Traumatic Brain Injury: An
Helping Mental Health Professionals
Identify, Support and Treat
Individuals with TBI
A Product of..
The Maryland TBI Post Demonstration Project
This Presentation prepared by:
Maryland Department of Health and Mental Hygiene
The Maryland TBI Post Demonstration Project
The Mental Health Management Agency of Frederick
“…supported in party by # 1H82 MC 00019-01 from the
Department of Health and Human Services (DHHS) Health
Resources and Services Administration, Maternal and Child
Health Bureau. The contents are the sole responsibility of
the authors and do not necessarily represent the views of
DHHS. This is in the public domain. Please duplicate and
distribute widely. “
• 1.5 million Americans each year
• 80,000 each year experience long term
disability following a brain injury
• Traumatic Brain Injury is the leading cause
of death and disability for Americans under
• Risk of TBI is higher for men then women
• In 2000 there were 5,229 traumatic brain
• 5% of all hospitalizations were TBI related
• 25% of all injury related deaths for ages 15-
24 were TBI related
• 11% of all injuries to children 14 and under
were TBI related
• Non-Firearm Assaults-9%
How Does TBI Compare?
• TBI results in 1 1/2 times more deaths each year
• More Americans died as a result of TBI between
1981 and 1993 then have been killed in all the
wars in our history combined
• Each year 1.5 million people sustain a TBI, that is
8 times the number of individuals diagnosed with
Why are the numbers so big?
• 30 years ago, 50% of individuals with TBI
died, the number today is 22%
• due to:
• Improved medical technology and
• Safety features such as car seatbelts, child
safety seats and airbags
• Traumatic Brain Injury is an insult to the
brain caused by an external physical force
• Acquired Brain Injury is an insult to the
brain that has occurred after birth, for
example; TBI, stroke, near suffocation,
infections in the brain, anoxia
Types of TBI-Mild
• Most common, 75%-85% of all brain
injuries are mild
• Individuals experience a brief (<15
minutes)or NO loss of consciousness
• Normal neurological exam
• 90% of individuals recover within 6-8
weeks, often within hours or days
Types of TBI-Moderate
• LOC/Coma between 20-30 minutes to 24 hours,
followed by a few days or weeks of confusion
• EEG/CAT/MRI are positive for brain injury
• 33-50% of individuals with moderate brain injury
have long term difficulties in one or more areas of
Types of TBI-Severe
• Almost always results in prolonged
consciousness or coma of days,weeks, or
• 80% of individuals with severe brain injury
have multiple impairments in functioning
• Memory • Executive skills
• Attention • Problem solving
• Concentration • Organization
• Processing • Self-Perception
• Aphasia/receptive and • Perception
expressive language • Inflexibility
• Motor skills/Balance
Possible Changes-Personality and
• Social skills problems
• Mood swings
• Problems with emotional control
• Inappropriate behavior
• Inability to inhibit remarks
• Inability to recognize social cues
Personality and Behavioral cont..
• Problems with initiation
• Reduced self-esteem
• Difficulty relating to others
• Difficulty maintaining relationships
• Difficulty forming new relationships
• Stress/anxiety/frustration and reduced
Lack of Awareness
A common and difficult to remediate
hallmark of a brain injury
Focus of Rehabilitation and
Often Lifetime Support
• Increase individual’s awareness of injury
• Increase awareness of the the impact these
deficits have on current functioning and
• Teach to anticipate how these deficits could
affect future plans/activities
• Teach the individual strategies for
compensating for injury imposed deficits
• Treating therapists should conduct home
visit to ensure strategies are meaningful in
and carry over to the home environment
Strategies for Remediation and
• Use of a journal/calendar
• Create a daily schedule
• “To do” lists
• Labeling items
• Learning to break tasks into small
• Use of a tape recorder
• Encourage use of rest and low activity periods
• Work on accepting feedback or coaching from
• Work on generalizing strategies to new situations
• Use of a high lighter
• Alarm watch
• Review schedule each day
• Post signs on the wall etc.
• Try to “routinize” the day as much as
• Model how to paraphrase during
conversations to maximize comprehension
• Instruct how to reduce injury imposed
tendency to be impulsive in word and/or
action by using breaks and pauses
• Speak in short, simple sentences and
• Request that the individual jot down notes
regarding discussions that he/she has with
others and other important information
• When giving instructions, do it verbally and
in writing and when possible, physically
model the task
• Don’t use the word inappropriate. Rather,
give useful and specific feedback about a
• Treat the individual like an adult in context,
tone and body language
• Ask the individual for permission to coach
• Be clear on your expectations of the individual
and his/her behavior
• Give feedback immediately using the sandwich
• Utilize positive reinforcement/feedback
• Formalize your expectations by negotiating a
written contract, signed by all involved parties
• Refer to the contract frequently, update as needed
The Goal is to…...
Enhance the Predictability of the
TBI Screening, Adapted From:
Ohio Valley Center for Brain Injury
Prevention and Rehabilitation
John Corrigan Ph.D
Have you ever been injured
following a blow to the head?
• As a child?
• Playing sports?
• From a fall?
Have you ever been hospitalized or
treated in an emergency room
following an injury?
• Treated and released?
• Evaluated by a neurologist?
• Had a CAT scan, MRI or EEG done while
in the emergency room?
Have you ever been unconscious
following an accident or injury?
• Have no memory for the event?
• Felt dazed or confused?
• Experienced a head ache, fatigue, dizziness,
or changes in vision?
Have you ever been injured in a
• Taken a direct blow to the head
• Experienced a violent shaking of the head
Have you ever been injured by a
spouse or family member?
Have you ever had any major
• Heart Bypass
• Brain surgery to treat a tumor, aneurysm,
• Toxic Shock Syndrome
• Seizure disorder
• Lead poisoning
Additional comments and
observations of the interviewer
• Any visible scars?
• Walks with a limp?
• Uses a cane or walker?
• Has a foot brace?
• Limited use of one hand?
• Appears to have difficulty focusing vision?
• Difficulty answering questions?
• Answers are unorganized and/or rambling
• Becomes easily distracted, agitated or is emotionally labile
What you are looking for…..
• Any reported or suspected functional
difficulties that are interfering with home,
work or community activities
If you suspect an individual has
had a brain injury…..
• Obtain the medical records if possible
• Interview family/friends for collaboration
• Arrange for a Neuropsychological evaluation
• Refer to a neuropsychiatrist for medication and
• Consider referral to a brain injury rehabilitation
• Brain Injury Awareness Presentation-Brain Injury
Association and the Brain Injury Association of Maryland,
• National Center for Injury Prevention and Control 2003
• Maryland Centers for Disease Control Surveillance 2003
• National Association of State Head Injury Administrators
• Brain Injury Association of America 703-
• Brain Injury Association of Maryland 410-
• Ohio Valley Center For Brain Injury
Prevention and Rehabilitation, 614-293-
Maryland TBI Post Demonstration