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OVERVIEW OF ACQUIRED
BRAIN INJURY
What is
it?
Any damage to the brain that occurs after
birth. This does not include damage that
is caused by congenital or degenerative
diseases.
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Physical Injury

e.g. Traumatic Brain
Injury: brain damage that is
caused by rapid movement
or impact to the head.

Some Methods
motor vehicle accidents
falls
baby shaking
Impact Injury to the Brain
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Cerebrovascular Accidents:

Ischemic: damage to the brain
that is caused by blockage of
blood vessels.

Hemorrhagic: brain damage
that occurs from rupture of
blood vessels.

Precipitating Factors
hypertension
high cholesterol









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2004
CVA
965 Trinidadians Hospitalized
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Tumors:

Brain Tumor: a mass of
useless cells that grow
out of control in the
brain.

Etiology

radiation


TOXINS
GENETICS
TOBACCO
RADIATION
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2000-2002
Brain Cancer
2nd leading type of cancer in the 0-14 age group
in the top 4 in the 14-24 age group
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Infections

e.g. Encephalitis: acute
inflammation and
irritation of the brain.

Infective Agents
viruses
toxins
bacteria



Brain showing severe infection
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How much does the general public know about ABI ?
Should public education focus on ABI instead of on the
different illnesses on an individual level?
. Could this approach lead to better prevention measures?
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A team approach is often used to treat
persons with ABI. The health team may
include Medical Practitioners,
Radiologist, Psychologist, Occupational
Therapist, Pharmacist, Psychiatrist,
Recreational Therapist and Social
Workers.

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An example of this team work is when
neurological investigation and
neuropsychological testing are used to
complement each other.
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Neurological
Investigations

1. Diagnose
2. Help to trace brain
changes
3. Identify anatomical
and physiological
location of damage.

Examples include:

MRI
SPECT





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Magnetic Resonance Imaging Procedure

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Neuropsychological Assessment
Interview
Behavioural
Observations
Neurological
Test
The neuropsychological assessment is very comprehensive .

Interview: a detailed history is collected
from the client and relatives.

History of the following:
Developmental
Occupational
Social
Family
Educational
Mental Health
Biographical
Medical
Treatment





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Behavioral Observations: using the senses to
gather information about the client.

Methods of observation include:
Open conversations
Structured conversations
Controlled environments
Uncontrolled environment
Familiar settings
Unfamiliar settings




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Neuropsychological Test: are based on standardized
procedures that yield results which are compared to that of the
standard population.

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Cognitive Impairment
Non Verbal Memory
. immediate
. delayed
. learning

Verbal Memory
. immediate
. delayed
. remote
. learning

Orientation
Processing Speed

Test




Weschler Memory Scale
Tactile Performance Test
WAIS (Weschler Adult Intelligence
Scale)




Weschler Memory Scale
Weschler Memory Scale
WAIS
Rey Auditory Verbal Learning Test


Galveston Orientation & Amnesia
WAIS
Test Commonly Used to Assess Cognition

Cognitive Impairment
Reasoning & Judgement
. concept formation
. reading comprehension
. judgement & safety
. logical deduction and reasoning

Oral reading

Calculation

Spelling

Attention & Concentration
. immediate
. sustained

Test

WAIS
Gray Oval Reading Test
WAIS
Luria-Nebraska receptive Speech Scale
(Selected items)

WRAT (Wide Range Achievement Test)

WRAT

WRAT


Digit Span Forward - WAIS
Digit Span Backwards- WAIS

Test Commonly Used to Assess Cognition
No local laws to govern who does psychological testing
The Public Service resources for testing children is inefficient


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Should there be routine neuropsychological screening for
ABI ?
Or what you do not know cannot hurt you?
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A cognitive deficit is any impairment in intellectual
functioning.

This includes:

Attention
Memory
Concentration
Perception
Planning
Organization
Orientation
Sequencing

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Feeling Personality
Abstract
Reasoning

Memory Concentration
Personality
Learning
Memory

Planning
Motivation
Perception
Learning
Memory

Perception
Comprehension
Visual
Processing
Thalamus
Anterior Temporal
Tempoparietal Occipital

Location of Damage
Prefrontal
Frontal Thalamic
Anterior temporal
Mid temporal/ Diencephalon
Tempo Parietal
Deeper Parietal
Occipital
Inferior Temporal
Posterior Temporal
Brain Stem/ Limbic system/Deep
Frontal Temporal Connections
Fibre Systems in Hemispheres

Function Effected
abstract reasoning, feelings, personality
planning, motivation
perception, learning, memory
learning, memory, personality
complex perception, comprehension
cognitive and perceptual integration
primary and secondary visual processes
memory, learning, visual discrimination
visiospatial, processing information, verbal visiospatial
learning, memory, personality

slight subjective changes
Brain


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Name: PG
Age: 25
Sex: Male
Ethnicity: American
Marital Status: Single
Occupation: Construction
Presenting Problem: Brain Injury
On Average One Person Who Has a History of Head Injury is
Admitted to St Anns Hospital Every Three Months.


