Brain Injury Essentials Overview and Resources John Pimentel, CBIST

Brain Injury: The Silent Epidemic Brain injury is a major public health problem in the United States, according to the world health organization Brain Injury will be the number one public health problem in the world by 2020 Brain injury is often called a silent epidemic because many of the problems that result from a brain injury are not always readily apparent. Brain injury is frequently not identified. Appropriate treatment at the right time, at the right dose and the right frequency is not readily available

Brain Injury: The Silent Epidemic The effects of brain injury (BI), such as changes in thinking, may not be readily apparent to an outside observer Negative consequences occur when the general public and medical providers do not recognize the effects of BI: Problems at work or school Changes in personal relationships Legal problems Homelessness

Brain Injury: Definitions AQUIRED BRAIN INJURY: An injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. Occurs after birth with presumed normal brain development preceding the injury Results in a change in neuronal activity affecting physical integrity, the metabolic activity, or the functional ability of nerve cells Acquired brain injury is an umbrella definition as it includes injuries caused by external physical forces applied to the head, as well as internal insults to the brain

Brain Injury: Definitions Traumatic Brain Injury: A Traumatic Brain Injury is an alteration in brain function, or other evidence of brain pathology, caused by an external force. With traumatic impact injuries the head is struck by an object or an object strikes the head resulting in either a: Closed injury Open (penetrating) injury

Brain Injury: Definitions Non Traumatic Brain Injury: It is the brain damage caused by internal factors such as: Lack of oxygen or nutrients to the nerve cells of the brain Exposure to toxins Pressure from a tumor or blockage Other neurological disorder

Brain Injury: Causes Causes of Traumatic Brain Injury Causes of Non-Traumatic Brain Injury Falls Assaults Motor vehicle crashes Sports and recreation injuries Shaken baby syndrome/abusive head trauma Gunshot wounds Workplace injuries Child abuse Domestic violence Military actions (blast injury) Stroke (hemorrhage or blood clots) Infectious disease (encephalitis, meningitis) Seizure disorders Electric shock/lightning strike Tumors (surgery, radiation, chemo) Toxic exposures (substance misuse, ingestion of lead, inhalation of volatile agents) Metabolic disorders (insulin shock, diabetic coma, liver and kidney disease) Neurotoxic poisoning (carbon monoxide poisoning, inhalants, lead exposure) Lack of oxygen to the brain (near drowning, airway obstruction, strangulation, cardiopulmonary arrest, hypoxia, anoxia)

Brain Injury: Severity of the Injury Mild Moderate Severe Loss of consciousness for less than 30 minutes (possibly no loss of consciousness) Coma more than 20-30 minutes, but less than 24 hours Coma longer than 24 hours, often lasting days or weeks. Glasgow 13-15 Glasgow 9-12 Glasgow 3-8 Post Traumatic Amnesia less than 24 hours Possible skull fractures with bruising and bleeding Bruising and bleeding in the brain Temporary or permanently altered mental and/or neurological state Signs of damage on EEG, CT, or MRI Post-concussion symptoms Some long term problems in one or more areas of life Long term impairments in one or more areas of life

Brain Injury: What determines the effect of brain injury Injury severity Age at injury Alcohol misuse Domestic violence Service in the military Participation in sports Number of brain injuries a person experiences

Brain Injury: Symptoms Cognitive Symptoms Perceptual Symptoms Physical Symptoms Behavioral/Emotional Symptoms

Brain Injury: Understanding the Person with Brain Injury Brain Injury is the beginning of a chronic process: Impacts multiple organ systems Can cause disease Can accelerate disease Everything is new – A brain injury survivor is starting everything from scratch. Daily Living Activities – Relearning skills, things that came natural or were taken for granted are now requiring lots of work/energy.

Brain Injury: Understanding the Person with Brain Injury They have a cognitive deficit, it does not mean that they do not have the capability to reason, it just means their ability to process information has changed. Behavioral and emotional management is a challenge – mood swings for no apparent reason. Physical functioning can be affected by the trauma of the injury.

