brain injury calista nabors, lmsw sedrick jackson, lcsw
TRANSCRIPT
What is Brain Injury Injury to brain tissue that temporary or
permanently impairs brain function
“Brain injury is not an event or an outcome. It is the start of a misdiagnosed, misunderstood, under-funded neurological disease.”
-Brain Injury Association of America
Disability Prevalence
Why is this important? Depression Stroke Epilepsy
The “Silent Epidemic”
Depre
ssio
nMR
TBI
Stro
ke AD
Epile
psy CP
SCI
0
4
8
12
16
20
Millions
Incidence Annual Rates 1.7 Million per year (CDC)
50,000 Deaths 235,000 Hospitalizations 1,100,000 ED visits
Comparison
HIV/Aids
Colon Cancer
Breast Cancer
All Cancers combined
TBI
0 100 200 300 400 500 600
Per every 100,000 people
Incidence of Select Health Problems in the U.S
Traumatic Brain Injury Act of 1996
Passed July 29th, 1996 Acknowledged the incidence and
prevalence of brain injury nationally “to expand efforts to identify methods of
preventing traumatic brain injury; expand biomedical research efforts or minimize the severity of dysfunctions a result of such an injury; and to improve the delivery and qualify of services through State Demonstration Projects”
Funding Private Insurance Department of
Defense/Veterans Administration
Some Federal grants for TBI-No feveral money for ABI
Private Pau Non-Profit support-
Scholarships given from community fundraising
Medicaid After
hospitalization Only 5% of
individuals with severe brain injuries have adequate funding for long term treatment
Cost Staggering
Life-long costs Year 2000
$60 Billion Lifetime cost
$406 Billion Neurological Rehab
starts at approx $30,000 per month
No two brain injuries are exactly the same
The effects of a brain injury are complex and vary greatly from person to person
The effects of a brain injury depend on such factors as cause, location, and severity
Types of Brain Injury Traumatic Brain
Injury (TBI) Penetrating:
foreign objects enters the brain Example: bullet
Closed Head: blow to the head Example: car
accident
Acquired Brain Injury (ABI)
occurred after birth, but is not related to congenital defect or degenerative disease
CausesTBI
Falls Motor Vehicle-
Traffic Accidents Struck by/against Assaults Blasts- Leading
cause of TBI for active military in war zones.
ABI Hypoxia Illness Infection Stroke Substance abuse Toxic exposure Tumor
Severity Mild Brain Injury
Loss of consciousness for less than 30 minutes (or no loss)
Glasgow Coma Scale of 13-15 Post-Traumatic amnesia less than 24
hours Temporary or permanently altered mental
state Post-concussion symptoms
Severity Moderate
Coma more than 20-30 minutes but less than 24 hours
Glasgow Coma Scale of 9-12 Skull fractures may be present Signs on EEG, CT or MRI Long term problems in one or more areas
of life
Severity Severe Coma longer than 24 hours Glasgow Coma Scale of 3-8 Bruising, bleeding in brain Signs on EEG, CT or MRI Long term impairments in one or more
areas of life.
Frontal Lobe Initiation Problem-solving Judgment Inhibition of behavior Planning/Anticipation Self-monitoring Motor planning
Personality/Emotions Awareness of
abilities/Limits Organization Attention/Concentration Mental Flexibility Speaking
Common Disabilities Problems with cognition
thinking, memory, and reasoning Sensory processing
sight, hearing, touch, taste, and smell Communication
expression and understanding Behavior or mental health
depression, anxiety, personality changes, aggression, acting out, and social inappropriateness
More serious injuries my result in unresponsiveness with periods of alertness; a persistent vegetative state
Substance Abuse 58% of individuals with acquired brain
injury had a history of alcohol abuse or dependence prior to injury (Kreutzer, Dougherty, &Harris, et al., 1990
Post Injury As many as 50% of individuals with an
acquired brain injury will return to using drugs and alcohol post-injury. (Sparadeo, Strauss &Barth, 1990)
Treatment Initial
Little can be done to reverse the initial brain damage, medical personnel try to stabilize an individual and focus on preventing further injury
Mild injury Mild traumatic brain injuries usually require no treatment
other than rest and over-the-counter pain relievers to treat a headache.
Moderate to severe cases Rehabilitation that involves individually tailored treatment
programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support.
Medication Therapy Depakote and Tegretol –work well for
aggression Desyrel (sedating property) Anti- Depressants
No MAOI’s- due to dietary constraints Inderal and Clonidine (antihypertensive
medications) Antipsychotics- impair recovery, memory,
learning, and lower seizure threshold.
Social Workers Role Social workers play a very meaningful role.
