Traumatic Brain Injury (TBI)

TBI results from: Penetrating Closed head injury

Prevalence cases of TBI/year in U.S. of these: die individuals have significant, long- term impairments every 15 seconds a person sustains a TBI

Causes of all TBIs are caused by motor vehicle accidents (MVA) Other causes Affect more males than females (2:1) highest frequency

Neurology Unlike stroke, TBI is brain damage is usually Damage can be to:

Damage is due to the injury due to impact (in that area) injury on the side opposite to the impact damage due to angular acceleration of the brain

Secondary effects Cerebral Hemorrhage --> hematoma: cerebral edema: increased

Coma Not all TBIs result in coma, but many do There are different levels of coma, measured on a Glasgow coma scale Rancho Los Amigos scale

Rancho Los Amigos Scale of Cognitive Levels inconsistent responses to intense stimuli (e.g., pain) blinks to strong light, turns toward sound, inconsistent response to commands

alert, active with aggressive behavior. Behavior is not purposeful, patient is disoriented gross attention to environment, highly distractible, responds to simple commands

inconsistent orientation to time and place, recent memory impaired performs daily routine in familiar environment, poor insight, judgment, and problem-solving responds appropriately in most situations

Impairments resulting from TBI Cognitive Physical Speech and Language Behavioral and Emotional

Potential Cognitive Problems Orientation Slowness of thinking Difficulty maintaining attention and concentration Reasoning and problem solving

Physical problems can include Potential Physical Problems Vision problems Lack of coordination Weakness or paralysis of muscles Problems sleeping

Potential Speech & Language Problems Speech ( ) Language impairment ( ) Commonly: anomia & impaired comprehension Problems with Voice & Swallowing Reading/writing

Potential Behavioral and Emotional Problems Lack of motivation Inability to self-monitor (denial) Difficulty with emotional control and anger management

Intervention - Role of SLP May address many areas depending upon client’s needs Orientation Memory Listening comprehension Speech intelligibility Pragmatics Reasoning and problem solving

Recovery is in a step-wise plateau. Cognitive Rehabilitation Treatment regimen designed increase functional abilities for everyday life by improving the capacity to process incoming information Repetitive activities to rebuild neural circuitry Attempted first e.g., classification tasks, word associations, rehearsal, memory aids

Develop alternatives, since some functional will not be recovered. When restorative approaches won’t work E.g., focused attending, rehearsal of new information

Stages of Recovery/Intervention Early Stage Beginning responses to environment in hospital – stabilization Intervention focus: Evidence to suggest that intervention can result in shorter rehabilitation & higher levels of cognitive functioning

Middle Stage Goal: Intervention focus: Orientation to everyday routine Routines, consistency Conversational speech Listening/comprehension Following directions Description, classification

Late Stage Goal: Intervention focus: Comprehension of complex information, directions Conversational/social skills (including problem solving) Compensatory strategies Self-inhibition Self-monitoring skills