How does a Brain Injury Affects the Individual? Occipital Lobe: Function: Visual Perception Center When Damage: Defects in vision Difficulty locating objects in the environment Difficulty identifying colors Production of hallucinations Visual Illusions – Inaccurately seeing objects Word Blindness – Inability to recognize words Difficulty in recognizing draw objects Inability to recognize the movement of an object Difficulties with reading and writing

How does a Brain Injury Affects the Individual? Parietal Lobe: Function: Location of visual perception; location for touch perception; goal directed voluntary movements, manipulation of objects, integration of different senses that allows the understanding a single concept. When Damage: Inability to attend to more than one object at a time Inability to name an object (Anomia) Inability to locate the words for writing (Agraphia) Problems with reading (Alexia) Difficulty with drawing objects Difficulty distinguishing left from right Difficulty doing mathematics (Dyscalculia) Lack of awareness of certain body parts and/or surrounding spaces that leads to difficulties in self-care (Apraxia) Inability to focus visual attention Difficulties with eye and hand coordination

How does a Brain Injury Affects the Individual? Temporal Lobes: Function: Hearing ability; memory acquisition; some visual perception; and categorization of objects When Damage: Difficulty recognizing faces (Prosopagnosia) Difficulty understanding spoken words (Wernicke’s Aphasia) Disturbance with selective attention to what we see and hear Difficulty with identification of and verbalization about objects Short term memory loss Interference with long term memory Increased or decreased interest in sexual behavior Inability to categorize objects Right lobe damage can cause persistent talking Increased aggressive behavior

How does a Brain Injury Affects the Individual? Frontal Lobe: Function: How we know what we are doing without our environment (Consciousness); how we initiate activity in response to out environment; judgments we make about what occurs in our daily activities; controls our emotional responses; control our expressive language; assigns meaning to the words we choose; involves word association; memory for habits and motor activities. When Damage: Loss of simple movement of various body parts (Paralysis) Inability to plan a sequence of complex movements need to complete a multi-stepped task (Sequencing) Loss of spontaneity in interacting with others Loss of flexibility in thinking Persistence of a single thought (Perseveration) Inability to focus on task (Attending) Mood changes (Emotional Labile) Changes in social behavior Changes in personality Difficulty with problem solving Inability to express language (Broca’s Aphasia)

Brain Injury Resources New Mexico

New Mexico Brain Injury Program The Brain Injury Program offers short-term services to New Mexicans living with Traumatic Brain Injury (TBI). Directed for folks who do not have access to long-term Medicaid services and who have a crisis need. Services offered: Service Coordination, Life Skills Coaching and Crisis Interim Services to eligible residents of New Mexico.

New Mexico Brain Injury Resource Center The New Mexico Brain Injury Resource Center (NMBIRC) is a one-stop shop for information and referrals on a wide variety of topics related to brain injury including services, supports, and education about brain injury. Services: Information and Referral, Resource Facilitation, Library, and Outreach. Contact: 1-844-3NM-BIRC (1-844-366-2474) or nmbirc@arcaspirit.org Comfort Zone

New Mexico Brain Injury Organizations New Mexico Brain Injury Alliance - help individuals living with brain injury and the communities learn about brain injury and resources to help cope with the effects of brain injury. Contact: 1-888-292-7415 New Mexico Brain Injury Advisory Council - to advocate for the development of a statewide system of comprehensive, community-based resources that will maximize personal choices and functional independence of persons with brain injuries, and promote prevention. Contact: (505) 476-7328

Brain Injury: Reversing the Silent Epidemic Current advances have not yet resulted in dramatically increased funding for services, basic research or prevention of brain injury There is continued need for: Public health education Funding to ensure ongoing support and services Awareness about concussion Epidemiological data collection Brain injury screening

Contact Information John Pimentel, CBIST Office: (505) 243-3875 Cell: (505) 235-7478 Email: jpimentel@arcaspirit.org

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