1. Brain Injury Essentials Overview and Resources
John Pimentel, CBIST

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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 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

9. 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

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

11. 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.

12. 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.

13. 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

14. 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

15. 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

16. 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)

17. Brain Injury Resources New Mexico

18. 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.

19. 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: NM-BIRC ( ) or
Comfort Zone

20. 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:
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)

21. 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

22. Contact Information
John Pimentel, CBIST Office: (505) Cell: (505)

23. QUESTIONS?