Brain Injury

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Recommended publications
  • Assessing the Severity of Traumatic Brain Injury—Time for a Change?
    Journal of Clinical Medicine Review Assessing the Severity of Traumatic Brain Injury—Time for a Change? Olli Tenovuo 1,2,*, Ramon Diaz-Arrastia 3, Lee E. Goldstein 4, David J. Sharp 5,6, Joukje van der Naalt 7 and Nathan D. Zasler 8,9 1 Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, 20521 Turku, Finland 2 Department of Neurology, Institute of Clinical Medicine, University of Turku, 20500 Turku, Finland 3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; [email protected] 4 Alzheimer’s Disease Research Center, College of Engineering, Boston University School of Medicine, Boston, MA 02118, USA; [email protected] 5 Clinical, cognitive and computational neuroimaging laboratory (C3NL), Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK; [email protected] 6 UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, London, W12 0NN UK 7 Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ Groning-en, The Netherlands; [email protected] 8 Concussion Care Centre of Virginia and Tree of Life, Richmond, VA 23233, USA; [email protected] 9 Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA * Correspondence: olli.tenovuo@tyks.fi; Tel.: +358-50-438-3802 Abstract: Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures.
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  • Diagnosing and Managing Concussion Tool
    Sections: A B C D References Diagnosing and Managing Concussion Tool This tool has been developed to support family physicians and nurse practitioners in consistently diagnosing and managing concussion in adult patients (≥ 18 years). Section A: Concussion overview Section C: Patient encounter forms pg.1 Clinical definition pg.5 Form: Diagnostic assessment pg.1 Common misconceptions about concussion pg.7 Form: Return to activities Section B: General treatment approach pg.9 Form: Symptom monitoring log (patient resource) pg.2 Assessment and diagnosis Section D: Additional resources pg.3 Management and recovery planning pg.10 Patient resources pg.4 Monitoring and follow-up pg.11 Provider resources Appendices Appendix A: Pharmacotherapy guidance Appendix B: Clinical symptom management guidance Section A: Concussion overview A concussion is an acute neurophysiological event related to blunt impact or mechanical injury applied to the head, neck, or body, with transmitting forces to the brain.1,2,3,4,5 • Although complex, concussion is manageable in a primary care setting. • There is no perfect diagnostic test or marker for concussion.3 • Although the terms concussion and mild traumatic brain injury (mTBI) are often used interchangeably, they are different conditions along a continuum.3 Evidence of intracranial injury or a persistent neurologic deficit are indicative of a mTBI.1,4 Clarifying common misconceptions about concussions • A concussion does not require a direct blow to the head. Concussion can be caused by impulsive forces acting elsewhere on the body transmitting to the head – such as sudden acceleration, rotation, deceleration (whiplash) or by multiple sub-concussive hits.1,3,4 • A concussion may or may not involve a loss of consciousness.
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  • Brain Injury in Children and Youth: a Manual
    Brain Injury in Children and Youth A Manual for Educators Revised 2018 ACKNOWLEDGMENTS In 2001, the Traumatic Brain injury (TBI) Manual was written as a joint effort between the Colorado Depart- ment of Education, the New Start Project within the Center for Community Participation at Colorado State University in Fort Collins, Colorado, and the Children’s Hospital Colorado. Since 2001, brain injury research and practice has changed significantly. In 2012, the Colorado Brain Injury Steering Committee, led by Karen McAvoy and Judy Dettmer, was instrumental in updating the TBI Manual and creating the stand alone spe- cial education eligibility category and criteria for TBI, which was formally adopted into the Colorado Rules for the Exceptional Children’s Educational Act (ECEA). The newest version of this manual was revised in 2018 by: Judy Dettmer, B.S.W., Director, MINDSOURCE Brain Injury Network, Colorado Department of Human Services Jeanne E. Dise-Lewis (†), Ph.D., Psychologist, Rehabilitative Medicine, Children’s Hospital Colorado, Died September 18, 2014 † Deceased. Patricia W. Colella, M.A., C.A.G.S., School Psychologist Nicole Crawford, Ph.D., Psychologist, Brain Injury Specialist, Colorado Department of Education Heather Hotchkiss, M.S.W., Principal Brain Injury Specialist, Exceptional Student Services Unit, Colorado Department of Education Karen McAvoy, Psy.D., Psychologist, Brain Injury Specialist, Colorado Department of Education Peter Thompson, Ph.D., School Psychologist, Douglas County School District Janet Tyler, Ph.D., Senior
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  • Coping with Memory Problems After Brain Injury Practical Strategies
