traumatic brain injury in veterans

24
Traumatic Brain Injury in Veterans Robyn Mehlenbeck, PhD* Equal Justice Works Leadership Development Training October 23, 2014 Washington, DC * George Mason University

Upload: eugenia-norton

Post on 31-Dec-2015

38 views

Category:

Documents


0 download

DESCRIPTION

Traumatic Brain Injury in Veterans. Robyn Mehlenbeck, PhD* Equal Justice Works Leadership Development Training October 23, 2014 Washington, DC. * George Mason University. WHAT IS TBI?. Traumatic Brain Injury:. Sudden physical damage and trauma to the brain - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Traumatic Brain Injury in Veterans

Traumatic Brain Injury in Veterans

Robyn Mehlenbeck, PhD*Equal Justice Works Leadership Development

TrainingOctober 23, 2014Washington, DC

* George Mason University

Page 2: Traumatic Brain Injury in Veterans

WHAT IS TBI?

2

• Sudden physical damage and trauma to the brain

• Focal Lesion: foreign body enters brain, targets specific area

• Mild Traumatic Brain Injury (mTBI): affects larger areas of the brain, white matter

• White matter responsible for relaying electrical signals around brain

Traumatic Brain Injury:

Page 3: Traumatic Brain Injury in Veterans
Page 4: Traumatic Brain Injury in Veterans

Causes of TBI

4

• Transportation accidents• Cars, motorcycles, bicycles, pedestrians (50%)

• Falls• Majority of TBI in ages 75 and older from falls

• Violence• Domestic violence, firearms assaults, child abuse (20%)

• Sports injuries• Approximately 3%

• Combat• Separate category, increasingly common in combat due to IED

(http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm)

Page 5: Traumatic Brain Injury in Veterans

Combat-Related TBI

5

• Especially common in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF)

• 66% of service personnel in Iraq exposed to or injured by a blast injury

• Frequently mTBI rather than focal lesion (80% mTBI)

• Affects large sections of the brain

• Effects not immediately noticeable

• Concentration and cognitive decline over time

Page 6: Traumatic Brain Injury in Veterans

Physical Symptoms of TBI

• Unconsciousness (seconds or minutes)

• Headache• Nausea and

vomiting• Dizziness• Seizures• Weakness

• Numbness in arms and legs

• Dilated pupils• Metallic taste in mouth• Ringing in ears• Fatigue and lethargy• Change in sleep

patterns• Difficulty with motor

coordination

Page 7: Traumatic Brain Injury in Veterans

Psych Symptoms of TBI

• Slurred speech• Confusion• Agitation• Memory or

concentration problems

• Amnesia about events prior to injury

• Behavioral changes• Mood changes

• Depression• Anxiety

• Difficulty with attention

• Difficulty with complex thinking

Page 8: Traumatic Brain Injury in Veterans

Neurology vs Neuropsychology?

• Neurology – MD

• Specialty that assesses, diagnoses and treats problems with TBI, among other nervous system problems

• Treats the physical symptoms and causes of TBI

• Neuropsychology - PhD

• Looking for behavioral manifestations of TBI

• Assesses and treats the cognitive, behavioral and psychological effects of the TBI

Page 9: Traumatic Brain Injury in Veterans

Types of TBI

9

• Two major types of traumatic brain injury

• Penetrating brain injury

• Closed head injury

Page 10: Traumatic Brain Injury in Veterans

Penetrating TBI

10

• Types of penetrating TBI

• Skull fracture bone of skull cracks or breaks

• Pieces of skull can press into brain tissue

• Foreign object enters brain (e.g. bullet)

• Damage occurs along path of injury (focal lesion)

• Symptoms vary according to part of brain that is damaged

Page 11: Traumatic Brain Injury in Veterans

11

Page 12: Traumatic Brain Injury in Veterans

Closed-head TBI

• Results from blow to the head (e.g. car accident, football tackle, impact from IED blast)

• Causes two type of brain injuries:

1. Primary

2. Secondary

Page 13: Traumatic Brain Injury in Veterans

Primary Closed-head Injuries

• Contusion• Bruising of brain tissue (swollen brain tissue and blood)

