Traumatic Brain Injury in Ohio

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Traumatic Brain Injury inOhio

• Program provided by
• Ohio Brain Injury Program and Advisory Committee
• Rehabilitation Services Commission

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FORMAT. HOWEVER, THE CONTENT OF THIS PRESENTATION
MAY NOT BE ALTERED.
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Objectives

• Define brain injury
• Give epidemiological data
• Summarize neuropathology of TBI
• Describe functional impacts commonly associated
  with TBI
• Physical
• Behavioral
• Communicative
• Impact on family
• Outline programs available in Ohio

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(No Transcript)
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Definition of Traumatic Brain Injury (Individuals
with Disabilities Education Act)
Traumatic brain injury means an acquired
injury to the brain caused by an external
physical force, resulting in total or partial
functional disability or psychosocial impairment,
or both, that adversely affects a childs
educational performance. The term applies to open
or closed head injuries resulting in impairments
in one or more areas, such as cognition
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language memory attention reasoning abstract
thinking judgment problem-solving sensory,
perceptual, and motor abilities psychosocial
behavior physical functions information
processing and speech. The term does not apply
to brain injuries that are congenital or
degenerative, or brain injuries induced by birth
trauma. Federal Register, Vol. 57, No. 189,
Tues., 9/29/92
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A Typical Day in the USA

• During a three hour period today
• 684 Americans will experience a TBI (5479/day)
• 17 Americans will die from a TBI (137/day)
• Most of these newly injured Americans will be
• young children
• young adults ages 1825
• elderly adults over age 65
• Vehicle crashes will account for nearly 50 of
  all these TBIs

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In Ohio by Midnight Tonight

• No one will be able to accurately report the
  number of persons who experienced a TBI today due
  to a lack of a TBI registry. However, based on
  national incidence and prevalence statistics, it
  is estimated that
• 30 Ohioans will have suffered a TBI today and
  will be counted as one of the 196,047 other
  Ohioans who are living with long term
  disabilities as a result of a TBI

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• 5 Ohioans will have died today due to a TBI
• 11 Ohioans injured today will be under 22 years
  old
• Statistics compiled by Ohio Legal Rights Service

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National Facts and Figures

• 100/100,000 Annual national rate of TBI
• 272,000 Americans who experience a TBI each
  year
• 52,000 Americans who die due to TBI
• 5,300,000 People in US with long-term
  disabilities as a result of a TBI
• 25 Percent of TBIs classified as moderate
  or severe

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• 30 Percent of individuals with TBI eligible
  for Medicaid
• 1825 Ages when most TBIs occur
• 20 Mortality rate for TBI in USA
• 50 Percent of TBIs related to vehicle crashes
• 34 Percent of all injury deaths in USA due to
  TBI
• 10 Percent of all individuals with disabilities
  in USA who have a TBI
• 20 Percent of individuals with TBI resulting
  from violence-related incidents

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Ohio Information About TBI

• 11,174 Estimated number of new incidences of
  TBI /year in Ohio
• 17.7 Mortality rate for TBI in Ohio in 1996
• 1982 Number of Ohioans who die of TBI each
  year
• 7768 Number of Ohioans who are hospitalized
  each year due to TBI
• 25903330 Number of Ohioans who are disabled
  each year due to TBI

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• 74 Number of Ohioans each year who persist
  in vegetative state due to TBI
• 196,047 Number of people living in Ohio with
  long term disabilities as a result of TBI
• 38 Percentage of individuals who receive a
  TBI prior to age 22
• Statistics compiled by Ohio Legal Rights Service

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Neuropathology of TBI

• The brain is a gelatin-like substance vulnerable
  to outside trauma. The cranium protects the
  brain against trauma, but does not absorb impact
  forces.
• During concussion, the brain rotates and twists
  inside the skull, causing damage to brain tissue

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Two Primary Mechanisms of TBI

• Acceleration/Deceleration Example A quarterback
  falls to the ground and hits the back of his
  head. The falling motion propels the brain
  against the skull.

