Traumatic Injuries:
Traumatic Brain Injury
KNR 279
TRAUMATIC BRAIN INJURY
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Insult to brain, not of degenerative
or congenital nature, but caused by
an external force that may produce
a diminished or altered state of
consciousness, which results in an
impairment of cognitive or physical
functioning
Open or closed injury
Mild (concussion) to severe (coma)
INCIDENCES OF TBI
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Over 2-5 million in US
1 injury every 15 seconds
Many result in life long disability
56,000 killed annually
Leading cause of death among
Americans under 45
Males 14-24 have highest rate
CAUSES OF TBI
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50% Motor vehicle crashes
21% Falls
12% Violence
10% Sports & recreation
7% Other
Symptoms: Frontal Lobe/Forehead
www.braininjury.com
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Paralysis
Problems sequencing for multi-step task
Persistence of a single thought
Inability to focus on task
Mood changes/emotional liability
Changes in personality
Difficulty with problem solving
Inability to express language
Parietal Lobe/ Near back & top of head
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Inability to attend to more than 1 object
at a time
Inability to name an object
Inability to locate words for writing
Problems reading
Difficulty with drawing tasks
Difficulty to distinguish left from right
Difficulty with math
Difficulty with eye-hand coordination
Occipital Lobes: Back of head
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Defects in vision (visual field cuts)
Difficulty locating objects in the
environment
Problems identifying colors
Difficulties with reading & writing
Visual illusions (inaccurately seeing
objects)
Temporal Lobes:
Side of head above ears
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Difficulty recognizing faces
Difficulty in understanding spoken words
Short term memory loss
Interference with long term memory
Inability to categorize objects
Right lobe can cause persistent talking
Increased aggressive behavior
Brain stem: Deep within brain
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Difficulty swallowing food & water
Problems with balance & movement
Dizziness & nausea
Sleeping difficulties
Decreased vital capacity in
breathing needed for speech
Cerebellum: Base of skull
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Loss of ability to coordinate fine
movements
Loss of ability to walk
Tremors
Slurred speech
Inability to make rapid movements
EFFECTS OF TBI
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Balance or equilibrium
Behavior / emotion
Cognitive
Physical
Seizures
Speech / language
Glasgow Coma Scale
Ranchos Los Amigos Scale
Level of Cognitive Functioning / Recovery
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I = No response, comatose
II = Generalized response,
nonpurposeful, inconsistent
III = Localized response,
inconsistent reaction to specific
stimuli
IV = Confused, agitated,
nonpurposeful behavior, inability to
process information
Ranchos Los Amigos Scale
Level of Cognitive Functioning / Recovery
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V = Confused, inappropriate,
nonagitated behavior, alert, highly
distractible, responds to simple
commands
VI = Confused but appropriate
behavior, goal-directed, uses
external input for direction
Ranchos Los Amigos Scale
Level of Cognitive Functioning / Recovery
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VII = Automatic, appropriate
behavior, robot like compliance with
routine, shallow recall, increased
awareness of others
VIII = Purposeful, appropriate
behavior, alert, oriented,
independent functioning
Recommended TR Interventions
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I, II, III = Sensory stimulation,
passive stretching, art, movement
to music, cognitive retraining,
reality orientation
IV, V, VI = Aquatic therapy,
expressive arts, leisure education,
horticulture, behavior management,
stretching & flexibility exercises,
table & board games
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Carter, Van Andel, & Robb, 2003
Recommended TR Interventions
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VII, VIII = Computer games,
Community integration, expressive
arts, social skills training
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Carter, Van Andel, & Robb, 2003
Considerations/Accommodations
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Decrease distractions in environment
Provide repetition & consistency
Demonstrate new tasks & provide
examples
Help with planning
Behavior management
Guidance with appropriate behavior in
social situations
May not remember that just asked
question
Considerations/Accommodations
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Structure
Start with simple tasks & small
steps
Give clear, concrete directions
Supervise, may not know own
limitations