What is a head injury?
 
 

Head injury facts:

incidence:

prevalence:

Who is most likely to sustain a head injury?

1.

2.

3.

some more facts:

• males sustain nearly 3 times as many brain injuries as females
• over 50% of individuals with brain injuries sustain them before age 35
• motor vehicle accidents (MVAs) cause nearly 1/2 of all brain injuries
• head injuries occur in more than 2/3 of all automobile accidents

• penetrating head injury:

example:

typical damage:

• closed head injury:

 

damage results from direct contact and/or inertial forces:

coup/contracoup -
 
 

acceleration/deceleration -

diffuse axonal injury (DAI) -

Secondary complications

edema -

raised intracranial pressure -

hypoxia -

infarction -

hematomas -

infection -

main idea:

different mechanisms theorized to account for this (that you won't be tested on!):

• diaschesis - recovery of function following temporary disruption of areas adjacent to primary area of damage
• axonal growth - making new connections
• denervation supersensitivity - partially damaged neurons become more sensitive to neurotransmitter
• substitution - intact areas of the brain take over functions of damaged areas

emergency care -

coma care -

skilled care -

inpatient rehabilitation -

outpatient rehabilitation -

community reintegration -

physical -

cognitive -

psychosocial -

Role of the SLP

speech

swallowing

language -
 
 

cognition -

cognitive rehabilitation -

Cognitive functions/deficits

1. sensory reception and perception
 
 
 
 

2. attention

alertness/arousal -
 
 

clinical model of attention (Sohlberg & Mateer, 1989):

a) focused attention

b) sustained attention

c) selective attention

d) divided attention

e) alternating attention

retrograde impairments
 
 

anterograde impairments
 
 

prospective memory
 
 

post-traumatic amnesia

4. executive functions

examples:

• goal selection
• planning
• anticipating problems
• recognizing errors and fixing them
• completing tasks

5. reasoning and problem solving
 
 
 
 

6. awareness
 
 
 
 

Approaches to cognitive rehabilitation

Brain injury education
 
 

Skills based training
 
 

Process oriented training

principles of treatment

hierarchy of treatment

repetition

addressing generalization

Communication deficits following ABI

Speech
 
 
 
 
 
 

Language

why not aphasia?

language of confusion

results from:
 
 

characteristics:

Pragmatics

Milton, Prutting and Bender, 1984:
 
 
 
 

1. Nonverbal communication
 
 
 
 

2. Communication in context

3. Message repair
 
 

4. Cohesiveness of narrative

Brain injury effects for adults and children
 

ADULTS

CHILDREN

Feelings that apply to everyone:
 
 

People tend to believe that brain injuries occur "by accident,"; that is, that they can not be anticipated or prevented. In truth, the vast majority of traumatic brain injuries are caused by incidents whose impact could be lessened, or actually prevented, through the adoption of certain safety-conscious behaviors.

Here are some of the simplest actions you can take to lessen your - and you loved ones' - risk of sustaining a traumatic brain injury:

Drive the speed limit. Upon adoption of the 55 mile per hour speed limit, the crash rate in the US decreased by 34%; the recent changes to higher speeds have seen an increase in the number of crashes. Driving 65 mph in a 55 mph zone increases the risk of automobile crash by a factor of 2.0, the same increase in risk associated with driving with a blood alcohol content of 0.09%.

Never drink and drive. Alcohol consumption is associated with 50% of automobile crash fatalities in the US.

Wear your seatbelt. Seatbelts have been shown to be effective for reducing the risk of serious injuries for drivers (52%) and right side front passengers (44%).

Wear a helmet. And be consistent in using them. Helmets are 78% effective in preventing head injuries in motorcycle riders and 80% effective for bicycle riders. They are also essential gear for popular activities such as skateboarding, rollerblading, and ice hockey (would Wayne Gretski have such a long and amazing career if he hadn't worn a helmet?).

Always keep firearms locked in a gun safe or cabinet and store bullets away from firearems. Never give children or adolescents access to firearms, including BB and pellet guns, without your supervision. Particular care should also be made to ensure that individuals who are depressed, seriously ill, or who have dementia are not able to access firearms.

Teach your children the importance of being safe. Make sure they wear their helmets consistently and properly (on straight and covering the forehead) and that they learn how to negotiate the streets safely. Bicycle related falls and pedestrian/automobile accidents are the greatest contributors to head injury in school aged children up to age 15.