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Acceleration/Deceleration
from Traumatic Brain Injury, Interactive
Therapeutics, Inc. c.1988, rev. 1999.
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Rotational
Example When a football player is tackled, his
head may strike an opponents knee this contact
to the head can cause a rotational motion.
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Rotational
from Traumatic Brain Injury, Interactive
Therapeutics, Inc.,c.1988 rev. 1999
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Vulnerable Tissues

• Gray Matter of the Brain
• Neurons, residing in the gray matter, are single
  cells that use chemical reactions to create
  electrical currents to carry out activities
• The gray matter is the site of processing,
  integration and memory
• Children are especially vulnerable
• Learning is affected by problems with integration
  and memory

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Vulnerable Tissues

• White Matter of the Brain
• Nerve cells are connected by axons (long
  projections of nerve cells resembling insulated
  wiring) which connect neurons to other neurons

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Functional Impacts of TBI

• Impaired mobility
• Impaired body functions
• Impaired sensory experiences
• Impaired communication
• Impaired cognitive functions

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Functional Impacts of TBI

• The experience, injury, and associated outcomes
  for each TBI survivor are complex and unique.
  Each case must be treated on an individual basis
  viewing and treating the survivor and family (and
  other support persons) based on findings.

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Functional Impacts of TBI

• Impaired Mobility
• Paralysis (partial or full)
• Spasticity
• Balance
• Gait

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Functional Impacts of TBI

• Impaired Body Functions
• Swallowing difficulties
• Temperature control
• Changes control of body functions (bowel and
  bladder, sexual functioning, hunger)

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Functional Impacts of TBI

• Impaired Sensory Experiences
• Vision
• Hearing
• Smell
• Taste
• Touch

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Functional Impacts of TBI

• Impaired Communication
• Speaking
• Expressing thoughts and ideas
• Understanding language
• Decreased everyday use of language

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Speaking Impacts

• A 22 year old male with severe slurring of speech
  and drooling. He is unable to be understood by
  anyone outside his immediate family. He uses a
  word communication book and an electronic device
  to be understood and to use the phone.

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Expressing Thoughts and Ideas

• An 18 year old female with moderate word finding
  and sentence structure problems. Listeners
  require several repeats of the message to
  understand what she intends.

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Understanding Language

• A 17 year old male with injury to the temporal
  lobes needs many repeats, restatements and visual
  aids to understand simple directions and
  comments.

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Decreased Everyday Use of Language

• A 19 year old college freshman has such a
  struggle and is so self-conscious about her
  speech, that she rarely attempts to express her
  thoughts and ideas. She is thought to be aloof.

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Functional Impacts of TBI

• Impaired Cognitive Functions
• Attention/Concentration
• Memory
• Decision making
• Executive functioning
• Organization
• Judgment

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Attention

• A man is unable to complete a task at work in a
  reasonable amount of time. He is distracted by
  the activities and noises around him.

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Memory

• A woman is unable to recall information given to
  her about carpooling plans for the coming week to
  her daughters school.

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Decision Making

• When shopping at a local department store, a man
  is unable to weigh the pros and cons of buying
  one of two expensive tools - and therefore,
  purchases both.

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Executive Functioning

• A woman is unable to plan and structure her day
  at the office and, therefore, completes nothing
  during the day.

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Organization

• A student has difficulty following the class
  schedule of assignments and class attendance. He
  is unable to organize his time and efforts.

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Judgment

• A man went out and bought two cars in the same
  day at different car dealerships. He bought one
  for himself and one for his son. He knew he
  bought two cars, but he was unable to determine
  that he could not afford them.

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Psychological Impacts of TBI

• Depression (survivor, family, friends)
• Lower threshold for frustration
• Anger, tantrums, and mood swings
• Impulsivity and distractibility
• Loss of former identity
• The Invisible Disability

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Invisible Disability

• Many times individuals recover physically, but
  continue to have cognitive problems which are not
  easily recognized by the general public.

