2007.11.01 ABIN-PA InfoLine 215-699-2139 PARTNERS IN REHABILITATION …. After Brain Injury Adapted with permission from a presentation by the Brain Injury.

2007.11.012007.11.01ABIN-PA InfoLine 215-699-2139 ABIN-PA InfoLine 215-699-2139

PARTNERS IN PARTNERS IN REHABILITATIONREHABILITATION

…. After Brain Injury …. After Brain Injury

Adapted with permission Adapted with permission

from a presentation by the from a presentation by the

Brain Injury Association of New JerseyBrain Injury Association of New Jersey


Acquired Brain Injury Network Acquired Brain Injury Network of Pennsylvaniaof Pennsylvania

Founded in 2007 by survivors and family Founded in 2007 by survivors and family members, ABIN-PA is a statewide members, ABIN-PA is a statewide

organization dedicated to raising public organization dedicated to raising public awareness about acquired brain injury and to awareness about acquired brain injury and to

providing support, education, information, providing support, education, information, advocacy and other services for individuals advocacy and other services for individuals with acquired brain injury and their families.with acquired brain injury and their families.


ABIN-PA Programs & ResourcesABIN-PA Programs & Resources

Staying in TouchStaying in Touch E-List:E-List: frequent emails on brain injury frequent emails on brain injury

and disability topics.and disability topics. Newsletter:Newsletter: free monthly snail-mail on free monthly snail-mail on

organization activities, features.organization activities, features. Website:Website: brochures, PowerPoints, brochures, PowerPoints,

resources, support groupsresources, support groups


Acquired Brain InjuryAcquired Brain Injury

an injury to the brain, an injury to the brain, occurring after birth, occurring after birth, causing cognitive, behavioral or physical causing cognitive, behavioral or physical

changes,changes, But not inherited, congenital, or degenerative. But not inherited, congenital, or degenerative.

Causes include trauma, anoxia, aneurysm, brain Causes include trauma, anoxia, aneurysm, brain infection, stroke, drugs, and brain tumors.infection, stroke, drugs, and brain tumors.


Traumatic Brain InjuryTraumatic Brain Injury an injury to the brain, an injury to the brain, occurring after birth,occurring after birth, due to an external force, due to an external force, causing cognitive, behavioral or physical causing cognitive, behavioral or physical

changes, changes, not inherited, congenital, or degenerative.not inherited, congenital, or degenerative.

Causes include motor vehicle crashes, falls, Causes include motor vehicle crashes, falls, sports injuries, assaults, and blast injuries. sports injuries, assaults, and blast injuries.


““The Silent Epidemic”The Silent Epidemic”

5.3 million5.3 million Americans Americans

PLUS 400,000 veterans PLUS 400,000 veterans returning home with brain injury from returning home with brain injury from

Afghanistan and Iraq.Afghanistan and Iraq.


Each Year in PennsylvaniaEach Year in Pennsylvania

2,0002,000 TBI fatalities TBI fatalities 7,8007,800 hospitalized for TBI hospitalized for TBI 41,00041,000 TBI emergency room visits TBI emergency room visits


Changes Over the YearsChanges Over the Years

30 years ago –30 years ago –

50% of those with a 50% of those with a TBI died as a result TBI died as a result

of the injury.of the injury.

Today –Today –

22% die as a result 22% die as a result of TBI of TBI..


Brain Lobes & Functions Brain Lobes & Functions


Frontal LobesFrontal Lobes

PlanningPlanning OrganizationOrganization Problem solvingProblem solving ReasoningReasoning Emotions Emotions Motor skills. Motor skills.


Parietal LobesParietal Lobes

Process incoming information such as Process incoming information such as being touched, hearing, seeing being touched, hearing, seeing


Temporal LobesTemporal Lobes

Manage auditory processing, attaching Manage auditory processing, attaching meaning to sounds that are heard. meaning to sounds that are heard.


Occipital LobesOccipital Lobes

Provide meaning to what is seen. Provide meaning to what is seen.


Brain StemBrain Stem

Regulates life-sustaining functions such as Regulates life-sustaining functions such as blood pressure, heart rate, breathing and blood pressure, heart rate, breathing and body temperature. body temperature.

Damage could result in an altered state of Damage could result in an altered state of consciousness, such as coma.consciousness, such as coma.


