- 1.Roger N. Braden, Esq., R.N. Chairman of Annual Northern
Kentucky Traumatic Brain Injury Conference Braden and Associates,
LLC 7000 Houston Road, Suite 36, Florence, KY 41042-4873
[email protected] http://www.bradenlawfirm.com/
2. What is the Brain? 3. Centers for Disease Control and
Prevention Dept. of Health and Human Services Childrens Health Act
of 2000 4. Centers for Disease Control Brain Injuries in the U.S.
An estimated 1.5 million people sustain a TBI annually. (2001) 5.3
Million currently living in the U.S. with TBI 5. Brain Injuries in
the U.S. 2 million seen annually in ER for TBI 25% admitted (2005)
A TBI occurs every 7 seconds A TBI related death occurs every 5
minutes 200,000 people are killed or injured annually 80,000
Americans experience onset of long-term disability from TBI 50,000+
die annually from TBI 75% are mild TBI 6. Brain Injuries in Ohio
Ohio does not currently have a TBI tracking system in place
Estimated 118,760 live with residual effects of TBI 7,300+
hospitalized annually 142% increase in sports/recreation related
TBIs over a 7 year period in 18 and younger March 2011 House Bill
143 7. Brain Injuries in Kentucky Approximately 212,000 to 250,000
Kentuckians live with TBI Kentuckys TBI rate is twice the national
average 1 in 5 households affected by TBI #1 killer based on
population 8. Brain Injuries in Indiana Over 150,000 living with
TBI 6,100 injuries occur annually 9. Chronic Traumatic
Encephalopathy Progressive degenerative disease found in
individuals who have been subjected to multiple concussions and
other forms of head injury Dementia pugilistica (boxing)
Degeneration of tissue and accumulation of tau protein Memory loss,
aggression, confusion and depression - within months to decades
later Chris Henry July 2010 10. ABI vs. TBI Acquired Brain Injury
Sustained during ones lifetime Includes stroke, trauma or tumor
Excludes neuro-degenerative disorders and brain injuries sustained
at birth Traumatic Brain Injury Caused by external force Can
involve damage to scalp and skull Falls, accidents, violence 11.
Shaken Baby Syndrome (Pediatric Abusive Head Trauma) Form of child
abuse Generally diagnosed from a triad of symptoms: Retina
hemorrhage Subdural hematoma Brain swelling In majority of cases -
no signs of external trauma Estimated death rates in infants - 15%
to 38% Usual mechanism of injury - rotational acceleration of the
head 12. Shaken Baby Syndrome From 2001 - 2005: 8-10 children in
Ohio died each year 150 children are seriously injured Ohio -
Claires Law - ORC 3701.63, 11/30/2007 OHIO DEPARTMENT OF HEALTH
SHAKEN BABY SYNDROME PROGRAM 246 N. HIGH STREET COLUMBUS, OHIO
614-728-0773 FAX: 614-564-2442 [email protected] 13. Shaken Baby
Syndrome Kentucky HB 285 (May 27, 2010) Nationally Sarah Jane Brain
Foundation 339 Fifth Avenue, Suite 405 New York, NY 10016 (212)
576-1180 [email protected] 14. Military/Veterans U.S.
MILITARY CASUALTY STATISTICS: OPERATION NEW DAWN, OPERATION IRAQI
FREEDOM, AND OPERATION ENDURING FREEDOM, Congressional Research
Service, September 28, 2010 TBI signature injury for Iraq and
Afghanistan wars TBI cases in military from 2000 to part of 2010 -
178,876 300,000 have suffered concussions 15. Age Groups Age groups
most likely to sustain a TBI: - Children 0-4 years - Adolescents
15-19 years - Adults 65 years and older Males twice as likely as
females to have TBI Males 15 to 24 have highest rate of TBI 16.
Injury Categories Motor vehicle accidents - 44% Falls 26% #1 cause
of TBI in ages 1-4 and 65 and over Assaults and firearms - 17%
Sports and recreation - 13% 17. Prison Statistics More than
2,000,000 people in U.S. prisons and jails 25-87% of prisoners have
history of TBI TBI experience mental health problems Female inmates
convicted of a violent crime are more likely to have suffered TBI
prior to committing crime 18. Disability/Medical Costs $73.7
billion in 2010 for stroke-related medical costs and disability
$60.0 billion in 2000 for medical and disability-related costs for
TBI 19. Types of Brain Injuries Severe traumatic brain injury GCS
score 3-8 Rancho los Amigos scale Think life care planner! 20.
