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Lecture 9

Lecture 9.doc

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Stuart Kamenetsky

Acquired Brain Injury Distinctions - Acquired vs. Traumatic Brain Injury o Traumatic involves external force (trauma, blow to head, baseball hat, car accident-head gets smashed a/g windshield) that causes damage (strong traumatic physical force a/g head) o Clear physical trauma applied to the head  Open head injuries • Skull fractured – much more visible – you can see injury is there (e.g. bleeding, gun shot wound) • Clear to see, understand & recognize • Skull damaged, ruptured  Closed head injuries • Does not involve fractured skull • Skull not severed/damaged, therefore we can’t tell from the outside that a brain injury occurred (no mark, no bruising maybe swelling) • (use MRIs, CT scans, etc) • We’re under mentality that it’s not so bad • Body moves quickly and skull comes to abrupt stop, brain has area that fluid and so on to keep moving until it is stopped by the skull  This movement could cause tearing of brain tissues inside the brain • Rupture of tissue is problematic • Brain damage – hemorrhaging = bleeding = produces pressure inside the brain  further damage of brain cells • Severe shaking or fall in which brain decelerates quickly and hits side of skull, certain nerve fibres are stretched or torn - Acquired is all of the above but also includes other types – includes TBI because it’s also acquired - This means that injury has been acquired, very broad - Examples of ABI that are not traumatic (no physical force): o Stroke as a result of disease – meningitis, encephalitis o Cancer, Brain tumours o Poison, Toxicity o Radiation o  Growth of unhealthy cells or destroys brain cells – sometimes aren’t discovered until much later e.g. brain tumour, very difficult to diagnose - Congenital vs. Birth process brain injuries o Congenital (present at birth) – we don’t necessary know why  e.g. Fetal Alcohol syndrome o Birth process  e.g. anoxia – not enough oxygen, born with umbilical cord around neck - Other: o Degenerative diseases (age related diseases) e.g. Parkinson’s, Huntington’s, Alzheimer’s, brain ages more quickly than it should Causes of TBI: o Highly preventable accidents  Automobile accidents (car seats, seat belts): especially when they sit in front seat and they don’t wear seat belts, body moves forward, head may move back,  Bikes (helmets)  Work accidents (helmets, safety precautions)  Sports (helmets, less competition – more competitive, more injuries)  Gun shot wounds (firearm control, safety precautions)  Purposeful  Accidents (there are clear laws about storing guns)  Military o Abuse/neglect of infants  Simply not knowing how to care for an infant (improper lifting accidents e.g. hitting infant’s head on something) - Disabilities can be prevented but also possible – clearly cross cultural and natural differences Stages of Treatment: o Adults who’ve acquired frontal brain injury as a result of auto collision:  Emergency/intensive care • High likelihood of being in a coma • In emergency, person will be assessed • All other injuries are dealt with along with brain injury • Need to be medically stabilized dealing with other medical problems that are life-threatening e.g. severe internal injuries (extensive bleeding from your brain) • Intensive Care to Recover, MRI esp. if it’s a closed-head injury • Longer person is in coma, less likely of recovery from coma – controversial treatments  Hospitalization • Physical recovery – good enough shape to return home after medical stabilization  Physio/Occupational/Speech Therapy (S.O.P. therapy) • Often life-long period • If there was a broken bone, we can physically fix it but in therapies for brain injury, all we can do is reduce swelling in brain (steroids), can replaces parts of skull but not brain • When person wakes up from coma, they’re a changed person - may need to relearn simple tasks they already knew (walking, reading, washing themselves); like little children – we can never know how extensive the injury is to the operation of the body functionally (functional cognitive testing is done by clinical neuropsychologists) • Often as these things are relearned, there is spontaneous recovery, we don’t completely understand how and why • Attempt to bring them up to independent functioning as possible  Community re-integration through group homes or independent living (growing field in Ontario) • Goal is for these ppl to move on to assume their normal life, ideally to their family, same type of life they had before • If brain injury is so extensive, that they are not the same person, then we need to find them another place to go • Often only long term care facilities for these ppl are old age homes • Now we have many more facilities in Canada • Good for individuals because focus is on reintegration into your community Difficulties o Self concept: adjusting goals & expectations of oneself to reduced abilities (career, family life) *most difficult*  One of the first things to go is extensive rationalization, higher cognitive processes – nobody wants to reduce expectations about oneself based upon reality and you have a brain injury and can’t analyze the situation in reality properly  Lack of ability to analyze life and come up with a realistic assessment very different from individual with down syndrome that never have these expectations o Frontal brain injury often results in lack of impulse control e.g. used to be a father o Dynamics of care and control in group homes  They don’t want to be there  Revolving staff: Ppl who work there are usually ppl who are very young and are not well educated (college 2 yr group home) – social work – level of maturity: haven’t been through life, don’t know what it’s like to be a 45 yr old  OHIP used to send these individuals to the US (not community integration)  area of growth and development in Ontario  Become micromanagers of these ppl’s lives (boss them around) • Not a good situation when all the problems are combined – very difficult for individuals to cope with new life • On one hand, they need it, on the other they don’t want it, don’t understand why they need it, their self concept hasn’t changed o Result – severe behavioural problems  E.g. movie theatre and somebody starts a temper tantrum, they would get taken out by police and may be restrained  injuries, death  closed mental institution, closed hospital ward then return to group home - Intervention o Combo of drugs and applied behaviour analysis (focus on ABCS of behaviour – Antecedents, Behaviour, Consequences)  Behaviour followed by something not pleasurable behaviour would be decreased (not modern)  AcquiredBehaviouralAnalysis: what comes before behaviour and consequences so we understand
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