• Can be in response to shaking of brain in skull (contrecoup)

• Hematomas/blood clots• Occur between the skull and the brain or inside the brain itself

• Diffuse axonal injury• Individual nerve cells damaged

• Loss of connections between neurons

• Laceration• Tearing of the frontal (front) and temporal (on the side) lobes or blood vessels of the

brain

• Force of the blow causes the brain to rotate across the hard ridges of the skull, causing the tears

Page 14: Traumatic Brain Injury in Veterans

Secondary Closed-head Injuries

14

• Evolves over time (after trauma has occurred)• Brain swelling (edema)• Increased pressure inside of the skull (intracranial

pressure)• Epilepsy• Intracranial infection• Fever• Anoxia: lack of oxygen supply to brain tissue

• Without oxygen, brain cells die within minutes

• Hematoma: heavy bleeding in or around brain

Page 15: Traumatic Brain Injury in Veterans

Closed-head Injury Illustration

( http://health.allrefer.com/health/head-injury-prevention.html)

Page 16: Traumatic Brain Injury in Veterans

What does it mean to have a TBI?

16

Typical Impairments:

Communication

Thinking/Executive Functioning

Psychological

Page 17: Traumatic Brain Injury in Veterans

Communication Difficulties

17

• Difficulty picking up social cues • e.g. interrupting

• Difficulty following conversations

• Occasional difficulty modulating tone of voice

• Difficulty processing subtleties/nuances in language • e.g. difference between tongue-in-cheek and seriousness

Page 18: Traumatic Brain Injury in Veterans

Communication Difficulties

18

• More severe difficulties include:• Aphasia

• difficulty understanding and producing spoken and written language

• Word Recall • Trouble recalling words/speaking in complete sentences

• Frequent pauses• Prosodic dysfunction

• difficulties with inflection and intonation

Page 19: Traumatic Brain Injury in Veterans

Cognitive Difficulties

19

• Slower processing of information

• Difficulty with short-term memory

• Retrograde Amnesia (hippocampus/prefrontal cortex)• Loss of specific memories from pre-trauma (unconsolidated)

• Anterograde Amnesia (hippocampus/prefrontal cortex)• Difficulty forming new memories after trauma

Page 20: Traumatic Brain Injury in Veterans

Cognitive Difficulties

20

• Executive functioning difficulty (prefrontal cortex)

• Poor planning, organizing skills• Setting goals• Completing tasks• Difficulty solving problems• Difficulty with abstract reasoning• Difficulty making judgments

• Impulsivity (prefrontal cortex)

Page 21: Traumatic Brain Injury in Veterans

Testing for effects of TBI

Comprehensive Assessment with emphasis on Executive Functioning

- Can be done by a neuropsychologist- Can be done by a psychologist with extensive

experience in the types of tests needed to examine the deficits concerned about

Page 22: Traumatic Brain Injury in Veterans

Testing for effects of TBI

Clinical Interview – looking for some identifying event/incident; any testing prior to the injury is a bonus

Cognitive Assessment – WAIS-V; Woodcock Johnson Cognitive/Achievement

Executive Functioning – Delis- Kaplan Executive Functioning System (D-KEFS)Rey-Osterrieth Complex Figure Test/Beery VMI

Psychological – ADD scales, Mental Status Exam

Test of Memory Malingering (TOMM) – gives some validity to whether a client is intentionally exaggerating memory symptoms

Page 23: Traumatic Brain Injury in Veterans

Rey-Osterrieth Complex Figure Test

- Add in figure; & scores on a sample w/deficits

Page 24: Traumatic Brain Injury in Veterans

Treatment of TBI

24

• Treatment dependent on severity of TBI• Combination of medical management of symptoms &

psychological intervention based on deficits

• In mTBI Cognitive Behavioral Therapy most common treatment form for psychological effects• Structured work on goal setting/problem solving• Structured work on impact of thoughts on feelings and

behaviors

• Additional treatment: • Nutrition• Education• Counseling & family support• Medication for symptomatic relief