BRAIN INJURY

BASICS
No Brain Injury is Too
Mild to Ignore,
Or Too Severe to
Lose Hope
 What is brain injury?
Brain injury is often defined as either a
Traumatic Brain Injury (TBI)
OR
Acquired Brain Injury (ABI)

Family Helpline: 1-800-669-4323

 Traumatic Brain Injury
Traumatic Brain Injury (TBI) is an insult to the brain
caused by an external force that may produce a
diminished or altered state of consciousness.

Causes of TBI can include motor vehicle crashes, falls,

sports injuries, assaults, blast injuries.

Family Helpline: 1-800-669-4323

 Acquired Brain Injury
Acquired Brain Injury (ABI) is an injury to the brain
which is not hereditary, congenital or degenerative
and has occurred after birth.

Causes of ABI include anoxia, aneurysms, infections to

the brain, stroke, brain tumors.

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 The Silent Epidemic
It is estimated that
5.3 million Americans
live with a disability as a result of brain
injury.

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 TBI in the
United States 50,000 Average annual
numbers, 1995-2000
Deaths

235,000
Hospitalizations

1,111,000
Emergency Department Visits

?? Receiving Other Medical Care or No Care ??

From the 2004 CDC Report: TBI in the United Sates: ED Visits, Hospitalizations and Deaths

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 Traumatic Brain Injury
in New Jersey
Approximately 8,000 adults and children
each year are hospitalized or die as a
result of a traumatic brain injury.

More than 20,000 people are treated

each year in doctor offices or emergency
rooms for TBI.*
* Conservatively extrapolated from national data

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 Traumatic & Acquired Brain
Injury in New Jersey
Although the cause of injury differs, many
programs and services for people with brain
injury serve both TBI & ABI.

For example, the TBI Medicaid Waiver & TBI Fund

both serve individuals with TBI & ABI.

Family Helpline: 1-800-669-4323

 Changes Over the Years
30 years ago
50% of persons with a
brain injury died as
a result of the injury.

Today
22% die as a result
of injury.

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 Functions of the Brain
The best way to
understand the affect
of injury to the brain
is to understand the
function of each area
of the brain and
related systems
and
structures.

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 Brain Stem
The brain stem,
located at the base of the skull,
is responsible for life-sustaining functions such as
regulation of blood pressure, heart rate, breathing
and body temperature.

Damage to the brain stem could result in an altered

state of consciousness, such as coma.

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 Cerebellum
The cerebellum,
located behind the brain stem,
is responsible for muscle coordination and
balance.

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 Occipital Lobe
The occipital lobes,
located at the back of your brain,
is the visual processing center in the brain.

Damage to these areas may result in neurological

visual impairment.

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 Temporal Lobes
The temporal lobes
lie at the sides of the brain and are the
auditory (hearing) processing system of
the brain.

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 Parietal Lobes
The parietal lobes,
located above your occipital lobes,
controls the way your brain responds to
information it receives, including visual, auditory
and physical information.

For example,
being touched, loud noises, bright lights.

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 Frontal Lobes
The frontal lobes,
located in the front of your brain,
control the processes of
planning, organization, problem solving,
reasoning, emotions and motor skills.

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 Severity of Injury
Sometimes, a brain injury is categorized in
one of the following three ways:
Mild Brain Injury
Moderate Brain Injury
Severe Brain Injury.

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 Mild Brain Injury
Not Just A Bump On The Head!

Loss of consciousness does not have to occur

the person may be dazed or confused
If loss of consciousness occurs, it is very brief,
usually a few seconds or minutes
A concussion is considered a mild brain injury
Testing or scans of the brain may appear normal

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 Moderate Brain Injury
A loss of consciousness lasts from a few
minutes to a few hours
Confusion lasts from days to weeks
Physical, cognitive, and/or behavioral
impairments last for months or are permanent.

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 Severe Brain Injury
Severe brain injury occurs when a prolonged
unconscious state or coma lasts days, weeks, or
months.
Persons who sustain a severe brain injury can
make significant improvements, but are often left
with permanent physical, cognitive, or behavioral
impairments.

Family Helpline: 1-800-669-4323

 Severity of Injury
Severity of injury does not guarantee outcome.
Persons who sustain a mild brain injury may have
ongoing difficulties for years to come and
persons with a severe brain injury may make
marked improvements over time.

Every brain injury is unique.

Family Helpline: 1-800-669-4323

 Brain Injury & Families
Just as each brain injury is unique, brain injury will
affect each family differently.