    Coping with Memory Problems after Brain Injury Practical Strategies Introduction Memory problems are one of the most common effects of acquired brain injury. Sadly there are no cures available, but there are a number of ways of coping and making life easier. This factsheet is designed to provide basic, practical suggestions on coping with memory problems and making the most of memory. The first main section outlines ways of adapting the environment and lifestyle in order to minimise the impact of memory problems. The second main section deals with techniques and strategies which can help people to make the most of their existing memory and to store and recall information more efficiently. Adapting and Coping with Memory Problems There are a number of ways to make life easier. These include: Adapting the environment Using external memory aids Following a set routine Combining several strategies to make a substitute ‘memory system’ Improving general well-being The rest of this section will provide suggestions for each of these categories. Adapting the environment One of the simplest ways to help people with memory problems is to adapt their environment so they rely on memory less. Some ideas for doing so which have helped others are: Keeping a notepad by the phone to make a note of phone calls and messages Putting essential information on a noticeboard Deciding on a special place to keep important objects like keys, wallets or spectacles and always putting them back in the same place Attaching important items to your person so they can’t be mislaid, for example using a neck cord for reading glasses Labelling cupboards and storage vessels as a reminder of where things are kept Labelling perishable food with the date it was opened Painting the toilet door a distinctive colour so it is easier to find Labelling doors as a reminder of which room is which Using external memory aids Many people use external memory aids, regardless of whether they have a brain injury or not.
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  • Clinical Guidebook 5. Mental Health Following Acquired Brain Injury
    Clinical Guidebook 5. Mental Health Following Acquired Brain Injury Pavlina Faltynek MSc, Laura Rees PhD, Ali Bateman MD, Shannon Janzen MSc, Robert Teasell MD FRCPC Table of Contents 5.1 Introduction to Neurobehavioural Disorders Post ABI ...................................................................... 3 5.2 Clinical Presentation of Neurobehavioral Sequelae .......................................................................... 5 5.2.1 Depression ................................................................................................................................. 5 5.2.2 Anxiety Disorders ....................................................................................................................... 6 5.2.3 Agitation and Aggression ........................................................................................................... 7 5.2.4 Addictive Behaviours ................................................................................................................. 8 5.2.5 Suicidal Ideation ....................................................................................................................... 10 5.3 Outcome Measures and Assessments ............................................................................................. 11 5.3.1 Agitated Behavior Scale ........................................................................................................... 11 5.3.2 Overt Behavior Scale ...............................................................................................................
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  • Brain Injury: What Is & What Now?
    Brain Injury: What is & What Now? An acquired brain injury (ABI) occurs after birth when the brain is injured, often resulting in Common Changes after Injury changes in how a person thinks, acts, and feels. Physical/Sensory Non-traumatic Brain Injury (HOW YOUR MUSCLES OR BODILY •Caused by internal forces HEALTH IS AFFECTED): •Common causes can include stroke, substance overdose, lack of oxygen, or Seizures/History of Sexual function tumors. Fatigue Balance Headaches Sensory changes Traumatic Brain Injury (TBI) Sleep disturbance (sight, smell, touch, •Result of external forces, a bump, jolt, or Weakness/paralysis hearing, taste) blow to the head directly or indirectly Movement & coordination •Can lead to potentially chronic challenges affecting not only the person, but the family, community, and services. Thinking •Common causes are falls, motor vehicle collisions, assaults, or blasts. (HOW YOU PROCESS AND ENGAGE WITH YOUR ENVIRONMENT): Different parts of the brain are responsible for different functions a person can perform, such as Memory/recall & Safety awareness a person’s movements, emotions, processing of mental flexibility and impulsivity the sounds/sights around, starting or holding a Attention/ concentration conversation, or being able to pay attention or Problem solving, remember information. & learning decision-making, Planning & organization judgement, and Parietal Lobe Frontal Lobe Integrating sensory Initiation & motivation reasoning Organization & regulation information Task-switching and (attention, processing, Social skills, decision-making, sequencing processing, & speech initiation, etc.) Occipital Fatigue Lobe Visual processing Feelings & Behavior Temporal Lobe Memory, language, Cerebellum (HOW YOU FEEL AND ACTIONS THAT hearing Coordination & Spinal Cord balance MAY BE DIFFERENT FROM BEFORE): When the brain is injured, tasks may be more Difficulty with regulation Lethargy challenging than prior to injury.
