THE ESSENTIAL BRAIN INJURY GUIDE Introduction, Overview & - PDF document

8/25/2017 THE ESSENTIAL BRAIN INJURY GUIDE Introduction, Overview & Etiology Section 1 Director of Brain Injury Presented by: Bonnie Meyers, CRC, CBIST Programs & Alliance of Services Connecticut Certified Brain Injury Specialist Training – October 26 & 27, 2017 This training is being offered Presented by Brain Injury Alliance of Connecticut staff: as part of the Brain Injury Rene Carfi, LCSW, CBIST, Education & Outreach Manager Alliance of Connecticut’s & ongoing commitment to Bonnie Meyers, CRC, CBIST, Director of Programs & Services provide education and outreach about brain injury in an effort to improve services and supports for those affected by brain injury. Contributors Mark J. Ashley, ScD, CCC-SLP, CCM, CBIST Maria Crowley, MA, CRC Kevin E. Crutchfield, MD David Demarest, PhD Mark Huslage, LCSW-C, CBIST Brent E. Masel, MD Emily McDonnell Drew A. Nagele, PsyD Ronald Savage, EdD 1

8/25/2017 Brain Injury Overview Learning Gain an understanding of the causes Be able to distinguish of brain injuries, both Objectives between primary traumatic and and secondary injury non-traumatic Be able to articulate the Be able to describe the effects of brain different patterns injury and injury of brain injury observed severity in specific age groups Know the symptoms clusters of neurologic disorders, neuroendocrine disorders, sexual dysfunction, and musculoskeletal dysfunctions resulting from brain injury TRAUMATIC IMPACT TRAUMATIC INERTIAL ACQUIRED NON-TRAUMATIC Contact Injury Non-Contact Injury BRAIN INJURY Internal Insult Head struck by or against an object Brain moves within skull OPEN PRIMARY Rotatio ional/Ang ngular r Forces Severe Reductions in Blo lood CLOSED (Penetrating) INJU JURY Non-Contact Injury Flow (Non-Penetrating) Skull ll Fr Fracture Hemorrhage Due to Clo lotting MEC ECHANISM Brain moves within skull Meninges Breach FOCAL FOCAL PRIM IMARIL ILY PRIM IMARIL ILY Y DIF IFFU FUSE INJU JURY - OR - - OR - CLA LASSIFICATION FOCAL (MULTIF IFOCAL) L) DIFFU FFUSE DIFFU FFUSE Brain n Cont ntusions ns Epi pidu dural Hematomas Diffuse Axo xona nal Inj njury Brain n Lacerations ns Subdu dural Hematomas White Matter Lesions ns INJU JURY White Matter Lesions ns Intracerebral Intracerebral PATHO-PHYSIOL OLOGY Hemorrhage Hemorrhage Hemorrhage Hemorrhage Diffuse Axo xona nal Inj njury Infections ns Stroke Blast Related Guns nshot Neurotoxi xic Poisoni ning ng Assaults Stabbing ng Falls Hypo poxi xia/Ano noxi xia INJU JURY Falls Falls Vehicular Accident nts CAUSES ES Ischemia Vehicular Accident nts Vehicular Accident nts Sports Accide dents Infection Sports Accide dents Sports Accide dents Tumors 2

8/25/2017 Closed Head Injury Causes of Traumatic Brain Injury Causes of Non-Traumatic Brain Injury • Falls • Stroke (hemorrhage or blood clots) • Assaults • Infectious disease (encephalitis, Motor vehicle crashes meningitis) • Sports and recreation injuries Seizure disorders • • • Shaken baby syndrome/abusive head • Electric shock/lightning strike trauma • Tumors (surgery, radiation, chemo) • Gunshot wounds • Toxic exposures (substance misuse, Workplace injuries ingestion of lead, inhalation of volatile • • Child abuse agents) • Domestic violence • Metabolic disorders (insulin shock, • Military actions (blast injury) diabetic coma, liver and kidney disease) Neurotoxic poisoning (carbon monoxide • poisoning, inhalants, lead exposure) • Lack of oxygen to the brain (near drowning, airway obstruction, strangulation, cardiopulmonary arrest, hypoxia, anoxia) Acquired Brain Injury Causes – Traumatic and Non-traumatic Primary and Secondary Injury 3

