease Control Brain Injuries in the U.S. An estimated 1.5 million people sustain a TBI annually. (2001) 5.3 Million currently living in the U.S. with TBI 5. Brain Injuries in the U.S. 2 million seen annually in ER for TBI 25% admitted (2005) A TBI occurs every 7 seconds A TBI related death occurs every 5 minutes 200,000 people are killed or injured annually 80,000 Americans experience onset of long-term disability from TBI 50,000+ die annually from TBI 75% are mild TBI 6. Brain Injuries in Ohio Ohio does not currently have a TBI tracking system in place Estimated 118,760 live with residual effects of TBI 7,300+ hospitalized annually 142% increase in sports/recreation related TBIs over a 7 year period in 18 and younger March 2011 House Bill 143 7. Brain Injuries in Kentucky Approximately 212,000 to 250,000 Kentuckians live with TBI Kentuckys TBI rate is twice the national average 1 in 5 households affected by TBI #1 killer based on population 8. Brain Injuries in Indiana Over 150,000 living with TBI 6,100 injuries occur annually 9. Chronic Traumatic Encephalopathy Progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury Dementia pugilistica (boxing) Degeneration of tissue and accumulation of tau protein Memory loss, aggression, confusion and depression - within months to decades later Chris Henry July 2010 10. ABI vs. TBI Acquired Brain Injury Sustained during ones lifetime Includes stroke, trauma or tumor Excludes neuro-degenerative disorders and brain injuries sustained at birth Traumatic Brain Injury Caused by external force Can involve damage to scalp and skull Falls, accidents, violence 11. Shaken Baby Syndrome (Pediatric Abusive Head Trauma) Form of child abuse Generally diagnosed from a triad of symptoms: Retina hemorrhage Subdural hematoma Brain swelling In majority of cases - no signs of external trauma Estimated death rates in infants - 15% to 38% Usual mechanism of injury - rotational acceleration of the head 12. Shaken Baby Syndrome From 2001 - 2005: 8-10 children in Ohio died each year 150 children are seriously injured Ohio - Claires Law - ORC 3701.63, 11/30/2007 OHIO DEPARTMENT OF HEALTH SHAKEN BABY SYNDROME PROGRAM 246 N. HIGH STREET COLUMBUS, OHIO 614-728-0773 FAX: 614-564-2442 [email protected] 13. Shaken Baby Syndrome Kentucky HB 285 (May 27, 2010) Nationally Sarah Jane Brain Foundation 339 Fifth Avenue, Suite 405 New York, NY 10016 (212) 576-1180 [email protected] 14. Military/Veterans U.S. MILITARY CASUALTY STATISTICS: OPERATION NEW DAWN, OPERATION IRAQI FREEDOM, AND OPERATION ENDURING FREEDOM, Congressional Research Service, September 28, 2010 TBI signature injury for Iraq and Afghanistan wars TBI cases in military from 2000 to part of 2010 - 178,876 300,000 have suffered concussions 15. Age Groups Age groups most likely to sustain a TBI: - Children 0-4 years - Adolescents 15-19 years - Adults 65 years and older Males twice as likely as females to have TBI Males 15 to 24 have highest rate of TBI 16. Injury Categories Motor vehicle accidents - 44% Falls 26% #1 cause of TBI in ages 1-4 and 65 and over Assaults and firearms - 17% Sports and recreation - 13% 17. Prison Statistics More than 2,000,000 people in U.S. prisons and jails 25-87% of prisoners have history of TBI TBI experience mental health problems Female inmates convicted of a violent crime are more likely to have suffered TBI prior to committing crime 18. Disability/Medical Costs $73.7 billion in 2010 for stroke-related medical costs and disability $60.0 billion in 2000 for medical and disability-related costs for TBI 19. Types of Brain Injuries Severe traumatic brain injury GCS score 3-8 Rancho los Amigos scale Think life care planner! 20. Types of Brain Injuries Moderate Brain Injury Length of stay at least 48 hours GCS score 9-12 or higher Operative cranial lesion Abnormal findings Think life care planner! 21. Types of Brain Injuries Mild Brain injury An injury to the head as a result of blunt trauma or acceleration or deceleration forces that result in one or more of the following conditions that are observed or self-reported: Transient confusion, disorientation, or impaired consciousness; Dysfunction of memory around the time of injury; Loss of consciousness lasting less than 30 seconds 22. Mild Traumatic Brain Injury TBI - The Silent epidemic Accounts for at least 75% of all TBIs in the U.S. Can cause long-term or permanent impairments and disabilities Difficulty returning to work to routine, daily activities and may be unable to return to work for many weeks or months Costs the nation nearly $17 billion annually 23. Post Concussive Syndrome Misleading Affected individuals need not have suffered a loss of consciousness No criteria in the etiology of post concussive syndrome 24. Polytrauma/Disease Multiple trauma Psychological processes/illness Behavior risk factors Pre-existing conditions 25. From Bone to Brain Skull upper / lower Cerebrospinal fluid maintains uniform pressure within brain and spinal cord Meninges Arachnoid Dura mater Pia mater 26. From Bone to Brain Subdural Hematoma Under dia mater of