Traumatic Brain Injury

Timothy R. Elliott, Ph.D.

5.3 million Americans (just over 2% of
the population) currently live with a
disability resulting from a TBI
1.5 million people sustain an TBI each
year
50,000 die due to TBI each year
Every 21 seconds a person in the US
sustains an TBI
TBI facts
an injury to the brain, occurring after
birth.not hereditary, congenital,
degenerative, or induced by birth
trauma
commonly results in a change in
neuronal activity, which affects the
physical integrity, the metabolic activity,
or the functional ability
an acquired brain injury
May result in mild, moderate, or severe
impairments in one or more areas
Injuries can range from very mild to very
severe, and depending on the location
of the brain injury, impairments may
include .
Levels of Injury
Closed head injury
occurs when an outside force impacts the
head hard enough to cause the brain to
move within the skull
Open head injury
can occur from motor vehicle crashes, gun
shot wounds, falls, shaking (a baby),
sports, and physical violence, such as
hitting or striking with an object

Types of brain injury
Airway obstruction
Near-drowning, throat swelling, choking,
strangulation, crush injuries to the chest
Electrical shock or lightening strike
Trauma to the head and/or neck
Traumatic brain injury with or without skull
fracture, blood loss from open wounds, artery
impingement from forceful impact, shock
Vascular Disruption
Causes of brain injury
Lack of coordination
Slowness or confusion in the planning and
sequencing of movements
Muscle spasticity
Speech disorders
Seizures, paralysis
Chronic, persistent pain (nerve damage,
fractures)
Sensory impairments (e.g., vision and
hearing loss
Impairments may include
Mood swings
Depression, blunted affect
Lack of motivation, decreased initiative
Agitation
Impulse control
Interpersonal difficulties, impaired
empathy
Social, emotional, and
behavioral impairments
Short and/or long term memory loss
Poor attention, judgment, and
concentration
Communication disorders related to
speech, writing, and reading
Cognitive impairments
Closed head injury
occurs when an outside force impacts the
head hard enough to cause the brain to
move within the skull
Open head injury
can occur from motor vehicle crashes, gun
shot wounds, falls, shaking (a baby),
sports, and physical violence, such as
hitting or striking with an object

Types of brain injury
Severity loss of consciousness
Posttraumatic Amnesia

Glasgow Coma Scale
Mild scores 13 15
Moderate scores 9 12
Severe < 8
Gross predictor of outcomes at 6 months

Post-Concussive Syndrome
History of head trauma
Evidence of difficulty in attention or memory
Significant impairment in role functioning
Three of these
Fatigue, disordered sleep, headache,
anxiety/depression, apathy, change in personality,
irritability/aggression, vertigo or dizziness
Veterans and ABI
By some estimates, as many as 10% of the
1.5 million soldiers may have some form of
traumatic brain injury
Over 60% of soldiers recently wounded in
action in Operation Iraqi Freedom sustained
blast injuries
Perhaps 60% and 80% of these blast-injured
soldiers have TBI
Veterans and ABI
The average age of a soldier stationed
in Iraq and Afghanistan is 19 years old
Estimating conservatively, the cost
of caring for veterans with TBI from
these wars could be $14 billion over 20
years, and $35 billion over their lifetimes
A brain injury is unpredictable
A person with a brain injury is a person first
No two brain injuries are exactly the same
The effects are complex and vary greatly from
person to person
The effects may depend on such factors as
cause, location, and severity
Rehabilitation Strategies
Compensatory
Written instructions, date books, calendars,
pagers, electronic or other assistive devices
Restoration
visual & auditory exercises, practice/performance,
reinforcement, monitoring, problem-solving
strategies, goal setting

Indicators of Adjustment
Severity of injury
Pre-injury personal and social
adjustment
Social support structures (e.g., family,
church, work history)

Health and Adjustment
Normal life expectancy
People with ABI generally have a
greater propensity towards poor health
habits as well as having poor health
profiles
At risk for secondary complications
including social (e.g., poverty, arrests)

Health-risk behaviors
Smoking
Alcohol misuse
Dietary problems or habits
Lack of exercise, Prolonged inactivity
Sedentary lifestyle
Obesity
Medications that may be debilitating over time
Indifference, lack of initiation
Negative moods


An Agenda for Public Health
Healthy People 2010 calls for
behavioral and social initiatives to
promote the health and quality of life of
persons with traumatic brain injury
Benefits of Exercise and Healthy
Lifestyles
Improved stamina and strength
Enhanced mood management
Sense of confidence, competence
Possible benefits to sense of balance
Weight management, improved cardio
fitness

Benefits of a Stretching Program

Increased range of motion
For some, there will be an increase in
muscular strength
Promoted relaxation
Stretched muscle tissue, flexibility
Positive effects on balance


Benefits of a Strength Program

Increased muscle endurance
Reduction of body fat
Increased metabolic rate
Increased body awareness




Benefits of a Cardiovascular
Program

Reduction of specific risk factors for
conditions (e.g., heart disease, stroke)
Increased cardio efficiency
More calories burned (weight loss)
Improved circulation
Decreased harmful cholesterol




Recreation and Leisure Benefits
Brainstorming activities

Online Resources




http://www.braininjuryresources.org/rec_hobbies.html

http://www.birf.info/home/library/recreation/rec-fitness.html

http://www.bobwoodrufffamilyfund.org/about_brain_injury.shtml

http://www.biausa.org/