BRAIN ASSOCIATION OF NC

BRAIN INJURY: SLIPS, TRIPS, & FALLS

Lauren Costello, MS CRC CBIST Question Round

What about you?

• Day fulfillment • Texting • Seatbelt • Helmet • Falls prevention • Causes of injury Can happen to anyone at anytime

• Falls • Aneurysms • Car accidents/pedestrian • • Violence/assault • Blast • Substance use overdose Acquired • Heart attack • Surgery Brain Injury • Drowning • Sports • Cycling Grandfather, husband, father, hard worker, 65yo

• Hard of hearing • Limited peripheral vision • Previously drove trucks for steel company, very independent • Fell outside, hit head on concrete slab on porch Meet • Went to Emergency Department & neurological scans were normal Richard (discharged with no limitations) • Has headaches daily Father, 82yo, moved from Florida to North Carolina

• Fell in 2019, now living with daughter • Unable speak aside from yes or no, walk, or make purposeful movements • CNAs come at night and sometimes during the day • Medicare, pension, & some supplement • Needing custom wheelchair, lift to go in Meet and out of house, accessible van, home Bob health & therapy within the same agency Your Examples ONE IN 10 US RESIDENTS AGED ≥18 YEARS REPORTS EACH YEAR

Among all age groups, falls can cause serious injury and are the second leading cause of (TBI)–related with a 17% increase seen in the US from 2008 to 2017. Acquired Brain Injury

Change in brain function after birth (not hereditary or degenerative)

Non- Traumatic traumatic Brain Injury What is a Brain Injury (TBI) Inside the body Outside the body Brain Injury? (stroke, aneurysm, (fall, vehicle, tumor, disease, etc.) violence, surgery) Mild TBI (most common)

brief, if any, loss of consciousness, vomiting/dizziness, lethargy, memory loss

Moderate TBI

unconsciousness up to 24 hours, contusions & bleeding, neuroimaging signs of injury Do you have to lose consciousness? Severe TBI unconsciousness longer than 24 hours (coma), neuroimaging signs of injury Brain Injury vs. vs. Normal Aging

CHANGE NORMAL AGING DEMENTIA

Remembering conversation or event that recent events or details took place a year ago or the conversations or the name of an acquaintance names of family members

Finding words & occasional difficulty frequent difficulty including forgetting things pauses and substitutions

Awareness personal worries about memory worries primarily from & changes relatives/support Changes after Brain Injury

PHYSICAL & THINKING & TALKING & EMOTIONS & SENSORY PROCESSING SOCIALIZING BEHAVIOR

Seizures, headaches, Remembering details Word-finding & Initiation & & pain & recall creating sentences motivation

Weakness, paralysis, Mental flexibility, Communicating Psych conditions, , & attention, sequencing, (understanding & unrelated laughter coordination & learning producing) or crying

Sleep disruption & Safety awareness & Processing Regulating fatigue impulsivity information emotion & actions

Sensory changes Problem solving Social skills Personality changes THINKING/ PHYSICAL/SENSES REMEMBERING • Headache • Difficulty thinking clearly • Nausea or vomiting (early on) Imbalance or dizziness • Feeling slowed down • • Difficulty concentrating • Fuzzy or blurry vision Feeling tired, having no • Difficulty remembering • Concussion new information energy • Sensitivity to noise or light & Falls • Slurred or difficult speech

EMOTIONAL/MOOD SLEEP

• Irritability • Sleeping more or less than • Sadness usual • More emotional • Trouble falling or staying • Nervousness or anxiety asleep • Consult with a medical professional. • Drink plenty of water & eat a healthy diet. • Rest within 48 hours of injury. When starting activity, avoid over-exerting or continuing when experiencing symptoms. • Get plenty of sleep, rest, and take breaks. • Avoid caffeine and "energy enhancing" Concussion products. • Avoid smoking, drinking alcohol, or over- Recovery the-counter unless prescribed. • Avoid contact sports or other situations that might lead to an additional concussion. INJURY MEDICAL Non-traumatic (aneurysm, Stabilization, life-saving stroke, tumor, overdose, measures in emergency heart attack, etc.) or department, intensive care, traumatic (fall, violence, or polytrauma center while motor vehicle collision or the person may or may not pedestrian, etc.) be conscious Brain Injury REHABILITATION Relearning how to walk, talk, Roadmap eat, dress, socialize, bathe, etc. which can take from weeks to months to years COMMUNITY Navigating services, accommodations, finances, etc. without much guidance CONNECTIONS WITHIN What's Going The communication cells in the brain may become severed, stretched, or disconnected. Thinking of it like on? a highway, the brain's connections end up having a pot holes or closed lanes requiring a detour.

AREAS OF THE BRAIN Different areas of the brain are responsible for different functions, much like a business divided into departments.

NEUROPLASTICITY The brain is able to adapt and change due to experience and repetition, making rehabilitation possible. Parts of the Brain

PARIETAL LOBE FRONTAL LOBE sensory integration, planning, initiation, environment impulsivity, social, awareness, & spatial attention, consequences orientation

OCCIPITAL LOBE TEMPORAL LOBE visual processing memory, hearing, language

CEREBELLUM coordination, voluntary BRAIN STEM movements, & balance involuntary functions (breathing, heart rate, etc.) KNOWN deaths, hospitalizations, and emergency department visits due to TBI WHAT'S THE NUMBER?

