Presented by: Elizabeth Bilderback Brain Injury

1. Brain Injury
Elizabeth Bilderback, MA
Elizabet.bilderback@healthsouth.com

2. Types of Brain Injury
• Traumatic- blow to head or
penetrating injury that disrupts the
functioning of the brain.
– Falls (28%)
– MVA‟s (20%)
– Struck by/against events (19%)
– Assaults (11%)
– Soldiers (blasts)

3. Types of Brain Injury (continued)
– Aneurysms
– Tumors
– Strokes
– Encephalopathies

4. Types of Brain Injury (continued)
• Concussions
– A type of brain injury that disrupts
functioning of the brain
– Do not need to lose consciousness to
have a concussion
– Multiple concussions can cause
cumulative and long lasting problems

5. What We Hear About
• 795,000 strokes every year in the U.S.
– Every 40 seconds, 1 person has a stroke
• 1.2 million coronary attacks every
year in the U.S.

6. Did You Know….
• According to the World Health
Organization TBI is the leading
cause of death and disability
in children and young adults
around the world and is
involved in nearly half of all
trauma deaths.

7. Brain Injury by the Numbers
• 1.4 million new traumatic brain
injuries (TBI) each year in the U.S.
– Every 23 seconds, 1 person sustains a TBI
• 360,000 active duty soldiers have
sustained TBIs in Iraq and
Afghanistan

8. TBI by the Numbers
• TBIs in the U.S.
– 50,000 die
– 235,000 are hospitalized
– 1.1 million treated and released from ER
– 75% are mild TBI or concussions
– 1.6-3.8 million sports and recreation-
related concussions in U.S. each year

9. TBI in Australia
• Use the term Acquired Brain Injury
which includes accidents, strokes,
infections, degenerative,
neurological disease and traumas
• “Common” in Australia- 432,700
Australians (2.2% of population) in
2003 had an ABI
– 1 in 50 have an ABI

10. TBI in Australia
• An individual with an ABI has an 80%
chance of developing a
diagnosable mental illness
• About 1/3 of clients of mental health
services have an underlying ABI

11. TBI in Canada
• TBI is the number one killer and
disabler of Canadians under age 40
– More than half are under age 20
– Majority are young men ages 15-30
– Highest incidence rate is 15-19 year
age group
– MVAs account for half of all TBIs
– 75% of all cycling deaths involve TBIs

12. TBI in Canada
• Every year 50,000 Canadians sustain
brain injuries
– Every 5 minutes someone is injured
– Every 7 hours someone dies

13. Brain Injury
• Traumatic brain injury can happen
to ANYONE
– Highest risk
• Males 1.5x to 2x as likely as females
• Highest risk age groups: 0-4 years and 15-
19 years with 15-24 years most likely to be
hospitalized
• Certain military duties or other jobs
increase risk

14. Brain Injury
• Cost
– $60 billion in the U.S. in 2000 for direct
medical costs and indirect costs such
as lost wages

15. Brain Injury
• Range in Severity
– Mild with transient symptoms to Severe
with lengthy loss of consciousness and
amnesia for the event (plus amnesia
before and after event)
• More recent and worse brain injuries
are easier for you to spot

16. Brain Injury
• Long term Consequences of
Physical Damage to the brain
– Physical Skills
– Sensation
– Thinking
– Learning
– Academics
– Behavior
– Personality
– Social Skills

17. Brain Injury
• Most frequent unmet needs
according to one study
– Improving memory and problem
solving
– Improving job skills
– Managing stress and emotional upsets
– Controlling temper
• 40% of individuals who had been
hospitalized had 1 or more unmet
need at 1 year post

18. TBI and Law Enforcement
• Not all brain injury survivors will be a
problem for law enforcement
– Brain Injury Causing:
• Anger Management issues
• Impulsivity
• Poor Judgment
– Brain Injury Plus:
• Substance Abuse
• PTSD
• Premorbid Personality
• Lack of Family/Social Support

19. TBI and Aggression
• One 1996 study on a military
population found TBI ↑ the risk of
behavioral discharge 4x and
criminal conviction 5x
• A 2003 study found 33.7% of
individuals in a TBI group met the
criteria for aggressive behavior in
the first 6 months post injury. Major
Depression also more frequent in TBI
group.

20. TBI and Aggression
• Focal frontal lesions in an aggressive
TBI group vs. a more diffuse lesion in
a nonaggressive TBI group

21. TBI and Insight
• A 1993 study found poor insight
regarding behavioral impairment at
6 months post injury
• A 2006 study found their TBI group
less able to recognize emotion in
others.

22. TBI Causes Physical Problems
– Loss of Motor Control and Coordination
• Hemiparesis
• Ataxia
• Balance
• Strength
• Endurance
• Spasticity

23. Physical Problems Continued
• Sensory Problems
• Diplopia
• Blindness
• Visual Field Cut
• Sensitivity to Hot/Cold
• Taste
• Hearing
• Sensation
• Smell
• Proprioception

24. Physical Problems Continued
• Speaking and Swallowing Disorders
• Dysarthria
• Dysphagia
• Fatigue
• Headaches
• Bladder/Bowel Incontinence
• Seizures

25. Brain Injury
• Our cognition or thought processes
guide behavior and lead to feelings
or emotions
• Brain Injuries Cause Cognitive
Problems.

