The Face of Traumatic Brain Injury

Gale Whiteneck, Ph.D.Director of Research Craig Hospital

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The Face of Traumatic Brain Injury

• More young than old

• More male than female

• More cognitive than physical disabilities

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Invisibility of TBI

• If disabilities have been too invisible to society

• If cognitive disabilities are invisible in the word of disability

• Then TBI may be a relatively invisible cognitive disability

• But the troupes returning from Iraq and Bob Woodward may change all that

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The Numbers of TBI• Each year in the US, CDC estimates:• 50,000 people die from TBI• 235,000 people are hospitalized with TBI• 1,100,000 people with TBI are treated

and released from Emergency Departments

• A large but unknown number are either seen in physicians’ offices or clinics or do not seek medical attention

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The Severity Spectrum of TBI• The depth of alteration of consciousness

(Glasgow Coma Scale)• The length of loss of consciousness• The length of Post Traumatic Amnesia (PTA)• Imaging of the brain (CT, MRI)• Severity measures are not necessarily

consistent• The initial severity is not necessarily a good

predictor of long-term outcome

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The Face of TBI in this Audience• Have you ever been injured?

– Car crash, sports, falls, violence, abuse

• Was your head or neck injured?– Blow to the head or whiplash

• Did you experience any alteration of consciousness?– Dazed or confused

• Did you experience loss of consciousness?– Knocked out or blacked out

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Have you ever had a TBI?

A: Never had an injury to the head resulting in even being dazed or confused

B: Have had one or more injuries to the head with altered consciousness, but never experienced loss of consciousness

C: Have had one or more head injuries with loss of consciousness, but never more than 30 minutes

D: One loss of consciousness greater than 30 min

E: More than one loss of consciousness > 30 min

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Pathways of TBI Care

• Hospitalization

• Seen in Emergency Department and released

• Seen in physicians office or clinic

• No medical care sought

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Consequences of TBI

Of all the people that are hospitalized (for even one night) after a TBI (even if it wasn’t the reason for the hospitalization), what proportion will have life-time cognitive deficits resulting in the need for assistance from others?

A: 1/10 B: 1/5 C: 1/4 D: 1/3 E: 1/2

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Consequences of TBI

• 5.3 million people are living in the US with significant disability after being hospitalized with TBI

• It is unknown what percentage of people with non-hospitalized TBI have significant life-time disability

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Types of TBI

• Focal

• Diffuse (increasing disruption of axonal fibers)– Mild concussion– Classic cerebral concussion– Diffuse axonal injury– Diffuse white matter injury

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Common Cognitive Impairments

• Attention/Concentration

• Speed of Information Processing

• Problem solving/judgment

• Short Term Memory

• Lack of self awareness

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Common Emotional Psychosocial Impairments

• Anxiety

• Mood disorders, depression

• Emotional dysfunction, impulsivity, anger

• Impaired social skills, loneliness

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Common ADL/Participation Difficulties

• Meal planning, preparation, cleanup

• Hygiene, dressing, grooming

• Money management, budgeting

• Time management

• Driving, public transportation

• Work, school, volunteer

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Technology Applications to TBI

• Cognitive rehabilitation

• PDA-based memory aids

• AT for independent living, working, QOL

• Advanced cognitive prostheses

• Aids in increasing social capital

• The NIDRR-funded TBI Model Systems as a research laboratory

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After Thinking About TBI BrieflyA: I never knew much about TBI and it doesn’t

interest meB: I have never focused on TBI in my work,

but see that it is an important disabilityC: I have never focused on TBI in my work,

but think it might be relevant to TBID: TBI has been one of the focuses of my

workE: TBI has been the primary focus of my

work, or soon will be

Questions?

Thank you!

Gale Whiteneck, Ph.D. 303-789-8204

gale@craig-hospital.org

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Craig HospitalSpecializing in Spinal Cord Injury

and Traumatic Brain Injury Rehabilitationsince 1956

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Craig Hospital ______________________________________________________________________________________________________________________

“A Century of Rebuilding Lives”

1907-2007