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  • Cognitive-Communication CHECKLIST Checklist for Acquired Brain Injury (CCCABI) ©Sheila Macdonald M.Cl.Sc
    Cognitive Communication CHECKLIST for Acquired Brain Injury (CCCABI) An SLP Screening and Referral Tool Sheila MacDonald SLP (C) COMMUNICATION AND BRAIN INJURY • Regardless of severity, acquired brain injuries (ABI) can result in complex cognitive, communicative, physical, and emotional impairments that require interdisciplinary assessment. •This checklist, the CCCABI identifies communication difficulties to be addressed by a speech-language pathologist (SLP) or speech therapist. Communication impairments after ABI: o Are prevalent with reported incidence rates higher than 75%. o Result from a variety of causes including: motor vehicle crashes, falls, sport concussions, blows to the head, stroke, neurological disease, cardiac arrest, or penetrating head injury etc. o Include difficulties with listening, speaking, reading, written expression and social interaction. o Are related to disturbance with underlying systems needed for communication (voice, speech muscles, language, word access, fluency, cognition, thought organization). o Can occur even after mild brain injury or concussion. •Cognitive-Communication deficits result from underlying cognitive or thinking difficulties in attention, memory, organization, reasoning, executive functions, self-regulation, or decreased information processing. • Communication skills are essential to success in daily life. Compromised communication can undermine social participation, family interactions, vocational and academic success. • Speech-language pathologists (SLP’s) are regulated health professionals who are trained to assess and treat communication disorders. They are called speech therapists in some countries. •A full SLP evaluation is recommended based on international standards of care for ABI (Togher et al, 2014). •A full SLP evaluation includes an interview, case history review, analysis of pre-injury functioning, administration & interpretation of standardized tests, qualitative assessment, and functional evaluation of real world communication.
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  • Clinical Guidebook 1. Introduction to Moderate to Severe Acquired Brain Injury
    1 Clinical Guidebook 1. Introduction to Moderate to Severe Acquired Brain Injury Pavlina Faltynek MSc, Robert Teasell MD FRCPC 2 Table of Contents 1.1 Evidence-Based Practice ........................................................................................................................ 3 1.2 What is an ABI? ...................................................................................................................................... 3 1.3 Grading ABIs ........................................................................................................................................... 6 1.4 Neuroanatomy Review .......................................................................................................................... 8 1.5 Mechanism of Injury ............................................................................................................................ 11 1.6 Types of ABI .......................................................................................................................................... 12 1.6.1 Diffuse Axonal Injury ..................................................................................................................... 12 1.6.2 Focal Injury .................................................................................................................................... 14 1.7 Disorders of Consciousness .................................................................................................................. 18 1.8 Post Traumatic Amnesia .....................................................................................................................
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  • 10. Post-Traumatic Seizure Disorder Following Acquired Brain Injury
    10. Post-Traumatic Seizure Disorder Following Acquired Brain Injury Robert Teasell MD FRCPC Shannon Janzen MSc Heather MacKenzie MD Pavlina Faltynek MSc Shawn Marshall MSc MD FRCPC Nora Cullen MSc MD FRCPC erabi.ca Version 13.0 Key Points Phenytoin may be an effective prophylactic drug for early post-traumatic seizures, however its effectiveness to treat late post-traumatic seizures has not been established. Phenytoin is more effective than valproate as a prophylactic anti-seizure medication. Levetiracetam is as effective as phenytoin in treating and preventing seizures in individuals in the intensive care unit post ABI. First generation anti-epileptic drugs are as effective as new generation anti-epileptic drugs in reducing post-traumatic seizures. Glucocorticoid administration may increase seizure frequency. Injections of midazolam may reduce active seizure activity. Carbamazepine may be effective in reducing seizure recurrence. Methylphenidate may be effective in reducing rate of post-traumatic seizures. Surgical resection may reduce seizures if the focus of the seizures can be localized. There is no difference in effectiveness between early craniectomy versus craniotomy for the reduction of the frequency of seizures. erabi.ca Version 13.0 Table of Contents 10.0 Introduction .................................................................................................................................... 1 10.1 Incidence of Post-Traumatic Seizures .............................................................................................