Brain injury often changes the roles and

responsibilities of family members. The change
can be so drastic it can be similar to bringing a
stranger home from the hospital with you.

Family Helpline: 1-800-669-4323

 Parental Relationships
Parents of children, adolescents, and adults
with brain injury may become lifelong
caregivers of their sons and daughters.

Family Helpline: 1-800-669-4323

 Sibling Relationships
Siblings live with the consequences of having a
sibling with a disability.
They may receive less attention from parents and
may take on a lifelong responsibility of worrying
and caregiving.

Family Helpline: 1-800-669-4323

 Spousal Relationships
A spouses relationship may shift mildly or
drastically from one of partner to one of
caregiver.

Family Helpline: 1-800-669-4323

 Child-Parent Relationships
The child of a parent with a brain injury may
experience a role reversal.
They may end up caring for their parent early in
their lives, and receive less attention from the
parent providing caregiving.

Family Helpline: 1-800-669-4323

 Grief & Loss
for the Individual

Potential loss of identity, self-esteem, self-control,

expression/communication, independence,
relationships, mobility, vocational/career identity,
productivity, income and assets.

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 Grief & Loss
for the Family
Potential change in relationships, dreams for
loved one, responsibilities as caregiver,
personal freedom, lifestyle, income and
assets.

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 Stages of Grief
There are several stages of grief that are
common following a brain injury that both
people with brain injury and family
members go through.

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 Stages of Grief
Denial
Anger
Bargaining
Depression
Acceptance

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 Denial
After a terrible experience, a person may act
as if it did not happen.

This could not have happened to me.

Shell be her old self again soon.

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 Anger

Once the person accepts that the event

occurred, anger and frustration are the next
emotions.
The anger can be directed at doctors, family,
friends, God, and even at self.

The doctor doesnt know anything.

No one is helpful.
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 Bargaining
Trying to make deals.

Ill be a perfect person if my son is able to

be normal again.
I will never do ____ again if you let me
return to my old self.

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 Depression
This is a very difficult and painful stage of
recovery for both people with brain injury
and family members.

Whats the use? Nothing will ever be the

same again.
Why bother with rehab?

Family Helpline: 1-800-669-4323

 Acceptance
As time passes, individuals and families can
come to accept the changes that have
taken place.

Nothing can make life as it was before, but

life can be new and worthwhile.

Family Helpline: 1-800-669-4323

 Living With Brain Injury

Brain injury will affect each individual differently,

but there are many common consequences.

The following consequences and strategies are

offered to help both you and your loved one
cope with brain injury.

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 Cognitive Consequences
Difficulty with...
Memory
Thinking
Problem solving
Persistence
Sequencing
Decision making Perception
Judgment
Organization Inflexibility
Planning Processing speed
Self-perception Concentration
Attention

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 Physical Consequences

Seizures Visual difficulties

Muscle spasticity Hemiparesis (paralysis)
Fatigue
Headaches
Balance problems
Speech difficulties

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 Emotional/Behavioral
Consequences
Anxiety Lack of motivation
Depression Egocentric behaviors
Mood swings
Lack of self-awareness
Impulsivity
Inappropriate behavior
and/or language
Irritability Sexual dysfunction
Social withdrawal Feelings of loneliness
Aggression

Family Helpline: 1-800-669-4323

 Strategies for
Living with Brain Injury
One of the most important things family
members can do is establish structure,
consistency, and repetition in their family
members routine.

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 Structure, Consistency &
Repetition
Establish a schedule.
Keep your family members environment
organized.
Utilize calendars, notebooks, wall charts, and
visual aids as reminders, but be careful not to
overstimulate with too much information.

Family Helpline: 1-800-669-4323

 Structure, Consistency &
Repetition
Remain consistent in what you do and what your
expectations are (for example, always remaining
a model of calm behavior during outbursts)
Repetition will provide a feeling of safety, and be
the key to new learning for your family member.

Family Helpline: 1-800-669-4323

 Breaking Down Tasks
It is always best to break tasks into steps, whether
it be completing paperwork for Social Security
Disability or preparing a meal.

Expecting large projects to be completed all at

once will be setting your family member and
yourself up for failure.

Family Helpline: 1-800-669-4323

 Minimizing Distractions
Providing as much of a distraction free
environment as possible will minimize
overstimulation and cognitive overload.

Family Helpline: 1-800-669-4323

 Anticipating Stressful Events
Anticipate situations that may be stressful for your
family members, and try to avoid or minimize the
stress.