8/25/2017 Brain Injury Severity Mild TBI Can have either brief or no loss of consciousness and its presentation may demonstrate vomiting, lethargy, dizziness, and inability to recall what just happened Moderate TBI Will be marked by unconsciousness for any period of time up to 24 hours, will have neurological signs of brain trauma, including skull fractures with contusion or bleeding, and may have focal findings on an electroencephalograph (EEG)/computed tomography (CT) scan Severe TBI Marked by a period of loss of consciousness of 24 hours or greater What Determines the Effects of Brain Injury?  Injury severity  Age at injury  Alcohol misuse  Domestic violence  Service in the military  Participation in sports  Number of brain injuries a person experiences Information about Incidence and Prevalence  TBI is a contributing factor to a third (30.5%) of all injury ‐ related deaths in the US  75% of TBIs that occur each year are mild TBI  An estimated 2.5 million people sustain a TBI yearly  2,214,000 emergency department visits (81%)  284,000 hospitalizations (16%)  53,000 deaths (3%) 4

8/25/2017 Age and Mechanism of Injury Highest Rates of TBI due to Falls by Age Percentage of Children with TBI   Group from Physical Abuse Children 0-4 (50% of all TBIs)  Children 0-3 years old (67%)  Adults 65 or older (61% of all TBIs)  Highest Rates of TBI from Motor  Highest Rates of Death from TBI due to  Vehicle Crashes Falls Adults 20-24 years of age  Adults aged 75 or older  Highest Rates of TBI Related Death  Highest Rates of Death from TBI (All  from Motor Vehicle Crashes Causes) Adults 16-19 years of age  Adults aged 75 or older  At any age, Highest Rates of Death from TBI  males have a (Firearms) higher rate of TBI- Adults Ages 20-24  related death Adults 75 or older  than females Each year, two million to It is estimated that a woman is four million women are beaten every 12 physically abused by seconds in the U.S. someone with whom they are intimate Intimate violence is The head, face and neck the leading cause of serious injury to are the most frequent sites American women of injury between the ages of 15 and 44 Domestic Violence A study found that 67% of women victims of domestic violence also had symptoms associated with brain injury Brain Injury in Prisons A high proportion of the 2 million people currently in U.S. prisons have a brain injury These injuries are not necessarily recognized, diagnosed, or treated Between 25 and 87 percent of inmates report having experienced a TBI, compared with a report rate of 8.5 percent in the general population 5

8/25/2017 Screening for TBI  Brain injury is often undetected in children, sports, the military, and prisons  Thorough screening is important so that appropriate services can be provided Continuum of Care National Accreditation Agencies  Commission for the Accreditation of Rehabilitation Facilities (CARF)  For post-acute BI programs  Residential  Outpatient  Vocational  Home and community programs  Stroke & pediatrics  Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)  For most hospital ‐ based programs  May also have CARF accreditation 6

8/25/2017 Funding Private Funding Public Funding  Auto insurance  Medicaid provides health care for more than 49 million low ‐ income people  Workers compensation insurance  Medicare provides healthcare to 44 million Americans who  Commercial health insurance are blind, aged 65 and older,  HMOs or who have disabilities  PPOs  POSs  Patient Protection and Affordable Care Act (PPACA)  HDPs of 2010 Federal Programs  Rehabilitation Act of 1973  TBI Model Systems -1987  TBI Act of 1996  TBI State Grants  Centers for Disease Control and Prevention (CDC)  Olmstead Decision - 1999  Case management Home and  Homemaker service Community ‐ Based  Home health aide services Waiver Programs  Personal care (HCBS)  Adult day health  Respite care Allows states, with approval, to try new  Habilitation services approaches for delivering health care providing costs  Services for chronic mental illness do not exceed costs of  Other services that help avoid institutional care institutionalization (such as assistive technology, etc.)  7

8/25/2017 Reversing the Silent Epidemic  Current advances have not yet resulted in dramatically increased funding for services, basic research or prevention of brain injury  There is continued need for:  Public health education  Funding to ensure ongoing support and services  Awareness about concussion  Epidemiological data collection  Brain injury screening TBI AS A CHRONIC DISEASE Mortality and Morbidity  Persons with a TBI have a life expectancy reduction.  Individuals surviving a TBI are at increased risk of death.  It is unclear if chronic damage is  Individuals surviving a TBI due to the initial traumatic insult or are at increased risk for progressive secondary injury. certain associated  TBI may reset the cellular timer conditions. and cause early degeneration and death of cells. 8