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Social Impacts of TBI

• Impact on the family members (parents,
  siblings, caregivers)
• Isolation for the child and family
• Loss of friends and peer support
• Transportation barriers
• Accessibility issues

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Family Needs Feelings

• Difficulty in processing the impact of the
  injury on the family member and the family as a
  whole
• Need to hear information repeatedly
• Need to have written information for later use

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Family Needs Feelings

• Fatigue
• May require respite care
• Isolation
• May benefit from support groups, information
  sources
• Frustration
• May need time alone
• May need the opportunity to vent

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Family Needs Feelings

• Specific service needs for the family and
  survivor
• Refer to Ohio Brain Injury Association, local
  social service agencies, local school district

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Domains of Assessment

• Intellectual
• Attention/Concentration
• Memory
• Language
• Motor
• Behavior
• Family

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Community Reintegration Impacts

• School
• Vocational
• Leisure
• Friends

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SchoolWhen a Child is Injured

• In the hospital
• Keep local school district informed
• Contact hospital social service for assistance
  with insurance, Social Security Disability,
  Medicaid
• Develop a plan for school reintegration while in
  the hospital

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SchoolWhen a Child is Injured

• Reintegration to the community (home and school)
• Developmental issues
• The brain is still developing, therefore, brain
  pathways and connections may or may not occur
• Problems in learning can emerge years later as
  developmental milestones are missed
• Child on achievement tests performs at age level
  after injury but may not demonstrate new learning

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SchoolWhen a Child is Injured

• Academic challenges
• Learning memory, language, integration of
  information, problem solving, organization
• Behavior frustration, intolerance,
  distractibility, impulsivity, attention

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SchoolWhen a Child is Injured

• Reintegration to school
• Establish hospital to school communication
• Contact early
• Contact often
• Transfer records among all facilities
• Include parents in all communication

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SchoolWhen a Child is Injured

• When there are concerns about school planning
• Contact the director of special education in your
  local school district
• Contact one of the 16 Ohio Special Education
  Regional Resource Centers (SERRC) for additional
  information and assistance
• Contact Ohio Resource Center for Low Incidence
  and Severe Handicaps (ORCLISH) for special
  assistance with a severely injured child

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Service Providers Within the Continuum

• Community Integration
• Psychological service providers
• OT, PT, and Speech Pathologist
• Assistive technology specialist
• Special educators

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Service Providers Within the Continuum

• Respite providers
• Transitional housing providers
• Independent Living Center advisors
• Vocational Rehabilitation assessors and
  counselors

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Ohio Resources

• Ohio Brain Injury Association (OBIA)1335 Dublin
  Rd Ste 217DColumbus OH 43215-1000614-481-7100He
  lpline 800-686-9563

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Ohio Resources

• Ohio Brain Injury Program and Advisory
  CommitteeRehabilitation Services Commission400
  E Campus View Blvd SW4Columbus OH
  43235-4604614-438-1340

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Ohio Resources

• There are numerous governmental Ohio State
  Departments that can help. Contact the
  appropriate ones as needed. A list of departments
  and phone numbers is in the handout

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National Resources

• Brain Injury Association (BIA)105 N Alfred
  StAlexandria VA 22314703-236-6000
• Website http//www.biausa.org

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National Resources

• Brain Injury Resource Center8737 Colesville Rd
  Ste 950Silver Spring MD 20910301-650-8080
• Website www.tbigrants.com

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National Resources

• National Information Center for Children and
  Youth with Disabilities (NICHCY)PO Box
  1492Washington DC 20013-1492800-695-0285
• Website http//www.nichcy.org

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Websites of Interest

• http//www.tr.wou.edu/tbi/index.html
• Oregon Teaching Research will provide articles
  and information regarding specific topics in TBI
• http//www.sasquatch.com/tpn/AZHIF.html
• Arizona BIA provides information and referral for
  families

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Websites continued

• http//www.sped.ukans.edu.spedprojects/tbi/TBIHOME
  PAGE.html
• The TBI project is funded by the Kansas State
  Board of Education and provides inservice and
  preservice to educators and related service
  personnel

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Websites continued

• http//www.tbi.pmr.vcr.edu
• This NIDRR TBI model system provides lists of
  experts, answers to frequently asked questions
  and several links to other sites on TBI,
  including one to Virtual Assistive Technology
  Center (free or inexpensive software for people
  with disabilities)