Effective Services for People Living with Brain Injury Jean Capler, MSW, LSW Local Support Network Leader The Rehabilitation Hospital of Indiana Department of Resource Facilitation Plan for Today Brain injury: what is it and what causes it? Differential diagnosis Comorbidity The Importance of Correct Diagnosis Brain injury specific treatment Brain Injury: What is it & what causes it? 1
Acquired Brain Injury An injury to the brain which is not hereditary, congenital, degenerative, or induced by birth trauma. An acquired brain injury is an injury to the brain that has occurred after birth. Includes TBI & non-tbi ABI Traumatic Brain Injury An alteration in brain function, or other evidence of brain pathology, caused by an external force. (BIAA) ABI: Traumatic Brain Injury Causes Falls Vehicle accidents Hit on the head by an object piercing/contusion Assaults Blast injuries Sports Injuries 2
Traumatic Brain Injury (TBI) Acceleration injuries Individual turns reflexively from impact Skull stops, brain rotates Areas of frontal and temporal lobes right next to skull most vulnerable Other TBI Mechanisms Subdural Hematoma Intracerebral Hematoma 3
70% 15% 15% Moderate to Severe TBI Mild with Persisting Sx Mild w/o Persisting Symptoms 10 ABI Non-Traumatic Brain Injuries Stroke Aneurysm Tumor Hypoxia or Anoxia Disease process (non-progressive) Neurotoxins Electric shock or lightening strike (including ECT) Common Effects of Brain Injury Cognitive Short term memory loss Slowed processing speed Attention & concentration Executive functions Communication Skills 4
Common Effects of Brain Injury Physical Seizures Headaches Fatigue Sleep disturbance Balance problems Speech & vision problems Motor coordination, spasticity, paralysis Common Effects of Brain Injury Emotional Anxiety & depression Impulsivity Mood swings & difficulty moderating emotions Agitation Lowered self esteem Restlessness Egocentric behaviors Differential Diagnosis Brain Injury, Dementia, Mental Illness 5
BI & Alzheimer s Disease Common Alzheimer s Sx s Problems learning & retaining new info Misplacing items Problems with complex tasks Problems with problem solving Problems processing conversations Difficulty finding words Problems regulating emotions Common Brain Injury Sx s Problems learning & retaining new info Misplacing items Problems with complex tasks Problems with problem solving Problems processing conversations Difficulty finding words Problems regulating emotions Chronic Traumatic Encephalopathy Caused by repeated mild head injuries Sports, multiple MVA, abuse Cause by a cascade of neurodegenerative changes including Development of tau neurofibullary tangles Diffuse plaques in some Cerebral atrophy & enlarged ventricles Symptoms appear years after injuries and are very similar to symptoms of Alzheimer s Gavett, et al., 2010 BI & Depression Common Depression Sx s Problems concentrating Difficulty making decisions Memory issues Slower thought processes Fatigue, low energy Sleep changes Aches, pains, headaches Irritability Sometimes flat affect Common BI Sx s Problems concentrating Difficulty making decisions Memory issues Slower thought processes Fatigue, low energy Sleep changes Aches, pains, headaches Irritability Sometimes flat affect 6
Differential Diagnosis Alzheimer s Disease Gradual onset, no identifiable event leading to onset Progressive, gets worse over time Brain Injury Typically sudden onset with identifiable event Typically some recovery over time after the event Differential Diagnosis People with brain injuries earlier in life can also later develop dementia as they age People with dementia can sustain a brain injury (TBI or stroke) Differential Diagnosis Depression & Brain Injury Depression is common after brain injury Depression worsens the sx s of brain injury People with depression can sustain a brain injury Neuropsychological evaluation is best way to clarify 7
Differential Diagnosis Requires SCREENING for brain injury OSU Screening instrument Detailed history of onset of symptoms If there is a history of BI, then further eval Neurology Neuropsychology Neuropsych eval Comorbidity Sufficient evidence of an association between: Moderate or severe TBI and Alzheimer s (Moderate or severe TBI and Parkinson s) TBI and depression Suggestive evidence of an association between: Mild TBI w/loc and Alzheimer s Mild TBI w/loc and Parkinson s TBI Association with Alzheimer s Studies suggest an association between early TBI and subsequent Alzheimer s Unclear if the actual cause of dementia is AD or perhaps CTE and related changes It s possible CTE-related changes trigger AD and other neurodegenerative disorders (Parkinson s, ALS) Gavett et al., 2010 8
TBI Association with Alzheimer s Unclear how many brain injuries or severity of BI will lead to these changes resulting in CTE and/or AD Unclear if there are any treatments that can arrest this cascade of changes in the brain Gavett et al., 2010 Importance of Correct Diagnosis CTE & AD: the neuropathological changes are different in each, so medical treatment would be different If a recent BI in person with AD understand the recovery process within context of AD BI and Depression: Treatment is different. If BI is not identified treatment for depression is ineffective Brain Injury Specific Treatment 9
Treatment & Services for BI Must identify the history of brain injury first! OSU Screening tool Evaluation by neuropsychologist and/or neurologist Cognitive Rehabilitation provided by speech therapists and/or neuropsychologist Indiana Vocational Rehabilitation services & Resource Facilitation For Employment Needs Indiana Vocational Rehabilitation: state agency that contracts goods and services for people to support their obtaining employment Resource Facilitation: brain-injury specific service to help BI survivors find & navigate services to help them recover, achieve stability, access support leading to better chance at employment. (18% vs 70%)! Contact Me for Consult if Possible Brain Injury Jean Capler, MSW, LCSW Local Support Network Leader RHI Resource Facilitation 812-325-6342 jean.capler@rhin.com 10
Literature Cited BIAA. 2016. The Essential Brain Injury Guide. 5 th Ed. Brain Injury Association of America Gavett, B.E., Stern, R.A., Cantu, R.C. Nowinski, C.J., and McKee, A.C. 2010. Mild traumatic brain injury: a risk factor for neurodegeneration. Alzheimer s Research & Therapy, 2:18. 11