LMSW: facilitates access to service agencies, assists with care decisions and planning, and facilitates communication among various professionals, care providers and family members
LCSW: continue support services to families and client. Facilitate support groups and provide individual therapy for the client and family members
Advocacy Currently one of the hottest medical topics Funding for treatment and placement is very limited
Medicaid does not pay for neurological rehabilitation
Common Therapy Models Cognitive Behavioral Therapy (CBT)
Mild/Moderate Cognitive Rehabilitation Therapy (CRT)
Mild/ Moderate Dialectical behavior therapy (DBT)
Moderate/Severe Behavioral Therapy
Mild/ Moderate/Severe
Cognitive Behavioral Therapy
CBT- Mild to Moderate Cognitive-behavioral therapy focuses on altering
thoughts or perceptions that are causing psychological distress
For those with moderate brain injury Therapist train the client to continuously ask questions
about strong emotional response Example: What is it that's really making me angry? Did it
always make me angry? Did it always make me this angry?
Computer-based cognitive therapy programs have helped many individuals suffering from brain injuries Fun way to exercise each the brain with card games,
mystery games etc. that can improve each area of the brain.
Cognitive Rehabilitation TherapyCRT
patient-specific and goal-oriented increase their ability to process and interpret
information Its goal is to help the client enhance his or her ability
to move through daily life by recovering or compensating for damaged cognitive functions
CRT involves a variety of treatments and often involves the participation of family or caregivers
CRT interventions are promising, however the Department of Defense recommends an investment in research to further define, standardize, and assess the outcomes of CRT interventions.
Dialectical Behavior TherapyDBT
Multi-treatment approach Individual Therapy Coaching Structure
Managing Crises Multiple stages
Connection between borderline personality disorder and brain injury Certain brain mechanisms underlying the impulsivity, mood
instability and negative emotions are responsible for maladaptive behaviors
The amygdala, which normally regulates arousal and emotions, may be involved in the disruption of normal emotional responses due to injury
Behavioral Therapy Clients with moderate to severe brain
injury's may not be able to cognitively process actions Severe brain injury may leave someone
intellectually inept Behavioral Therapy
Reward and punishment systems Operant conditioning Positive reinforcement
Treatment Plan Break it down!
Outcomes: the big idea Goals: break the general outcome down Objectives: no ambiguity, clearly defined
Person Centered Supportive Simple Consistency Positive Daily Planner: Slowly adjusting daily plan.
Adjustment for All
6 stages of adjustment for the family 1)Shock, Hope, Denial 2)Recognition and Helplessness 3) Annoyance, Expectations, Reality, Seeking
information 4)Realism, Exhausted, Pulling away, Bereavement 5) Sadness, grief, mourn 6) Understanding, acceptance, family unit
PTSD for entire family: acute or delayed anxiety
Change Identifying events in environment: ABCs
Antecedent Behavior Consequence
Positive reinforcement Yes or No questions Stay Calm Maintain a Sense of Humor Avoid Arguments Don’t Take things personally Redirection
Quiz What part of the brain causes the most change in
personality when injured? True or False: CBT is the best treatment for all clients
with Brain Injury Are open ended questions appropriate for brain injured
clients? True or false: all brain injuries are the same? What are the two types of brain injury? True or false: All brain injuries are the same. True or False: Punishment for bad behavior is good
practice? How many stages of adjustment are their? True or False: Medicaid covers brain injured individuals
long term care What is the 3rd most prevalent disability seen in the
United States?
References American Speech Language Hearing Association; Traumatic Brain
Injuryhttp://www.asha.org/public/speech/disorders/TBI.htm Brain Injury Association of America; http://www.biausa.org/living-with-brain-injury.htm Brain Injury Resource Center; http://www.headinjury.com/rehabcognitive.html Centers for Disease Control and Prevention; http://www.cdc.gov/TraumaticBrainInjury/index.html Institute of Medicine; http://www.iom.edu/Reports/2011/Cognitive-Rehabilitation-Therapy-for-Traumatic-
Brain-Injury-Evaluating-the-Evidence.aspx The Gale Group Inc., Gale…. Gale Encyclopedia of Alternative Medicine Mayo Clinic; http://www.mayoclinic.com/health/traumatic-brain-injury/DS00552/TAB=indepth National Institute of Health; NINDS Traumatic Brain Injury National Institute of Mental Health: Borderline Personality Disorder PsycCentral;http://psychcentral.com/news/2011/10/13/cognitive-rehabilitation-therapy-for-traumatic-
brain-injury-tbi-does-it-work/30325.html Texas Health and Human Services Commission; office of Acquired Brain Injury;
http://www.hhsc.state.tx.us/hhsc_projects/abj/index.shtml The Bridge of Central Massachusetts: DBT for Individuals with Intellectual Disabilities Kreutzer, JS Dougherty DR, and Harris AZ. Et al (1990). Alcohol use among persons with traumatic
brain injury. Journal of Head Trauma Rehabilitation 5:9-20 Sparadeo, FR, Strauss D &Barth, JT(1990). The incidence, impact and treatment of substance abuse in
head trauma rehabilitation. Journal of Head Trauma Rehabilitation 5 (3), 1-8 The Essential Brain Injury Guide Academy of Certified Brain Injury Specialists, Brain Injury Association
of America.