Mental Health
Issues and Cognitive
Impairment
UNIT 12: ACQUIRED BRAIN INJURIES
LISA GIALLONARDO RN, MSCN
Overview
 Acquired brain injuries
 Brain injuries across the lifespan
 Clinical description
 Traumatic brain injury
 Non traumatic brain injury
 Caring for the client with acquired brain injuries
 Personal support worker considerations
The Brain
 Responsible for all human functions:
 thinking,
 problem solving,
 emotions,
 consciousness,
 social behaviour.
 Responsible for all basic bodily functions:
 breathing,
 eating,
 sleeping,
 moving,
 the five senses
Responsible for how we think, feel, perceive, and act in the world—it is the
organization of who we are
Point to Ponder?
Why are sports fans concerned about the number of
concussions sustained by Eric Lindros or Sydney Crosby?
Why is it law that children wear helmets when riding a
bicycle?
The Reason…
Acquired Brain Injury (ABI)
ACQUIRED BRAIN INJURY is damage to the brain that
occurs after birth and is not related to a congenital
disorder or a degenerative disease.*
ACQUIRED BRAIN INJURY is not Cerebral Palsy,
Alzheimer’s Disease, Multiple Sclerosis, Parkinson’s
Disease.
The Facts
11,000 Canadians die every year as a result of
traumatic brain injury.
6,000 Canadians become permanently disabled as
a result of traumatic brain injuries.
ABIs ACROSS THE LIFESPAN
ABIs in Children
 Preschoolers are at the second highest risk of sustaining an acquired brain
injury.
ABIs in Adolescence
 Individuals between the ages of 16 to 25 are at the highest risk of sustaining an
acquired brain injury.
ABIs in Adulthood
 ABIs are the leading cause of death and disability among people under the age
of 45.
ABIs in the Elderly
 The elderly are the fastest growing demographic group with increasing numbers
of ABI’s is seniors.
How does it happen?

The brain is made up of millions of neurons.

Each neuron may have up to 10,000 connections

When a neuron is damaged, it and all the connections stop functioning.

When neurons stop functioning, they die.

Once a neuron dies it cannot reconnect and heal itself.

The damage is permanent.
Clinical
Description
Types of ABIs
1.
Traumatic Brain Injury

2.
Occurs when an external force traumatically injuries the brain
Non-Traumatic Brian Injury

Occurs when a medical problem or disease process causes damage to
the brain (internal process)
traumatic or non-traumatic causes of
ABI?
Gun shot
Anoxia
Aneurysm
Sports injury
Infection
Shaken baby syndrome
Motor vehicle accident
Fall
Brain Tumours
Meningitis
Signs and Symptoms
 Confusion




Person
Place
Time
Period of memory loss
 Brief to prolonged loss of consciousness
 Nausea and vomiting
 Increased confusion during the days following even a mild blow to
the head
Concussion Guidelines
A concussion is a change in mental status resulting from an external
force and may involve loss of consciousness.
Guidelines are dependent upon the degree of the concussion
First Degree/Simple
Confused that lasts for 15 minutes or less
ie unaware of what happened and/or is disorientated to
place or time
No loss of consciousness
Dizziness, headaches, nausea, memory loss
SHOULD NOT RETURN TO ACTIVITY WITHOUT APPROVAL OF PHYSICIAN
Second Degree/Complex
Confused that lasts longer than 15 minutes
ie unaware of what happened and/or is disorientated to
place or time
AND/OR
Temporary loss of consciousness
 ie does not open eyes, can not focus, does not respond to
name
MUST BE SEEN BY A PHYSICIAN IMMEDIATELY
ACQUIRED Brain
injury outcomes
Outcome dependants
Characteristics of the injury




Area(s) of the brain injured
Severity of the injury
Nature of the injury
Focal or diffuse
Individual characteristics
 Age and developmental stage at time of injury
 Pre-existing skills and knowledge
 Previous ability to learn
The Environment
 Informed and supportive family and friends
 Timely access to quality medical care and rehabilitation
 Community supports
Deficits can be reversed
 Speed and extent of recovery will vary from person to person.
 Physical recovery of the brain
 Swelling decreases and normal blood flow is restored
 Some reorganization of neural pathways do occur
 Brain can compensate for some types of impaired function
 Greatest improvement made in the first 2 years.
 In children, consequences of ABI may not be noticed until the child
reaches a later developmental stage.
Caring for the client
with an acquired
brain injury
Cognitive Challenges
 Ability to learn
 Memory
 Organization
 Attention and concentration
 Perception-visual and auditory
 Reasoning
 Problem solving
Behavioural and emotional
challenges
 Disinhibition
 Aggression
 Depression
 Initiation
 Poor self-image
 Poor social behaviour
Physical challenges
Headaches
Tinnitus
Cognitive fatigue
Visual field neglect
Seizures
Physical fatigue
Self care deficits
Mobility
Fine motor skills
Caring for the client with an
acquired brain injury: General
Techniques
 Redirection
 Restructuring
 The Back Door Approach
 Positive Reinforcement
 Active Ignoring
 Cueing
 Changing the Antecedent
Caring for the client with an
acquired brain injury
Redirection
◦ Attempts to refocus client on what is happening and change his attention to
something else.
◦ Used when the client is upset, perseverating or has become rigid in his
thinking.
Caring for the client with an
acquired brain injury
Restructuring
◦ Guide the client to construct another understanding, perspective or
interpretation of an event or thought.
◦ Instead of accusing the client of being wrong, offer different scenarios of the
event to guide the client into the reality of the situation.
◦ Used when the client is confabulating, or has rigid or concrete thinking.
Caring for the client with an
acquired brain injury
Back Door Approach
◦ Interventions that are implemented without the person being aware that
you are addressing their deficit.
◦ Used when the client has agnosia or lacks awareness of his deficits.
Caring for the client with an
acquired brain injury
Positive Reinforcement
◦ Rewarding wanted behaviour.
◦ Letting the client know that their behaviour is correct and appropriate.
◦ This will increase the occurrences of wanted behaviour.
Caring for the client with an
acquired brain injury
Active Ignoring
◦ Involves continued monitoring the clients behaviour while deliberately not
responding or reacting to it.
◦ This will help to decrease unwanted behaviour.
Caring for the client with an
acquired brain injury
Cueing
◦ A type of signal that is used to prompt another person to engage or
disengage in a particular behaviour.
◦ Cues can be verbal or nonverbal.
◦ Used with memory problems, failure to initiate, attention and organizational
problems.
Caring for the client with an
acquired brain injury
Changing the antecedent
◦ Focuses on changing the trigger or situation (antecedent) that elicits
negative behaviour in the client.
◦ Once an antecedent is identified, the environment or situation is changed so
that the behaviour is diminished.
◦ Antecedents can be environmental, internal or cognitive.
PSW
Considerations
PSW considerations
Many clients with an ABI live in group homes or
supportive housing.
Survivors of ABIs are frequently very different,
demanding people - this kind of loss is inestimable.
Survivor losses may include: self esteem, career,
earning potential, friends and family
PSW considerations
The complexity of the brain makes it difficult to determine extent of
recovery and prognosis
Observe for changes and report to supervisor or family
Factors that influence recovery
◦ Characteristics of the injury
◦ Physical recovery of the brain
◦ The individual
◦ The environment