The Human Cost of Brain Injury
Dr Tracey Ryan-Morgan
Consultant Clinical
Neuropsychologist
BIRT & Talis Consulting Limited
TBI Statistics: 2011 data
• Estimated 1 million people attend A&E in
the UK following head injury
• Of these, around 135,000 people are
admitted to hospital each year due to
brain injury
• Estimated 500,000 people (aged 16-74)
living with long-term disabilities as a
result of TBI
• Over 130,000 people have a stroke each
year in England and Wales
• There are NO specific data for Wales!
www.headway.org.uk
Terminology?
• Traumatic Brain
Injury
– This is commonly
defined as an
alteration in brain
function, or
evidence of brain
pathology, caused
by an external
force
• Acquired Brain
Injury
– This is defined as
an injury to the
brain which is not
congenital,
hereditary,
degenerative or
caused by birth
trauma.
Causes of Acquired Brain Injury
There are many causes of acquired brain
injury and these include:
–
–
–
–
–
–
–
–
Trauma to the head (TBI)
Cerebral thrombosis or haemorrhage (strokes)
Tumour
Epilepsy (Primary)
Hypoxia (reduced or absence of oxygen)
Neurodegenerative disease (e.g. dementia)
Brain infection (e.g. meningitis or encephalopathy)
Chronic alcohol or drug misuse
Epidemiology of TBI
Of all traumatic brain injuries:
• Mild TBI or concussion accounts for 80%
• Moderate TBI accounts for 10%
• Severe TBI accounts for 10%
Severity of head injury is classified
according to:
1. How long and to what level the person has
altered consciousness (GCS and LoC)
2. How long before the person’s memory starts
laying down new memories post incident
(PTA)
Indicators of severity
Typical behaviours which challenge – after
an acquired brain injury
•
•
•
•
•
•
•
Lack of empathy
Lack of insight / self-awareness
Disinhibition in speech / behaviour
Agitation
Aggression (verbal / physical)
Impulsivity
Impaired social judgement
Impact on Families
• Family members experience high levels of anxiety,
stress and depression after brain injury
• There is a decrease in relatives’ capacity for coping,
particularly with emotional and behavioural problems
• Some families cope better than others, but all
experience difficulties
• There is a higher degree of parental stress in
families where one spouse has had a brain injury
• The head injured person’s role in their family
changes after a head injury (Kieffer-Kristensen & Teasdale, 2011)
Impact on Relationships
• Spouses report feeling isolated within a marriage
where their emotional needs are not being met and
where their roles within the relationship have changed
• Marriages are most susceptible to breakdown between
5 and 6 years post-injury (Wood & Yurdakul, 1997)
• Some studies report a high separation rate among
couples where one spouse had suffered a TBI (Wood & Yurdakul,
1997, Wood, Liossi & Wood, 2005) whereas other studies provide data to
contradict this finding (Kreutzer, Marwtiz, Hsu, Williams & Riccick, 2007)
• There is evidence that the longer the couple were
married prior to injury and the length of time since
injury makes divorce / separation less likely
Driving / accessing the Community
• Many individuals who return to driving
post brain injury report problems with:
– behaviour (anger, aggression, irritability:
48.2%),
– memory ( 64%),
– concentration and attention (28.1%), and
– vision (28.1%).
(Hawley, 2001)
Impact on identity
• Many people experience identity change after
brain injury. Impaired self-awareness after
acquired brain injury is also common and can,
along with other factors, affect the identity
change a person may experience (Coetzer, 2008)
• Individuals often struggle to understand and
accept the changes brought about by brain
injury and to reconcile their pre- and post-injury
selves (Doherr, 2013)
Impact on Mood
• Typically, studies show that about a third
of TBI survivors experience emotional
problems between 6 months and a year
post injury.
• The presence of emotional or
behavioural problems post injury which
impact on the individual’s family have
been reported at 84% .
• Clinically significant levels of
hopelessness (35%) suicidal ideation
(23%), and suicide attempts (18%) postinjury have been identified
(Gracey, 2002)
Impact on Employment / studies
– Among people with TBI over 40% returned
to work after one year with a further 40%
returning to work after two years
– Length of time since injury made little
difference to the chances of returning to
work
– Many people with TBI were unable to
sustain their job
(Velzen et al. 2009)
Impact on Employment / studies
– Difficulties in social communication and
interpersonal functioning have been shown
to be barriers to a successful return to work
even though returning to work is seen as a
benchmark in recovery and assists the
individual with post-injury identity and
adjustment and contributes to the financial
resources of the family.
(Bowen, Hall, Newby, Walsh, Weatherhead & Yeates , 2009)