Traumatic Brain Injury (TBI)
Dec 27, 2015
Traumatic Brain Injury (TBI)
TBI results from: Penetrating
Closed head injury
Prevalence cases of TBI/year in U.S.
of these: die individuals have significant,
long-term impairments every 15 seconds a person sustains a TBI
Causes of all TBIs are caused by motor
vehicle accidents (MVA) Other causes
Affect more males than females (2:1)
highest frequency
Neurology Unlike stroke, TBI is
brain damage is usually Damage can be to:
Damage is due to the
injury due to impact (in that area)
injury on the side opposite to the impact
damage due to angular acceleration of the brain
Secondary effects Cerebral Hemorrhage --> hematoma:
cerebral edema: increased
Coma Not all TBIs result in coma, but many
do There are different levels of coma,
measured on a Glasgow coma scale Rancho Los Amigos scale
Rancho Los Amigos Scale of Cognitive Levels
inconsistent responses to intense stimuli (e.g., pain)
blinks to strong light, turns toward sound, inconsistent response to commands
alert, active with aggressive behavior. Behavior is not purposeful, patient is disoriented
gross attention to environment, highly
distractible, responds to simple commands
inconsistent orientation to time and place,
recent memory impaired
performs daily routine in familiar environment, poor insight, judgment, and problem-solving
responds appropriately in most situations
Impairments resulting from TBI Cognitive Physical Speech and Language Behavioral and Emotional
Potential Cognitive Problems Orientation Slowness of thinking Difficulty maintaining attention and
concentration Reasoning and problem solving
Physical problems can include Potential Physical Problems
Vision problems Lack of coordination Weakness or paralysis of muscles Problems sleeping
Potential Speech & Language Problems Speech ( ) Language impairment ( )
Commonly: anomia & impaired comprehension Problems with
Voice & Swallowing Reading/writing
Potential Behavioral and Emotional Problems Lack of motivation Inability to self-monitor (denial) Difficulty with emotional control and anger
management
Intervention - Role of SLP May address many areas depending
upon client’s needs Orientation Memory Listening comprehension Speech intelligibility Pragmatics Reasoning and problem solving
Recovery is in a step-wise plateau. Cognitive Rehabilitation
Treatment regimen designed increase functional abilities for everyday life by improving the capacity to process incoming information
Repetitive activities to rebuild neural circuitry Attempted first e.g., classification tasks, word associations,
rehearsal, memory aids
Develop alternatives, since some functional
will not be recovered. When restorative approaches won’t work E.g., focused attending, rehearsal of new
information
Stages of Recovery/Intervention Early Stage
Beginning responses to environment in hospital – stabilization
Intervention focus:
Evidence to suggest that intervention can result in shorter rehabilitation & higher levels of cognitive functioning
Middle Stage Goal:
Intervention focus: Orientation to everyday routine Routines, consistency Conversational speech Listening/comprehension Following directions Description, classification
Late Stage Goal:
Intervention focus:
Comprehension of complex information, directions
Conversational/social skills (including problem solving)
Compensatory strategies Self-inhibition Self-monitoring skills