Chapter 1 Flashcards
Cost of BI to society ($)
$76.5 Billion (cost of care and lost productivity)
3 reason a person is at risk for developing significant disability
- awareness and understanding about brain injury remains fairly limited
- BI is frequently not identified
- treatment is not always readily available
acquired brain injury
injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma
traumatic brain injury
alteration of brain function or other evidence of brain pathology, caused by an external force.
2 primary methods mechanisms of TBI
- impact to the head
2. inertial forces which affect the brain
2 types of traumatic impact injuries
- open (penetrating)
2. closed (non-penetrating)
Closed injury
can cause brain lacerations and contusion, or ICH
Inertial forces
non-contact/impact forces; acceleration-deceleration forces where brain is rapidly accelerated within the skull followed by rapid deceleration
results in coup-contracoup injury
phase 1 of secondary brain injury
impaired blood flow
tissue damage
metabolic imbalance
membrane permeability
phase 2 of secondary brain injury
axon terminal depolarization intracellular breakdown apoptosis release of exitatory neurotransmitters free radical generation necrosis
leading cause of traumatic brain injury
falls
how many people sustained a TBI in 2010
2.5 million
percentage of TBIs each year that are mTIBs/concussions
75%
Percentage of brain injuries each year that result in death
2% (53,000)
Percentage of brain injuries each year that result in hospitalization
11% (284,000)
Percentage of brain injuries each year that result in ED visits
87% (2,214,000)
risk factors and indicators for how a BI may affect one’s life
injury severity age at injury alcohol misuse domestic violence service in military participation in sports
risk for second brain injury after first
3 times greater
risk for 3rd brain injury after 2nd
8 times greater
age groups in which falls cause most TBIs
0-4 years
75+ years
leading cause of TBI-related death
MVC
age group in which MVCs cause highest rate of TBI
20-24 years
highest rate of TBI causes for age 0-14
Fall (50.2%)
Struck by or against (24.8%)
MVC (6.8%)
highest rate of TBI causes for age 65+
Fall (60.7%)
Unknown (24.7%)
Struck by or against (5.7%)
MVC (7.9%)
concussion
- trauma-induced alteration in mental status
- may or may not involve LOC
- can result in memory loss for events immediately before or after trauma
- can result in local neurological deficits that may or may not be transient
- may demonstrate vomiting, lethargy, dizziness, and inability to recall what just happened
percentage of sports-related mTBIs that result in LOC
8.9%
age groups most likely to sustain TBI
15-19 years
20-24 years
65+ years
age group with highest incidence of TBI-related hospitalization and death
75+ years
annual percentage of TBIs that occur in children age 0-14
30%
non-accidental trauma causes at least ___% of deaths from head trauma in children under 2 years old
80%
firearm-related TBI deaths are highest among what age groups
20-24 & 75+ years
MVC-related TBI death rates are highest among which age group?
15-24 years
fall-related TBI death rates are highest among which age group?
75+
at any age and by any cause, which gender has the highest rate of TBI-related death?
males
which sports have the highest rates of TBI
bicycling football (highest) playground activities basketball soccer (highest) horseback riding ATV riding
age group with highest rate of ED visits from sports related TBIs
10-19 years
Activities causing TBI at highest rate for children under age 9
playground injuries
bicycling
percentage of people who have shown alcohol intoxication at time of injury
37-51%
age group of drivers with highest percentage of drunk drivers
- 21-24 years (34%)
- 25-34 (30%
- 35-44 (25%)
percent of women victims of domestic violence who also had symptoms of BI
67%
Brief, general screening tools for TBI
Acute Concussion Evaluation (ACE)
HELPS
More detailed TBI assessments
ImPACT (athletes)
Warrior Administered Retrospective Casualty Assessment tool (WARCAT)
Traumatic Brain Injury Questionnaire (TBIQ)-criminal justice system
the continuum of care for BI has changed in response to what 3 factors?
- failures of existing tx options to prevent complications and show functional improvement
- The unique needs of the patient population
- impact of early cost-containment efforts to develop
benefits of accreditation of a hospital
- person centered practices that focus on their health and safety
- robust performance measurement, management, and improvement system that focuses on continuous improvement of both clinical and business practices
- delivery of quality services by competent and well-trained personnel
- accountability to persons served, payers, and regulators
gold standard of accreditation for hospitals, home care, or nursing care centers
Joint Commission
CARF International Accreditation
Commission on Accreditation of Rehabilitation Facilities
- has specific standards for BI rehab
- for sub-acute and post-acute settings, can apply for Medical Rehabilitation Section of CARF accreditation in specific areas
lost productivity costs to society
loss of earning potential, payment of taxes, and re-investment of earnings into the economy
insufficient or inappropriate diagnosis cost to society (not money)
can result in emotional and behavioral disorders, psychiatric hospitalizations, substance misuse, loss of relationships, homelessness, criminal activity
Annual costs of brain injury (medical + lost productivity)
$76.5 billion (does not include non-traumatic BI)
percentage of people with severe BI that have adequate funding for long term tx and supports
5%
primary private funding for BI care
auto insurance
work comp
commercial health insurance
primary public funding for BI care
medicaid/medicare
Home and community Based Waivers
Home and Community Based Waiver Programs (HCBS)
allows medicaid recipients to waive one or more of the requirements for eligibility for funding and provision of services.