Types of Brain Injuries Moderate Brain Injury Length of stay at
least 48 hours GCS score 9-12 or higher Operative cranial lesion
Abnormal findings Think life care planner! 21. Types of Brain
Injuries Mild Brain injury An injury to the head as a result of
blunt trauma or acceleration or deceleration forces that result in
one or more of the following conditions that are observed or
self-reported: Transient confusion, disorientation, or impaired
consciousness; Dysfunction of memory around the time of injury;
Loss of consciousness lasting less than 30 seconds 22. Mild
Traumatic Brain Injury TBI - The Silent epidemic Accounts for at
least 75% of all TBIs in the U.S. Can cause long-term or permanent
impairments and disabilities Difficulty returning to work to
routine, daily activities and may be unable to return to work for
many weeks or months Costs the nation nearly $17 billion annually
23. Post Concussive Syndrome Misleading Affected individuals need
not have suffered a loss of consciousness No criteria in the
etiology of post concussive syndrome 24. Polytrauma/Disease
Multiple trauma Psychological processes/illness Behavior risk
factors Pre-existing conditions 25. From Bone to Brain Skull upper
/ lower Cerebrospinal fluid maintains uniform pressure within brain
and spinal cord Meninges Arachnoid Dura mater Pia mater 26. From
Bone to Brain Subdural Hematoma Under dia mater of between dura
mater and arachnoid Epidural Hematoma Outside dura mater
Subarachnoid Hemorrhage Under arachnoid Cerebro-vascular Involves
cerebrum and blood vessels supplying it 27. Knowing the Brains
Anatomy Frontal lobe Planning, organizing, problem solving,
selective attention, personality and higher cognitive functions
including behavior and emotions 28. Knowing the Brains Anatomy
Parietal Lobe (2) Controls sensation, touch, pressure, judg ment of
texture, weight, size, shape Right side damage may cause
visuo-spatial deficits Left side damage may interrupt persons
ability to understand spoken/written language 29. Knowing the
Brains Anatomy Temporal lobe (2) Distinguishes different smells and
sounds; sorts new information; major role in short-term memory
Right side injury may cause issues with visual memory (people,
photographs) Left side injury may case issues with verbal memory
(recalling names, certain words, phrases) 30. Knowing the Brains
Anatomy Occipital lobe Process visual information, colors, shapes
31. Knowing the Brains Anatomy Cerebellum Coordinates movement,
balance and muscle coordination Damage may result in ataxia and can
interfere with a persons ability to walk, talk, eat and perform
self care tasks 32. Knowing the Brains Anatomy Brain stem Connects
brain to spinal cord Neurological functions include those necessary
for survival (breathing, digestion, heart rate, blood pressure) and
for arousal (awake and alert) Most cranial nerves come from the
brainstem Pathway for all fiber tracts passing up and down from the
peripheral nerves and spinal cord to the highest part of the brain
33. Knowing the Brains Physiology Neurons - cells that constitute
nerve tissue; Have the property of transmitting and receiving nerve
impulses Dendrites - branching protoplasmic processes that conduct
impulses toward the body of a nerve cell Glial cells - does not
conduct electrical impulses, but supports them and insulates
neurons 34. Knowing the Brains Physiology Forebrain Anterior of the
three primary divisions of the developing vertebrae brain or the
corresponding part of the adult brain including the cerebral
hemisphere and the thalamus and hypothalamus 35. Knowing the Brains
Physiology Midbrain Middle division of the three primary divisions
of the developing vertebrae brain; or Corresponding part of the
adult brain that includes a ventral part containing the cerebral
peduncles and a dorsal tectum containing corpora quadrigemina and
surrounds the aqueduct of sylvius connecting the 3rd and 4th
ventricles 36. Knowing the Brains Physiology Hindbrain posterior
division of the three primary divisions of the developing vertebrae
brain or the corresponding part of the adult brain that includes
the cerebellum, pons, and medulla oblongata 37. Knowing the Brains
Physiology Thalamus serves as a relay station to and from the
cerebral cortex, and functioning especially sensation and arousal
38. Knowing the Brains Physiology Hypothalamus Temperature control
issues, edema, vomiting, nausea, irritability, psychiatric
problems, rage, laughing, crying, excessive sexuality, antisocial
behavior, hallucinations, coma, somnolence, excessive salivation,
bradycardia 39. Knowing the Brains Physiology Pituitary gland
regulates the many hormones that control various functions and
organs in the body Controlled by hypothalamus 40. Knowing the
Brains Physiology Adrenal glands (suprarenal glands) Responsible
for releasing hormones in response to stress -
corticosteroids-cortisol- catecholamines-epinephrine. 41. History
CDC Many healthcare providers fail to recognize the potential
impact of mild TBI No physical injury Facial injury increases
suspicion of head/brain injury X-ray/MRI/CT normal Delay in
treatment Didnt hit head, wasnt unconscious 42. Rehabilitation
Critical care / stabilization Acute care Acute rehabilitation
Sub-acute rehabilitation Long term / Post acute rehabilitation
Specialized rehabilitation Continuing support 43. Glasgow Coma
Scale Involves three determinants: - Eye opening - Verbal responses
- Motor response (movement) 44. Glasgow Coma Scale Scoring Score 13
15 Mild brain injury Score 9 12 Moderate brain injury Score 8 or
less Severe Brain injury 45. Other Scales Rancho Los Amigos scale
Mayo-Portland Adaptability Inventory 46. Imaging X-ray CT MRI fMRI
EEG PET scan SPECT scan MMPI 47. Testing Neuropsychological Testing
Blood Tests Ultrasound Thermography Cerebrospinal fluid analysis
Electronystagmography (ENG) 48. Testing Evoked potentials (a/k/a
evoke responses) Auditory evoked potentials Visual evoked
potentials Intrathecal contrast enhanced CT scans (cisternogrphy)
Diffusion tensor imaging (DTI) Fractional anistrophy (FA) QEEG
brain topography 49. Testing Quantitative EEG Cerebral Angiography
Transcranial doppler ultrasound 50. Help! I need somebody.. Brain
Injury Association of America (703) 761-0750 www.biausa.org Brain
Injury Association of Indiana (317) 356-7722 www.biausa.org/indiana
Brain Injury Association of Ohio (614) 481-7100 www.biaoh.org Brain
Injury Alliance of Kentucky (502) 493-0609 www.biak.us