For example, large family gatherings could be

overwhelming and trips to the store when they
are crowded and noisy could be cognitively
overwhelming.

Family Helpline: 1-800-669-4323

 Watch for Depression
Signs of depression to watch for include:
Changes in eating habits
Changes in sleeping habits
Remarks about the futility of life
Dwelling on the past
Excessive time spent in non-active ways
like watching too much television

Family Helpline: 1-800-669-4323

 Behavioral Challenges
An estimated 90% of all people who are severely
disabled by a brain injury may experience some
related emotional, behavioral or psychiatric
problems.

40% of these individuals still have behavioral

issues 5 years after the injury.*
*Brain Injury Association of America

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 Behavioral Challenges
Individuals with milder brain injuries can also
experience behavioral challenges, including
mood changes, irritability and fatigue, which
might be more difficult to identify as being
related to the brain injury.

Family Helpline: 1-800-669-4323

 Behavioral Challenges
Behavioral challenges can range from mild
personality changes to persistent difficulty
controlling emotions, lack of inhibition,
managing ones behavior, and even violent
outbursts.

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 Behavioral Challenges
Behavioral problems can cause:

Marital discord
Problems with social relationships
Family difficulties
School or workplace problems

And should never be ignored

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 Behavioral Challenges
There are professionals who can assist with
behavioral problems, including:
Neuropsychologists: expertise in assessing
the relationships between the brain, behavior
and cognition

Neuropsychiatrists: can prescribe medications

that affect mood, thinking and behavior

Family Helpline: 1-800-669-4323

 Behavioral Challenges:
Tips for Families
Identify stress relievers (taking deep breaths,
removing the person from the aggravating
environment)
Learn to recognize when behaviors will occur
(when someone is tired, ill, overwhelmed)

Family Helpline: 1-800-669-4323

 Behavioral Challenges:
Tips for Families
Identify specific triggers or events (changes in
routine, dealing with difficult tasks or people)
Identify triggers that your family member is
becoming upset (facial expressions, body
language)

Family Helpline: 1-800-669-4323

 Behavioral Challenges:
Tips for Families
Identify a plan for when behaviors happen
having a plan will help to ease your stress, as
well as your family members stress
Know when to seek the help of a professional
you dont have to do it all yourself

Family Helpline: 1-800-669-4323

 Behavioral Challenges:
Things to Remember
Remain involved in activities to avoid social
isolation
Allow for independence
Coach, encourage and reinforce positive
behavior
Understand the person may be doing their best
to control the behavior

Family Helpline: 1-800-669-4323

 Support Systems
Develop a support system for your family member,
and avoid social isolation.

This could include family, friends, support groups,

a mentor, a local church group, social and
recreational groups in the community, your local
Independent Living Center.

Family Helpline: 1-800-669-4323

 Getting Involved
Daily activities like returning to work,
volunteering, taking a class, and
participating in community activities will
not only provide a structured routine, but
will also increase your family members
self-esteem and avoid social isolation.

Family Helpline: 1-800-669-4323

 Independence
Family members or caregivers should let the
recovering TBI survivor burn dinner every
night if necessary but step in if the house is
burning down. Claudia Osborn

Be cautious that caregiving allows for the

opportunity to be independent and make
mistakes.
Family Helpline: 1-800-669-4323
 Things to Remember
Every individual is different, and every
injury is unique.
Get to know your family members abilities, not
just their limitations.
Listen to your family member.
Treat them in an age appropriate manner.

Family Helpline: 1-800-669-4323

 Things to Remember

Everyone needs to have control over

their own life.

Without such control, dissatisfaction,

frustration, resentment and depression are
likely to occur.

Family Helpline: 1-800-669-4323

 Tips for Caregivers
Take care of yourself, you will need to sleep
and eat to maintain your strength and well-
being.

Family Helpline: 1-800-669-4323

 Tips for Caregivers
Delegate responsibilities like household
chores, staying with your loved one,
running errands.

Friends and family often want to help, but

dont know what to do.

Family Helpline: 1-800-669-4323

 Emotional Support
Make sure you have someone to express your
emotions to, accompany you to appointments,
have fun with.

You do not always have to be strong and you can

accept help. Utilize friends, family, advocates to
support you and your loved one.

Family Helpline: 1-800-669-4323

 Become an Advocate
Learn about brain injury, question the rehabilitation
team, be involved, obtain articles, books, and
videos to help you learn.

You will often have to educate those around you

about brain injury. Being an advocate and
asking for help will ease this burden.

Family Helpline: 1-800-669-4323