Done by state, needs CMS approval
Vocational Rehab
The Rehabilitation Act of 1973 set foundation for these federal/state-supported programs that assist persons to secure gainful employment
Olmstead Decision
gradually challenged federal, state, and local governments to develop more opportunities for persons with disabilities to be served through community-based services
TBI Act of 1996
Passed to expand efforts to
1. identify methods of preventing TBI
2. expand biomedical research efforts or minimize the severity of dysfunction as a result of TBI
3. improve the delivery and quality of services through state demonstration projects
Gave authority for
-CDC to establish projects to prevent and reduce the incidence of TBI
-NIH to award grants to conduct basic and applied research on developing new methods for more effective diagnosis, therapies, and continuum of care
-HRSA to make grants to states to carry out demonstration programs and implement systems that ensure statewide access to comprehensive and coordinated TBI services
Requirements for HRSA grant funding
- have statewide TBI advisory board
- designate lead state agency for BI
- maintain staff positions responsible for TBI activities
- statewide needs assessment to address full spectrum of services from initial acute treatment through community reintegration for persons with TBI
- statewide action to develop comprehensive community based system of care, encompassing physical, psychological, educational, vocational, and social aspects of TBI services while addressing the needs of persons with TBI and their families
persons with TBI are ___times more likely to die compared to non-TBI injuries
2 times
Persons with TBI have a life expectancy reduction of ___ years
7 years
Persons surviving TBI greater than 1 year are ___ times more likely to die of seizures
37
Persons surviving TBI greater than 1 year are ___ times more likely to die of septicemia
12
Persons surviving TBI greater than 1 year are ___ times more likely to die of pneumonia
4
Greatest proportion of deaths following TBI are from
circulatory problems
Persons surviving TBI greater than 1 year are ___ times more likely to die of suicide
3
Persons surviving TBI greater than 1 year are ___ times more likely to die of aspiration pneumonia
49
Persons surviving TBI greater than 1 year are ___ times more likely to die of digestive disorders
2.5
Overall, persons with TBI are ___ times more likely to die compared to uninjured individuals
1.5
TBI accounts for __% of all epilepsy cases in the general population
5
leading cause of epilepsy in young adult population
Within 1 week after a penetrating TBI, ___% of individuals will experience a seizure
35-65
Risk of sudden death in epilepsy patients (SUDEP) is ___ times that of the general population
20 times
Olmstead utilizes Title ___ of ADA
Title II- states administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities
Highest award given to CARF-accredited facilities
3 years of accreditation
Other designations given by CARF below highest level
1 year accreditation
provisional accreditation
non-accreditation
Common comorbidities following BI
- epilepsy
- Alzheimer’s
- sleep disorders
- hypopituitarism
- sexual dysfunction
- Chronic traumatic encephalopathy (CTE)
- neuroendocrine disorders
- incontinence (neurogenic bladder)
- psychiatric diseases
- spasticity
- HO
CMS requires states to enforce service definitions so that providers of BI services are providing:
- Person centered planning (PCP) as part of delivery process
- PCP that supports individuals to be as independent as possible based on comprehensive assessments and conducted as much as possible in real-life settings
- age appropriate services and supports
- freedom to move about in the community
- home-like residential setting in community with privacy
- services that are integrated and accessible to other public services like transportation and recreation
- PCP that involves vocational and integrated employment goals, including volunteer work when appropriate, or other meaningful daytime activities
TBI Model Systems
develops a model system of care and maintains a standardized national database for innovative analyses of treatment and outcomes
TBIMS center requirements
coordinated system of emergency care, acute neuro-trauma management, comprehensive inpatient rehab, long-term interdisciplinary follow-up services
Center on Outcome Measurement in Brain Injury (COMBI)
an online resource for detailed information and support on outcome measures for persons with BI
-maintained by the Rehab Research Center at Santa Clara Valley Medical Center
dementia puglistica
medical term for CTE or being punch drunk
Symptoms of CTE
begins slowly with deterioration in: -concentration -attention -memory -judgment -insight -occasionally accompanied by dizziness and headaches Other symptoms: -suicidal thoughts -apathy -impulsiveness
severe symptoms of CTE
- parkinsonism
- impaired coordination
- slowed gait
- slurred speech
- masked face
- difficulty swallowing
- tremors
indicators of severity of CTE
severity correlates with length of time engaged in the sport and the number of traumatic injuries
psychiatric diseases at risk for following TBI
OCD anxiety psychotic disorders mood disorders major depression
incidence of post-injury fractures with TBI
30%
Heterotropic ossification (HO)
development of new bone formation in soft tissue planes surrounding neurologically affected joints
- high risk for people who experience fractures of long bones with TBI
- if left untreated, will eventually lead to abnormal bony fusions and subsequent functional limitations
incidence of HO following TBI
10-20%