THE SILENT EPIDEMIC

UNKNOWN In 2013, 2.8 million people sustained a TBI mis/undiagnosed or treated in the United States in non-hospital settings US Numbers

Emergency Department (ED) Visits (2006-2014) • Highest rates being among older adults (≥ 75 years), young children (0-4 years), and individuals 15-24 years

• 80% increase for TBI-related ED visits as a result of falls US Numbers

Hospitalizations (2006-2014) • Highest among older adults aged 55 and older

• Despite the overall decrease in TBI-related hospitalization rates, there were increases in the rates attributable to falls US Numbers

Deaths (2006-2014) • Highest among older adults aged 55 and older in the US

• Despite the overall decrease in TBI-related rates, there were increases in the rates attributable to falls NC Numbers

2005-2014 Data • Falls are a leading cause of TBI in NC residents ages 65 and older, accounting for 36% of TBI deaths and 43% of TBI hospitalizations. • Eighty-four percent of fall deaths and 69% of hospitalizations among older adults were associated with a TBI. Changes after Brain Injury

What to expect

NEXT STEPS Physical

• Seizures CHANGES • Fatigue • Headaches & pain AFTER • Sleep disruption • Weakness or paralysis INJURY • Movement & coordination • Change in sexual functioning • Balance & dizziness • Sensory changes or overstimulation Thinking

• Memory or recall • Mental flexibility CHANGES • Attention, concentration, & learning AFTER • Planning & organization • Initiation & motivation INJURY • Task-switching & sequencing • Mental fatigue • Safety awareness & impulsivity • Problem-solving & decision- making Communication

• Social skills CHANGES • Speech • Facial muscles affected AFTER • Affect, tone, and inflection • Comprehension INJURY • Reading • Word-finding • Incongruent emotion with speech • Short concrete responses Feelings

• Difficulty with regulation CHANGES (emotions or actions) • Self-awareness AFTER • Irritability • Unrelated laughter or crying INJURY • Personality changes • Lethargy or slowness • Restlessness • Psychological conditions (depression, anxiety, etc.) Activities

Try your hand at some of the changes after brain injury Collaboration in the Community

Your Role

NEXT STEPS Brain Injury Association of North Carolina

• Statewide non-profit

• Empowering individuals & their families

• Education (webinars, courses, conferences, materials)

• Support (resource guidance, camp, Get to activities, exhibits, groups) Know Us • Awareness (prevention, safety, events)

Ex Squeeze Me • 2020 • Advocacy (legislation, committees, policy) Next Steps & Collaboration

General Medical Follow-up Prevention & Awareness & Assessment Wellness Brain Injury is widespread with higher risk for individuals older than 65

• More likely to have fatal consequences or be hospitalized after brain injury • Brain injury can result in changes of how a person thinks, acts, feels, communicates, and more • It affects not only the person, but the family and community

Falls & Brain can be General dangerous at any age • Brain injury can happen at any time, any age, and lead to long-term changes Awareness • With one life, people want to be as healthy as long as they can Connect with resources & people

• Resource guidance for fall prevention and brain injury services to assist after a fall • Difficult to navigate the system in conjunction with insurance & finances • Home modification, technologies, allied health, support groups, yoga & strength/balance training

Medical Educate, then advocate

• Medical staff need to be aware of the nature and Follow-up & invisibility of brain injury rather than attributing changes to normal aging • Materials should be distributed to individuals and Assessment families to look for any changes after a fall or hit to the head Fall Prevention is Brain Injury Prevention

• Strengthening core and other muscles can help with balance and movement • Nutrition and hydration helps prevent dizziness • Proper footwear & helmet use are essential • Modify the home (lighting, grab bars, de-clutter, secure/remove rugs, etc.)

Preparation, Problem Solving, Prevention & & Planning Ahead • Educating Nursing & Senior Center Staff about brain Wellness injury & falls • Meeting the individuals where they are and feel comfortable - supporting people in their wellness, not shaming or judging • Teaching how to get up properly from a fall if safe Final Thoughts

GENERAL MEDICAL FOLLOW- PREVENTION & AWARENESS UP & ASSESSMENT WELLNESS

Falls can happen to anyone, Always consult with doctors Before any diagnosis or regardless of age, particularly after a fall with symptoms symptoms, an individual is a when you are not prepared. present - educate people on person first - wanting dignity, Consequences can range symptoms to watch out for respect, kindness, and form minor to fatal. even with no blacking out. fairness. Potential Community Projects

FALLS SAFETY CLINICS FALLS CONFERENCE Stations for wellness Speakers & exhibits related to falls • Living space modifications, • Interactive sessions, shorter Nutrition, Concussion, EMS/Fire, duration OT/PT screens, Senior Services • Wellness & giveaways Potential FALL PREVENTION BINGO Tips, strategies, modifications, etc. Community • Safe For Elders • Eastern NC Falls Prevention Projects • Bingocize LOCATIONS Raleigh, Asheville, Greenville, Charlotte, & Winston-Salem

PHONE NUMBER Connect (919) 833-9634 With Us

EMAIL ADDRESS [email protected] Resources & References

• Peterson AB, Kegler SR. Deaths from Fall-Related Traumatic Brain Injury — United States, 2008–2017. MMWR Morb Mortal Wkly Rep 2020;69:225–230. DOI: http://dx.doi.org/10.15585/mmwr.mm6909a2 • https://www.cdc.gov/STEADI/ • https://alzheimer.ca/en/Home/About-dementia/What-is- dementia/Normal-aging-vs-dementia • https://www.injuryfreenc.ncdhhs.gov/DataSurveillance/Falls- SER-NC-2016-FINAL.pdf • https://www.aging.com/preventing-falls-in-older-adults/ • https://www.cdc.gov/traumaticbraininjury/data/index.html • https://www.biausa.org/brain-injury/about-brain- injury/basics/injury-severity