Traumatic Brain Injury. Living with the cognitive, behavioral and psychosocial consequences of TBI

Transcription

1 Traumatic Brain Injury Living with the cognitive, behavioral and psychosocial consequences of TBI

2 Marilyn Lash, M.S.W. Chair, North Carolina Brain Injury Advisory Council Tel

3 Wounded Warriors Meaning of Trauma Latin for wound Wounded Body Mind Spirit Relationships The Big Picture over a Lifetime Walsh, F. (2006). Strengthening Family Resilience. New York: The Guilford Press.

4 Brain Injury is a Family Affair Mourning the Survivor Ambiguous Loss Each family member affected Parent Spouse / Partner Sibling Child

5 We ve only been married 2 years and now I m his caregiver. When fear becomes the reality Blast injuries PTSD Undiagnosed concussions Emotional trauma for parents, spouses and children

6 Life changes when a family member Helps with physical care Gives emotional support Supervises for safety Helps with communication Manages new behaviors Advocates for services Provides/replaces family income

7 Physical Changes after TBI Headaches Seizures Nausea Weakness or paralysis Balance difficulties Clumsiness Changes in vision or hearing

8 More Physical Changes Loss of smell or taste Changes in appetite or swallowing Sensitivity to smells, light, sound Changes in sensitivity to touch Fatigue Sleep disturbances

9 Cognitive Changes after TBI Amnesia (retrograde & post) Short-term or long term memory loss Slowed processing of information Difficulty with organization Poor judgment Inability to multi-task Lack of initiation Distractibility Repetitiveness

10 Communication Changes Slurred or unclear speech Difficulty finding right word Difficulty staying on topic Poor conversational skills Difficulty reading or writing Rate of speech fast or slow Literal interpretation Impaired comprehension

11 Behavioral & Emotional Changes Increased anxiety or depression Ego centric or self centered behavior Easily irritated, angered or frustrated Overreactions crying or laughing Sexual behavior hypo or hyper Impulsiveness Mood swings Stubborness or rigid thinking

12 Fall Out at Home Loss of friends leads to isolation Depression Substance abuse alcohol and drugs Stress on caregivers Secondary losses income, job, relationships, roles Marital relationships and parenting

13 Critical Issues for IoM to Address Feedback on Draft Report A comprehensive continuum of brain injury services simply does not exist in North Carolina. Annual report to Governor by Council, 2009.

14 Concussion There s nothing mild about it. IoM: A small %age of patients may experience a more prolonged course and benefit from further evaluation. Post Concussion Syndrome Number of concussions + time between concussion Comorbidity with PTSD Reluctance to report tough it out military culture Non pursuit of medical evaluation for concussion (57%) Normal CT scans and neuro exams Increased risks for aging veterans over time

15 Concussion Recommendations Need more than screening Improved diagnosis with intervention and treatment Concussion clinics in VAs and community access (Vet Centers) Concussion specialists on staff and for consultation Neuropsychologists with training in post concussion syndrome Family and service member education on concussion symptoms and consequences, including risky behaviors

16 Post Traumatic Stress Disorder Intrusive nightmares & flashbacks Numbing feeling depressed & empty Avoidance of triggers Hyperarousal anxious & vigilant Treatment and education for codisorders of TBI and PTSD across facility and community providers Consequences increased substance abuse, domestic violence, homelessness, arrests/jail.

17 Family Impact - cannot treat TBI in isolation from family Gap in VA service system Family education and training needed Family support, counseling, mentors Caregiver training and skills Risks: divorce, child neglect/abuse, domestic violence, aging caregivers What about me? Military children

18 Treatment Moderate to Severe TBI IoM = Need to address long term impact over lifetime Population in greatest need for neurobehavioral services, residential care, and long term supports. Backlog in processing disability applications Case management services in community Public sector does not have a safety net

19 Substance Abuse Increased risk after TBI Initial use declines then increases Traditional approaches limited (AA) Linked to depression, isolation, suicide risk, PTSD Mandate TBI and PTSD screening in all SA programs

20 Unmet Needs in TBI in NC Continuum of neurobehavioral services Family support and education Residential services Community supports, transportation, recreation, home care, day programs, clubhouses

21 Neurobehavioral Task Force Specialized Neurobehavioral Unit Based on best clinical practices Crisis support, short-term care, stabilization Trained staff with behavioral expertise Safe and protective environment Case management

22 Triage and Screening for Hospitals and Rehabilitation 6 level 1 Trauma Centers in NC Prehospital staff EMS and police Local Emergency Departments Case management Discharge planning

23 Team Models for Neurobehavioral Services Regional NB teams to Prevent crises Provide education and resources Give consultation Mobile SWAT teams for multi settings In-home support and training Homemaker and home health agencies

24 Vocational Rehabilitation - TBI High unemployment rate for more serious injuries Neuropsychological assessments required for vocational services Training for VR staff on TBI

25 Lead Agency Div Mental Health State funded services can help fill in some of the gaps. (Ch 1, p 2) - FALSE Inadequate funding for civilians DoD contracts with private providers helpful but NC has very limited community capacity Home and Community Based Medicaid Waiver Dedicated fund with recurring revenue Licensing requirements for TBI services and programs