CerebellumCerebellum

Responsible for muscle coordination Responsible for muscle coordination Responsible for balance Responsible for balance


Mild Brain InjuryMild Brain Injury

Perhaps brief loss of consciousness, Perhaps brief loss of consciousness,

maybe a few seconds or minutes.maybe a few seconds or minutes. Survivor may be dazed or confused.Survivor may be dazed or confused. Permanent physical, cognitive, and/or Permanent physical, cognitive, and/or

behavioral impairments may or may not behavioral impairments may or may not occur. occur.

Testing or brain scans may appear Testing or brain scans may appear normal.normal.


Moderate Brain InjuryModerate Brain Injury

Loss of consciousness from minutes to a day.Loss of consciousness from minutes to a day. Confusion lasts days, weeks or longer.Confusion lasts days, weeks or longer. Permanent physical, cognitive, and/or behavioral Permanent physical, cognitive, and/or behavioral

impairments may or may not occur. impairments may or may not occur. Testing or brain scans may appear normal.Testing or brain scans may appear normal.


Severe Brain InjurySevere Brain Injury

Unconscious state or coma lasts days to Unconscious state or coma lasts days to months. months.

Survivors may improve greatly, but are often left Survivors may improve greatly, but are often left with permanent physical, cognitive, or behavioral with permanent physical, cognitive, or behavioral impairments.impairments.


Severity vs. OutcomeSeverity vs. Outcome

Severity does not predict outcome. Severity does not predict outcome. A mild brain injury may cause difficulties A mild brain injury may cause difficulties

for years while a severe brain injury may for years while a severe brain injury may improve greatly over time. improve greatly over time.


Effect on Survivor Effect on Survivor

I feel like a stranger on an alien planet with I feel like a stranger on an alien planet with unfamiliar language and customs. unfamiliar language and customs.

I feel that I am buried alive. I feel that I am buried alive. I don’t know who I am or who I was. I don’t know who I am or who I was. I feel totally alone because I don’t I feel totally alone because I don’t

recognize faces or remember my friends recognize faces or remember my friends or family. or family.


Reaction of Survivors Reaction of Survivors

Nothing has happened. Nothing has happened. I don’t need or want help. I don’t need or want help. I will be back to my old life in a few days, I will be back to my old life in a few days,

weeks, or months. weeks, or months. No sense of time, day/night, weekday vs. No sense of time, day/night, weekday vs.

weekend, holidays, weather. weekend, holidays, weather. May misread situations and react too May misread situations and react too

slowly, too little or too strongly. slowly, too little or too strongly.


Brain Injury & FamiliesBrain Injury & Families

ParentsParents SiblingsSiblings SpouseSpouse Child Child

Roles and responsibilities of family members Roles and responsibilities of family members may change. Changes in a loved one can may change. Changes in a loved one can

be so drastic that it seems a stranger be so drastic that it seems a stranger came home from the hospital. came home from the hospital.


Grief & Loss Grief & Loss for the Survivorfor the Survivor

identity, self-esteemidentity, self-esteem self-control, independenceself-control, independence expression/communicationexpression/communication relationships, mobilityrelationships, mobility vocational/career, productivityvocational/career, productivity income and assets.income and assets.


Grief & Loss Grief & Loss for the Familyfor the Family

RelationshipRelationship Future dreams for the loved oneFuture dreams for the loved one Responsibilities as caregiverResponsibilities as caregiver Personal freedomPersonal freedom Lifestyle, income and assets.Lifestyle, income and assets.


Stages of Grief Stages of Grief

DenialDenial AngerAnger BargainingBargaining DepressionDepression AcceptanceAcceptance


Cognitive ConsequencesCognitive Consequences

MemoryMemory

PersistencePersistence

Decision makingDecision making

OrganizationOrganization

PlanningPlanning

Self-perceptionSelf-perception

AttentionAttention

ThinkingThinking Problem solvingProblem solving SequencingSequencing PerceptionPerception JudgmentJudgment

InflexibilityInflexibility Processing speedProcessing speed ConcentrationConcentration


Physical ConsequencesPhysical Consequences

SeizuresSeizures Muscle spasticityMuscle spasticity FatigueFatigue HeadachesHeadaches Balance problemsBalance problems Speech difficultiesSpeech difficulties

Visual difficultiesVisual difficulties Hemiparesis (paralysis)Hemiparesis (paralysis)