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  • TBI and Memory
    Wisconsin’s Traumatic Brain Injury (TBI) Statewide Task Force/Network Memory Module A Training Module for Parents and Educators of Children Who Have Experienced a Traumatic Brain Injury Funded by an IDEA Discretionary Grant # 2006-9911-22 through the Wisconsin Department of Public Instruction (http://www.dpi.wi.gov) Wisconsin Traumatic Brain Injury Initiative The Wisconsin TBI Initiative is funded through a DPI discretionary grant that provides comprehensive support, guidance and training for all working with children with TBI. A statewide task force has developed materials, training sessions, and formed collections of resource materials. Through DPI discretionary funds, these services/programs are provided to all school districts in Wisconsin. Acknowledgments We would like to acknowledge the efforts of several groups and individuals who provided valuable assistance in the development of these materials. A special thank you to Kathy Wanat, CESA 6; Kim Swenson, CESA 11; Angie Ricci, CESA #11; Judy O’Kane, Wisconsin Department of Instruction project consultant; and Therese Canfield, project coordinator for their extra efforts. We wish also to acknowledge the feedback and suggestions of the Wisconsin CESA TBI Network, made up of representatives from each CESA. Their suggestions, based on use of the training materials and consultation activities, help ensure the materials were responsive to the needs of teachers, parents, and students with brain injury. These CESA Trainers include: CESA 1 Chris Finne, Diane Sims CESA 2 Marie Dorie, Rosemary Gardner CESA 3 Niki Schermacher CESA 4 Colleen Mulder CESA 5 Diane Hatfield, Jo Ellen Waddell CESA 6 Kathy Wanat CESA 7 Dan Konop CESA 8 David Nass CESA 9 Beverly Lonsdorf CESA 10 Carolyn Christian CESA 11 Therese Canfield, Kim Swenson CESA 12 Laura Comer University of Wisconsin – Madison Dr Julia McGivern, TBI Initiative Consultant Finally, we acknowledge the many students, families, and teachers who have helped us all learn about meeting the needs of students with TBI.
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  • Acquired Brain Injury
    © Hamilton Health Sciences, 2002 PD 4347 – 11/2011 wpc/pted/Brain/ChildrensPediatricBrainInjuryHandbook-lw.doc dt/November 22, 2011 Table of contents Topic Page Introduction 1 What is an acquired brain injury? 3 What type of damage has occurred? 4 How much damage has occurred? 5 What tests will my child need? 7 What happens when the brain is injured? 8 How does the brain work? 9 What does each part of the brain do? 10 What happens during recovery? 14 How will my child’s behaviour change during recovery? 17 How much will my child recover? 18 How can I help my child recover? 19 How do the health care providers help my child? 21 How do we work together? 24 What happens when my child is ready to leave 25 the hospital? Where can I get more information? 27 Definitions of common medical words 30 Questions and notes 32 A guide for families of children with an acquired brain injury Introduction At McMaster Children’s Hospital, your child will be cared for by a team of health care providers called the Acquired Brain Injury Team (ABI Team). You and your family are an important part of this team. Together, we will identify your child’s needs and design a plan of care to meet those needs. The health care providers will give you information and support. We believe that you need to know as much as possible about your child’s injury so that you will be able to take part in all stages of his or her care.
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  • Technical Report #2 Treatment for Depression Following Traumatic Brain Injury: a Systematic Review
    Technical Report #2 Treatment for Depression Following Traumatic Brain Injury: A Systematic Review Developed by the Model System Knowledge Translation Center (http://msktc.washington.edu) with support from the National Institute on Disability and Rehabilitation Research (NIDDR) by Grant #H133A060070 October, 2009 Background: Depression following TBI is associated with worse global outcomes (Federoff et al., 1992), worse social functioning during the first year post injury (Jorge et al., 1993b; Schoenhuber et al., 1988), and lower health-related quality of life (Christensen et al., 1994; Rutherford, 1977), even after controlling for medical, demographic and neuropsychologic factors. Purpose: This report outlines the methodology used to systematically review the published literature on pharmacologic, other biological (e.g., electroconvulsive therapy), and psychotherapeutic or rehabilitation treatments for depression after TBI. (see Fann, J., Hart, T. & Schomer, K., Treatment for Depression Following Traumatic Brain Injury: A Systematic Review, Journal of Neurotrauma (in press). Process for Topic Selection: This topic was nominated by members of the Traumatic Brain Injury Model Systems and approved by the directors of the Traumatic Brain Injury Model Systems during the directors’ meeting in December, 2007. Authors for this review were nominated by members of the MSKTC Research Advisory Board. Criteria for Considering Studies for Review: The following criteria were used to select studies of depression interventions in the TBI population in the published literature for this systematic review (see Appendix A: Project Development Plan): a) a study of depression in persons with TBI; b) published since 1980; c) written in English; d) conducted in adults over 18 years; e) a study population that includes adults with TBI and depression.
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