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Since adults with ABI are more at risk for cognitive defects
should the public resources that are available be more
focused on the adult population?
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Substitution
Substitution explains that rehabilitative
outcomes are seen when brain tissue that has
been slightly damaged or not damaged at all
take over the roles of those tissue that have
been damaged.
It suggests that the brain is flexible in the
way that it communicates with its structures.
Another premise is that the brain has reserve
tissue that is either not utilized or
underutilized. (Ruff, & Baser, 1990).

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Compensation

Compensation theory proposes that
parts of the brain that are responsible for
lower level functions take over higher
levels of functioning when there is brain
damage (Ruff, & Baser, 1990).


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Relearning

Relearning theory proposes that when
individuals are exposed to activities and
feedback is given the person can learn
new behaviors despite how severe the
brain is injured.

In addition, new ways of doing things
can compensate for lost functions. This is
the main principle behind rehabilitative
treatment (Ruff, & Baser, 1990).

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Based on the number of people hospitalized with
different classes of ABI, it can be considered to be
one of the leading causes of disability in Trinidad.

Many of the rehabilitative strategies are lacking the
supportive research. Should therapist continue to use
them despite this lack of empirical evidence?
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Goals of rehabilitative strategies includes the
improvement of the clients quality of life by increasing
independence and facilitating readjustment. Another
goal is to exercise the brain.


Research has shown that rehabilitation is linked to
structural and functional changes in the brain.

It should not be assumed that people living with ABI
will return to their pre-injury level of functioning.
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Pharmacological Interventions: have been used to treat
symptoms such as poor concentration and other
behavioral problems.
The classes of drugs used is dependent on the presenting
problem.
Anxiolytic- anxiety
Hypnotics - insomnia
Antidepressants- depression
Stimulants- concentration and impulsivity

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One limitation of pharmacological strategies is that they
may have side effects.
However, they may serve as one of the more cost
effective strategies for the financially challenged.
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Social workers are involved to assist the person in
accessing social services such as housing and finance.
People need to meet their basic physiological needs,
such as food, clothing, and shelter, in order to recover
and survive.
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Occupational therapy helps clients to improve their
social skills, and assist to reintegrate clients back into
the community. This is an important part of
rehabilitation.


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Family therapy, is a necessary part of the
rehabilitative process for persons living with
cognitive defects. The family needs to
resolve emotional issues, so that they are
able to offer the client a supportive,
nurturing environment.
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Biofeedback: this is a new method that is being used by
psychologist who have specialist training in this area.
It uses reinforcement to alter brain activity. The
patient is given information about how his or her body
is functioning. The person then uses this feedback to
train their reaction. It is especially useful in treating
the physical effects of ABI.
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Retraining Methods

Written Rehearsal
Verbal Rehearsal
Acronym Formation
Visual Imagery
Chunking
Association
Rhyme Formation

Compensation Methods

Storage Devices
Cueing Devices
Restructure
Environment

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Strategies to Improve Memory

Retraining Methods
e.g.
Compensation Methods
e.g.
CHECKLIST4
3
Strategies to Improve Memory
CHUNKING
ACRONYMS
ALARM CLOCK
DIARY
COMPUTERS

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Daily Orientation Groups


Individual Orientation

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Strategies to Improve Orientation


Environmental Restructuring
Salience of Target Groups
Checklist
Self Monitoring
Self Talk
Overlearning
Altering Consequences
Feedback
Cueing devices






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Strategies to Improve Attention


Video Therapy
Natural Consequences
Personal Adjustment Group






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Strategies to Improve Self Awareness

Video therapy in action

Scheduled Problem Solving
Current Event Groups
Flow Sheet
Problem Solving Groups






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Strategies to Improve Problem
Solving


Planning Groups
Planning Checklists
Repeated Exposure
Current Events






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Strategies to Improve Planning
Disorder

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A session with an Occupational Therapist in Trinidad
starts at $200TT, and the price for neuropsychological
testing can be thousands of dollars.

Do the benefits of rehabilitation outweigh the cost,
considering that that there is no guarantee that the individual
will return to a higher level of functioning?

It is better to be cost effective and stick with pharmacological
methods, which are much more reasonably priced?
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Should private service providers lower their cost so
that more people can afford to assess their services?
Is the quantity of money that these professionals are
asking for on par with the standard of service that
they provide?
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ABI is any injury that occurs to the brain after birth that is
not related to degenerative or congenital disorders.
It can be diagnosed using a variety of methods including
MRIs. Neuropsychological assessment findings are also
seen as indicators and aid to plan rehabilitation.
Persons impacted by ABI often experience psychological,
biological and social effects.
Theory, and some research indicate that some of the effects
of impact can be treated, but never 100% return to normal.
Treatment includes rehabilitation methods such: music
therapy, occupational therapy, family therapy, group
therapies, individual therapy, and pharmacological
strategies.
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Refreshments are served