26. TBI Causes Cognitive Problems
• Attention/Concentration
• Visual Spatial Skill
– Understanding and manipulating things
you see
• Perception/Judgment
– Self Awareness
– Deficit Awareness
• Goal Setting
• Disordered/Slowed Learning
– ↓ ability to learn from experience

27. Cognitive Problems Continued
• Memory
• Recognition
• Recall
• Prospective
• Auditory
• Visual
• Immediate
• Long-term

28. Cognitive Problems Continued
• Slowed Speed of Information
Processing and Slowed Reaction
Time
– Especially with decision making
– Response Selection
– Mental Transformations
– Stressful Situations
– Complex Situations

29. Cognitive Problems Continued
• Communication
– Reading/Writing
– Expressive Language
• Verbal Fluency
– Receptive Language
• Auditory Comprehension
• Math Skills
• Time Management

30. Cognitive Problems Continued
• Executive Skills
– Plan, Direct, Execute and Monitor Activities
– Initiation
– Planning/Organizing/Categorizing/Sequencing
– Reasoning
– Abstract Thought
– Flexibility of Thought
– Problem Solving/Judgment
– Learning from mistakes/ Thinking about
consequences

31. TBI Causes
Behavioral/Psychosocial Problems
• Disinhibition/Impulsivity/Impatience/
Restlessness
– May be unaware of this and its effects
on others
– May be related to less tolerance for
frustration/noise/problems
– Verbal Outbursts
– Physical Outbursts
– “I‟ll do it now and think about it later”

32. Behavioral/Psychosocial
Problems continued
• Egocentricity/Self-centeredness
– How does my behavior impact you?
– I‟m most important
– With decreased empathy, interpersonal
sensitivity, self-reflectiveness, and/or
self-critical attitudes

33. Behavioral/Psychosocial
Problems continued
• Rigidity/Inflexibility/Stubbornness
– I‟m right and don‟t argue with me
• Sexual Problems
– Increase or decrease in drive/interest

34. Behavioral/Psychosocial
Problems continued
• Oversensitivity/Suspiciousness
• Irritability
– Easily annoyed/bothered
• Apathy
– I don‟t care
• Silliness/Childishness

35. Behavioral/Psychosocial
Problems continued
• Reactionary Disturbances
– Denial
– Depression
– Anxiety
– Frustration
– Sleep Disturbances
– Suicidal Thoughts
– Loss of Self-Esteem
– Loss of Self-Confidence
– Anger
– Mood Swings

36. Brain Injury as an excuse…
Is brain injury an excuse for
inappropriate or
illegal behavior?
People are still responsible
for their behavior,
injury or not

37. 2 Situations
you will encounter:
You will be informed of an injury
OR
You will have NO CLUE

38. At HEALTHSOUTH
We tell the patient/family
to inform Police of the injury
if they call the Police for ANY reason
We also tell the patient to inform the
Police Officer of their injury if they
happen to be stopped or detained
for any reason

39. No CLUE?...Things to Look for:
• Suture Lines on the head (surgery)
• Subtle Dents on head (surgery or monitors)
• Asymmetrical Face – 1 side droops
• Eyes that don‟t seem to work correctly
• Struggle finding words
• Disorganized Speech
• Tangential or Verbose

40. No Clue, cont…things to look for
• “FLK” & “FLA”
-Dressed Inappropriately
-Odd, Broad Based Gait
-Arm that Hangs in an Odd way
-Arm Swing is off
• Braces / Splints

41. Do‟s & Don‟ts
with Brain Injured Citizens
• Do not Over-Stimulate
– Brain injured individuals can only process certain amounts of information,
and can lose behavioral control if over-stimulated
• Reduce Stimulation
– Do this by removing spectators and personnel, having only 1 person talk,
reducing noise, and removing environmental objects that stimulate, such
as music.
• Make Surrounding Environment Safe
– Remove dangerous objects, if possible
• Allow the Individual to „walk off‟ any agitation
– Allow the individual to move
• Model Calm Behavior
– Speak Quietly
• Direct the Individual away from the source of frustration
– Reduce anger and frustration by changing the topic

42. Do‟s & Don‟ts
with Brain Injured Citizens
• Do not lecture or argue with the individual,
it will only escalate the situation
• Try to be consistent and predictable
• Be aware of Body Language, yours and theirs. Be aware of
interpersonal space, posturing and speed of approach.
• Do not touch an agitated individual unless you are prepared for
a physical alteration
• If possible, clearly and simply, state the consequences and
impact of the individual‟s behavior
• Do not take what they say personally

43. Thank You!
Elizabeth Bilderback, MA
Elizabet.bilderback@healthsouth.com