between dura mater and arachnoid Epidural Hematoma Outside dura mater Subarachnoid Hemorrhage Under arachnoid Cerebro-vascular Involves cerebrum and blood vessels supplying it 27. Knowing the Brains Anatomy Frontal lobe Planning, organizing, problem solving, selective attention, personality and higher cognitive functions including behavior and emotions 28. Knowing the Brains Anatomy Parietal Lobe (2) Controls sensation, touch, pressure, judg ment of texture, weight, size, shape Right side damage may cause visuo-spatial deficits Left side damage may interrupt persons ability to understand spoken/written language 29. Knowing the Brains Anatomy Temporal lobe (2) Distinguishes different smells and sounds; sorts new information; major role in short-term memory Right side injury may cause issues with visual memory (people, photographs) Left side injury may case issues with verbal memory (recalling names, certain words, phrases) 30. Knowing the Brains Anatomy Occipital lobe Process visual information, colors, shapes 31. Knowing the Brains Anatomy Cerebellum Coordinates movement, balance and muscle coordination Damage may result in ataxia and can interfere with a persons ability to walk, talk, eat and perform self care tasks 32. Knowing the Brains Anatomy Brain stem Connects brain to spinal cord Neurological functions include those necessary for survival (breathing, digestion, heart rate, blood pressure) and for arousal (awake and alert) Most cranial nerves come from the brainstem Pathway for all fiber tracts passing up and down from the peripheral nerves and spinal cord to the highest part of the brain 33. Knowing the Brains Physiology Neurons - cells that constitute nerve tissue; Have the property of transmitting and receiving nerve impulses Dendrites - branching protoplasmic processes that conduct impulses toward the body of a nerve cell Glial cells - does not conduct electrical impulses, but supports them and insulates neurons 34. Knowing the Brains Physiology Forebrain Anterior of the three primary divisions of the developing vertebrae brain or the corresponding part of the adult brain including the cerebral hemisphere and the thalamus and hypothalamus 35. Knowing the Brains Physiology Midbrain Middle division of the three primary divisions of the developing vertebrae brain; or Corresponding part of the adult brain that includes a ventral part containing the cerebral peduncles and a dorsal tectum containing corpora quadrigemina and surrounds the aqueduct of sylvius connecting the 3rd and 4th ventricles 36. Knowing the Brains Physiology Hindbrain posterior division of the three primary divisions of the developing vertebrae brain or the corresponding part of the adult brain that includes the cerebellum, pons, and medulla oblongata 37. Knowing the Brains Physiology Thalamus serves as a relay station to and from the cerebral cortex, and functioning especially sensation and arousal 38. Knowing the Brains Physiology Hypothalamus Temperature control issues, edema, vomiting, nausea, irritability, psychiatric problems, rage, laughing, crying, excessive sexuality, antisocial behavior, hallucinations, coma, somnolence, excessive salivation, bradycardia 39. Knowing the Brains Physiology Pituitary gland regulates the many hormones that control various functions and organs in the body Controlled by hypothalamus 40. Knowing the Brains Physiology Adrenal glands (suprarenal glands) Responsible for releasing hormones in response to stress - corticosteroids-cortisol- catecholamines-epinephrine. 41. History CDC Many healthcare providers fail to recognize the potential impact of mild TBI No physical injury Facial injury increases suspicion of head/brain injury X-ray/MRI/CT normal Delay in treatment Didnt hit head, wasnt unconscious 42. Rehabilitation Critical care / stabilization Acute care Acute rehabilitation Sub-acute rehabilitation Long term / Post acute rehabilitation Specialized rehabilitation Continuing support 43. Glasgow Coma Scale Involves three determinants: - Eye opening - Verbal responses - Motor response (movement) 44. Glasgow Coma Scale Scoring Score 13 15 Mild brain injury Score 9 12 Moderate brain injury Score 8 or less Severe Brain injury 45. Other Scales Rancho Los Amigos scale Mayo-Portland Adaptability Inventory 46. Imaging X-ray CT MRI fMRI EEG PET scan SPECT scan MMPI 47. Testing Neuropsychological Testing Blood Tests Ultrasound Thermography Cerebrospinal fluid analysis Electronystagmography (ENG) 48. Testing Evoked potentials (a/k/a evoke responses) Auditory evoked potentials Visual evoked potentials Intrathecal contrast enhanced CT scans (cisternogrphy) Diffusion tensor imaging (DTI) Fractional anistrophy (FA) QEEG brain topography 49. Testing Quantitative EEG Cerebral Angiography Transcranial doppler ultrasound 50. Help! I need somebody.. Brain Injury Association of America (703) 761-0750 www.biausa.org Brain Injury Association of Indiana (317) 356-7722 www.biausa.org/indiana Brain Injury Association of Ohio (614) 481-7100 www.biaoh.org Brain Injury Alliance of Kentucky (502) 493-0609 www.biak.us
