Traumatic Brain Injury Notes
The topic for the day is head injuries with the reminder 'Don't ride murder cycles.'
Two rules to limit concussions and broken bones:
Don't jump off anything you can't climb up.
Don't go fast leaning in pedal.
Traumatic Brain Injury (TBI)
TBI typically refers to injuries from an external cause.
Strokes and aneurysms can be considered internal TBIs.
Types of TBI
Open Head Injury: Skull is broken, and something penetrates the skull (e.g., Phineas Gage).
Closed Head Injury: Injury happens internally without skull breakage (e.g., a fall and hitting the head).
Protection and Forces at Play
The head is well-protected, but injuries can occur.
Closed head injuries involve multiple forces.
Initial side of impact.
The brain is suspended in cerebral spinal fluid, which cushions it.
Brain sloshes around inside the skull upon impact, causing bruising (contusion).
Brain bounces, causing injury on the opposite side (counter lesion or counter injury).
Neural connections can get torn due to the brain bouncing, called shearing.
Impact and Examples
Injuries can be devastating due to damage at the point of impact, opposite the point of impact, and shearing injuries.
Helmets should be worn even in grocery carts to prevent serious head injuries in children.
Symptoms of TBI tend to be more diffuse compared to the localized effects seen in aphasia's related to strokes.
NFL concussion protocols and concerns about long-term impacts of repeated head injuries, such as personality changes and reduced empathy.
Subtle Language Difficulties
Individuals with TBI may have subtle language difficulties, not detectable through standard articulation, vocabulary, or syntax tests.
Difficulties manifest in high-level thinking, theory of mind, and empathy tasks.
Inability to recognize appropriate or inappropriate behavior.
Examples and Personal Anecdotes
A student with a TBI asked an inappropriate question about age, showing a lack of awareness due to the injury.
Sharing life experiences inappropriately can be a sign of TBI.
Social Aspects of Language
Subtle language differences refer to an inability to modify behavior or recognize when something is appropriate.
This impacts social relationships and is not detectable through standard language tests.
Increase in lability (emotional instability) is also common, with quick shifts in emotions.
SLP and Strategies
SLPs dig deeper to assess social situations and theory of mind tasks.
SLPs help individuals develop strategies to improve social interactions.
Example: Jared Newport
Jared Newport, who is on the spectrum, was taught not to express his immediate thoughts and avoid using the word "stupid".
He followed this rule to improve interactions, demonstrating how individuals can follow rules without fully understanding why.
Personal Routines
Following routines or rules without fully understanding their purpose can be helpful.
Example: Not drinking coffee until being awake for at least two hours.
Signs of TBI Severity
More severe TBIs can result in loss of memory, cognition, disorientation, and language.
The expression, 'If you've seen one instance of x, you've seen one instance of this' applies to TBI.
Recovery Windows
First 48 Hours: Major changes are likely to occur.
First Week: Significant changes can still happen.
First Month: Minor changes may occur.
Two Years: Most changes occur within this period.
SLP Roles in Different Settings
Inpatient Acute Setting: Immediate assessment to establish the level of care and rehab options.
Rehabilitation Setting: Further screening and therapy within the first week to a month.
Outpatient Clinics: Long-term rehab (one to two years).
Insurance companies typically do not provide therapy beyond two years post-injury.
Doctor Ballan's Research
Doctor. Ballan's research showed that therapy post two years of head injury or stroke can still be beneficial.
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Key Takeaways
Don't ride murder cycles.
Remember the journal assignment and quiz retakes.