Emotional/Behavioral Emotional/Behavioral ConsequencesConsequences

DepressionDepression AnxietyAnxiety Mood swingsMood swings ImpulsivityImpulsivity IrritabilityIrritability

Social withdrawalSocial withdrawal AggressionAggression Lack of motivationLack of motivation Egocentric behaviorsEgocentric behaviors Lack of self-awarenessLack of self-awareness Inappropriate behavior Inappropriate behavior

and/or languageand/or language Sexual dysfunctionSexual dysfunction Feelings of lonelinessFeelings of loneliness


Strategy: StructureStrategy: Structure

Schedule.Schedule. Organized environment.Organized environment. Calendars, notebooks, wall charts, and visual Calendars, notebooks, wall charts, and visual

aids (but too much information will overwhelm).aids (but too much information will overwhelm).


Strategy: Consistency & RepetitionStrategy: Consistency & Repetition

Be consistent in what you do Be consistent in what you do Be consistent in what you expect Be consistent in what you expect Model the behavior you expect Model the behavior you expect Promote calm through predictability. Promote calm through predictability. Use frequent repetition for new tasks. Use frequent repetition for new tasks.


Strategy: Break Down TasksStrategy: Break Down Tasks

For every task, small steps with frequent For every task, small steps with frequent breaks. breaks.

Expecting large projects to be completed all Expecting large projects to be completed all at once is a prescription for failure.at once is a prescription for failure.


Strategy: Minimize DistractionsStrategy: Minimize Distractions

Remove distractions to minimize Remove distractions to minimize overstimulation and cognitive overload.overstimulation and cognitive overload.


Strategy: Proactive PlanningStrategy: Proactive Planning

FEELINGS: hungry, tired, ill, confusedFEELINGS: hungry, tired, ill, confused EVENTS: changes in routine, dealing with EVENTS: changes in routine, dealing with

difficult tasks or individualsdifficult tasks or individuals SIGNALS: facial expressions, body language, SIGNALS: facial expressions, body language,

choice of words, sighingchoice of words, sighing


Possible Stress RelieversPossible Stress Relievers

eatingeating closing your eyesclosing your eyes

resting resting taking deep breathstaking deep breaths

getting a huggetting a hug readingreading

TVTV taking a walktaking a walk

playing solitaireplaying solitaire taking a showertaking a shower

YESYES SometimesSometimes

NONO Don’t Don’t know!know!


Make An Action Plan Make An Action Plan

Plan together to minimize stress – an advance Plan together to minimize stress – an advance plan will help everyone to remain calm.plan will help everyone to remain calm.

Seek suggestions from others when needed. Seek suggestions from others when needed.


Build ResilienceBuild Resilience

Activities prevent boredomActivities prevent boredom Social connections prevent social isolationSocial connections prevent social isolation Independence creates self-esteemIndependence creates self-esteem Positive coaching builds successPositive coaching builds success Rewards emphasize achievementsRewards emphasize achievements Understand that everyone may be doing their Understand that everyone may be doing their

best very in difficult circumstancesbest very in difficult circumstances


Emphasize IndependenceEmphasize Independence

““Family members or caregivers should let Family members or caregivers should let the recovering TBI survivor burn dinner the recovering TBI survivor burn dinner

every night if necessary but step in if the every night if necessary but step in if the house is burning down.” – Claudia Osbornhouse is burning down.” – Claudia Osborn

Encourage responsibility with help. Encourage responsibility with help.


Planning for SuccessPlanning for Success

Every individual is different, every injury is Every individual is different, every injury is unique, and improvement is gradual. unique, and improvement is gradual.

Work with current abilities and limitations.Work with current abilities and limitations. Focus on helping with goals. Focus on helping with goals. Model calm behaviors. Model calm behaviors. Help with reasoning. Help with reasoning.

Acquired Brain Injury Acquired Brain Injury Network of Network of

Pennsylvania, Inc.Pennsylvania, Inc. InfoLine 215-699-2139InfoLine 215-699-2139

www.abin-pa.orgwww.abin-pa.org

[email protected]@abin-pa.org

2007.11.01 ABIN-PA InfoLine 215-699-2139 PARTNERS IN REHABILITATION …. After Brain Injury Adapted with permission from a presentation by the Brain Injury.

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