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TBI INFO - TRAUMATIC BRAIN INJURY INFORMATION
TRAUMATIC BRAIN INJURY – TBI:
Brain Injury is often called the ‘silent epidemic’.
Every 21 seconds, someone in the
US suffers a BRAIN INJURY.
Brain Injury disables 20 times more people than:
Breast Cancer, Aids, Spinal Cord Injury and Multiple Sclerosis
COMBINED.
People with mild brain injures do not show the effects physically but have cognitive deficits.
Some are in mental hospitals and prisons.
Some are trying to get back to a ‘normal’ life.
People with severe brain injuries are living in nursing homes, institutions and at home with their families and are rarely seen by the public.
Barbara Del Buono, author of Acknowledged A Man, served on the first Governor’s Task Force on Brain Injury in the
US. She is a founding member of the Connecticut Brain Injury Association. Barbara is an advocate for the TBI community and speaks on their behalf at meetings and on radio
and TV appearances. She has been a Caregiver to her son for 27 years.
Through Acknowledged A Man, Barbara tells the inspiring story of her son Nick and his astounding recovery from Traumatic Brain Injury. A senseless act of violence in a YMCA changed his life forever. Nick’s injury was massive enough to make even the most seasoned ER doctor cringe.
Barbara describes Nick’s losses as great, his strength Herculean, his courage heroic and his spirit indomitable.
Barbara shares the peace found in forgiving and the triumphs she discovered in home rehabilitation.
Barbara can help all of us who deal with tragedy find ways to cope and take charge of our changed lives in a new and wonderful way.
TBI is caused by a bump, blow or jolt to the head, a penetrating head injury that disrupts the normal function of the brain.
Cognitive ability is the mental process or faculty of knowing, including aspects such as awareness, perception, reasoning, language, memory and judgment. Memory loss is a common disability in TBI persons. Any and all of these functions can be affected by TBI.
Communication includes speaking, listening, reading, writing and gesturing. Any and all of these functions can be affected with a TBI. It is imperative that all TBI persons receive a neuro-psychological exam to define their deficits and receive appropriate rehabilitation for them. It is also necessary for the family members to understand these deficits and learn how to deal with them appropriately. Hearing and sight tests are also imperative after TBI.
Phycho-social or 'behavioral problems' are another common disability for TBI persons. These include fatigue, denial, depression, lack of motivation, agitation, restlessness, lack of emotional control and difficulty relating to others.
Coma is a profound state of unconsciousness. It is a world of its own, a planet where lost people grope their way out of a darkness the rest of us cannot imagine. Range of motion exercises and sensory stimulation are necessary to aid in coma recovery.
Vegetative State (PVS) is a highly provocative diagnosis because it is not a ‘state’ that always remains persistent. With proper therapy, patients sometimes and often do make progressive steps through the stages of coma and come to a full conscious level. The problem is that they cannot do this alone and must have help from outside themselves to accomplish this. Family members are often the patient’s best resource since there is a known background with the patient and he/she may be able to more readily respond to someone from their life before TBI.
Organ donation is often brought up after a serious TBI. In some states, doctors have the right to declare a person ‘brain dead’ and disconnect life-saving equipment. This decision is always a difficult one that each family must decide on their own. Correct information is needed to make an intelligent decision. One thing you must know is that some organs cannot be retrieved unless the patient’s heart is beating. For some people this does not mean ‘dead’.
GLASCOW COMA SCALE
Examiner Patient Response Score
Eye
Opening Spontaneous Opens eyes on own 4
Speech Opens eyes when asked to in a loud voice 3
Pain Opens eyes when pinched 2
Pain Does not open eyes 1
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Examiner Patient Response Score
Best Motor
Response Commands Follows simple commands 6
Pain Pulls examiner’s hand away when pinched 5
Pain Pulls part of body away when pinched 4
Pain Flexes body inappropriately to pain 3
decorticate posturing
Pain Body becomes rigid in extended position 2
when pinched - decorticate posturing
Pain Has no motor response to pinch 1
________________________________________________________
Examiner Patient Response Score
Oral
Response Speech Carries on a conversation correctly and tells examiner 5
where he is, who he is, the month and year
Speech Seems confused or disoriented 4
Speech Talks so examiner can understand but makes no sense 3
Speech Makes sounds that can’t be understood 2
Speech Makes no noise 1
________________________________________________________
Total of 15 means he/she is no longer in a coma
RLA levels of Cognitive Function
I. NO RESPONSE - The individual appears to be in deep sleep and is completely unresponsive to any stimuli.
II. GENERALIZED RESPONSE - The individual reacts inconsistently and non-purposefully to stimuli. Responses are limited in nature and often the same regardless of the stimuli presented. Responses may include gross motor movements, vocalization and physiologic changes. Response time is likely to be delayed. Deep pain evokes the earliest response.
III. LOCALIZED RESPONSE - The individual responds specifically but inconsistently to stimulus. Responses are directly related to the type of stimuli presented. For example, an individual's head will turn toward a sound of his/her eyes will focus on an object when presented. The individual may follow simple commands and my respond better to some people (ie. family and friends) than others.
IV. CONFUSED AGITATED - The individual is in a heightened state of activity with severely decreased ability to process information. Behavior is non-purposeful relative to the immediate environment. Attempts to climb out of bed, remove restraints and hostility are common. The individual requires maximum assistance to perform self-care activities. An individual may sit, reach or walk, but will not necessarily perform these activities upon request.
V. CONFUSED - INAPPROPRIATE - The individual appears alert and responds to simple commands fairly consistently. Agitation, which is out of proportion, (but directly related) to stimuli may be evident. Lack of external structure results in random or non-purposeful responses. Inappropriate verbalizations and high distractibility are common. Memory is severely impaired, but the individual may self-feed with supervision and requires only assistance for self-care activities.
VI. CONFUSED - APPROPRIATE - The individual shows goal-oriented behavior, but is dependent upon external input for direction. Response to discomfort is appropriate. Responses are incorrect due to memory problems but are appropriate to the situation. Simple commands are followed consistently and carry-over for relearned activities is evident. Orientation is inconsistent but awareness of self, family and baisc needs is increased.
VII. AUTOMATIC - APPROPRIATE - The individual appears appropriate within hospital and home settings, goes through daily routine automatically but is robot-like, with shallow recall of activities performed. Has absent to minimal confusion and lacks insight. The individual frequently demonstrates poor judgment and problem solving and expresses unrealistic future plans. With structure the individual is able to initiate tasks or social and recreational activities
VIII. PURPOSEFUL - APPROPRIATE - The individual is alert and oriented, able to recall and integrate past and recent events and is aware of and responsive to the environment.
Independence in the home and community has returned. Carry-over for new learning is present and the need for supervision is absent once activities have been learned. Social, emotional and cognitive abilities may still be decreased.
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