1. Update on Closed Head Injuries Sponsored by Barss Residential Long Term Care January 15, 2009 Fort Gratiot, MI www.barssresidential.com

2. Goals Appreciate impact Appreciate impact Improve care Improve care Encourage prevention Encourage prevention

3. Objectives Describe primary causes Describe primary causes Describe how the brain works Describe how the brain works Utilize strategies Utilize strategies Discuss prevention Discuss prevention

4. Outline What they are What they are Why important Why important Who is at risk Who is at risk How brain injury impacts function How brain injury impacts function What you can do What you can do

5. Traumatic brain injury (TBI) An injury to the brain caused by external trauma to the head or violent movement of the head Thurman et al., 1994 Thurman et al., 1994

6. Prevalence

7. In Michigan... 200,000 citizens live with disabilities 2,500 new citizens per year 1,500 fatalities in 2004

8. Major Causes of TBI in Michigan Motor Vehicle – cars, motorcycle, recreational vehicles. Violence – substance abuse related, domestic, and shaken baby syndrome. Falls – primarily among elderly and children. Blast - "Signature Wound"

9. In Michigan...

10. Severity Mild (75%) Mild (75%) 1-3 months 1-3 months Moderate (10-30%) Moderate (10-30%) 1 year 1 year Severe (5-10%) Severe (5-10%) higher risk for long term disability higher risk for long term disability

11. Post acute care should be based on assessment of current functioning rather than on diagnosis of severity made immediately after injury

12. What happens

13. Primary events Axonal shearing Axonal shearing Contusion Contusion Bruising Bruising Bleeding Bleeding Depressed skull fracture Depressed skull fracture

14. Secondary events Swelling (cerebral edema) Swelling (cerebral edema) Hematoma Hematoma Increased intracranial pressure Increased intracranial pressure Anoxia Anoxia

15. Consequences No two are alike No two are alike Minority of survivors have long-term, physical signs Minority of survivors have long-term, physical signs Cognitive/Behavioral/Emotional Cognitive/Behavioral/Emotional

16. Physical Consequences Pain Pain Swallowing and speech Swallowing and speech Sensory Sensory Fatigue Fatigue Body movement Body movement

17. Behavioral Consequences Emotional dyscontrol Emotional dyscontrol Social inappropriateness Social inappropriateness Difficulty with relationships Difficulty with relationships Lack of response to social cues Lack of response to social cues Mood swings Mood swings

18. Cognitive consequences Slower processing Slower processing Language difficulties Language difficulties Inattention Inattention Poor concentration Poor concentration Memory deficits Memory deficits

19. Brain Behavior Relationships

20. Brain-behavior relationships Right Right The big picture The big picture Visuospatial relationships Visuospatial relationships Self-awareness Self-awareness Creativity Creativity Visual memory Visual memory

21. Brain-Behavior Relationships Left Left Language Language Emotional regulation Emotional regulation Verbal memory Verbal memory Logic Logic Sequencing Sequencing

22. Brain-Behavior Relationships Frontal Parietal Occipital Temporal Brain stem Hippocampus Amygdala

23. Frontal lobe Executive function Purposeful behavior Complex reasoning Organization Problem solving Flexibility Speaking

24. Frontal lobe Initiation Initiation Self-monitoring Self-monitoring Inhibition Inhibition Judgment Judgment

25. Temporal Lobe Memory Understanding language Organizing and sequencing Hearing

26. Standing in the Shoes... Susan Wehry

29. Complex Mild to severe Different areas Multiple areas Recovery varies

30. Recovery Weeks  Years Weeks  Years Lifelong Lifelong Unique Pre-injury personality Learning style Location and severity Psychological reaction Family involvement

31. Rehabilitation Functional assessment Functional assessment Targeted to specific strengths, deficits Targeted to specific strengths, deficits Family involvement and support critical Family involvement and support critical

32. Rehabilitation Cognitive Cognitive Speech Speech Occupational Occupational Physical Physical Social Social

33. Primary Prevention Causes Causes Seat belts Seat belts Environmental hazards Environmental hazards Conflict resolution Conflict resolution Risk factors Risk factors Age Age Gender Gender Alcohol Alcohol

34. Secondary Prevention Physical deficits may  further injury Physical deficits may  further injury Attend to risk of falls, choking Attend to risk of falls, choking Cognitive deficits  further disability Cognitive deficits  further disability Target rehabilitation towards strengths Target rehabilitation towards strengths

35. What you can do Personal prevention Personal prevention Share what you've learned Share what you've learned Act as an advocate Act as an advocate Become involved Become involved Brain Injury Association of Michigan Brain Injury Association of Michigan

36. References and Resources www.cdc.gov/ncipc/tbi/TBI.htm www.cdc.gov/ncipc/tbi/TBI.htm www.cdc.gov/ncipc/tbi/TBI.htm www.mitbitraining.org/ www.mitbitraining.org/ www.mitbitraining.org/ http://www.bianys.org/veterans/BeyondTheInvisible320x2 40.wmv http://www.bianys.org/veterans/BeyondTheInvisible320x2 40.wmv http://www.bianys.org/veterans/BeyondTheInvisible320x2 40.wmv http://www.bianys.org/veterans/BeyondTheInvisible320x2 40.wmv