It can be shocking to family members when a loved one diagnosed with traumatic brain injury as the result of a car accident, fall, or other cause of injury starts exhibiting signs of unwanted behaviors including agitation, aggression, and uncontrolled anger shortly after discharge from a rehabilitation facility.  Discounting the phase of recovery at Ranchos Los Amigos Level IV, signs and symptoms of underlying behavioral issues may not be apparent during the early stages of acute rehabilitation.  It is safe to say that the hospital and acute rehabilitation stages following TBI are where the highest number of medications are prescribed. These can include seizure and anxiety medications which are prescribed to prevent seizures and prevent agitation which can impact rehabilitation efforts.  It is up to the primary physician managing the care of the patient to determine if these medications should continue following discharge home with family members.

In the most typical cases of TBI where anti-anxiety medications are discontinued at the time of discharge from the hospital or from acute rehabilitation, it can take some time for unwanted behaviors to surface.  Family members are happy that all is well and their loved one is home so things can go well for a period of time.  Without a regular routine or structured day, however, combined with the lack of stimulation and preferred activities, it is not uncommon for the individual diagnosed with TBI to become frustrated, restless, and easily agitated.  Family members may find they are living with a very different person than the person they lived with prior to the TBI diagnosis.  Driving, working, socializing, and living alone in an apartment has changed for the person with TBI – through no fault of his or her own – to not being able to drive or work, and living with family members now.  Frustration with the inability to do “normal” activities and boredom from not being able to “do anything” can lead to inappropriate relationships.  Substance abuse and drinking alcohol (whether or not these were habits before the injury) are all too common occurrences and can exacerbate anger, leading to more aggressive and even violent behaviors if neurobehavioral rehabilitation is not provided.

A highly specialized residential post-acute neurobehavioral rehabilitation program will have a multidisciplinary team in place consisting of (and not limited to) the following specialties: neuropsychiatrist, neuropsychologist, certified behavior analyst, psychologist, neurologist, nurse.  Supported living and assisted living services will be provided in such programs where individuals with TBI – and some with multiple or repetitive MBI – are encouraged to do as much as possible as independently as possible.  A positive and gentle neurobehavioral philosophy will prove over time to have the best results and successful long-term outcome, which is the overall goal in any rehabilitation program.

Behavioral signs and symptoms can be caught early.

March is “Brain Injury Awareness Month” and today is the 8^th yet it does not appear that any of the national media programs and newspapers or local news programs and local newspapers (Florida) are aware of this. There’s nothing mentioning “Brain Injury Awareness Month” in the lobby or halls of the trauma center visited this week and nothing in the neuro ICU or the trauma ICU waiting areas.  How do we bring traumatic brain injury and mild brain injury awareness to the public the same way breast cancer awareness is brought to the public?  Statistically, there are more brain injuries diagnosed (and undiagnosed) than there are individuals diagnosed with breast cancer (CDC).

The Brain Injury Association of Michigan (www.biami.org) is extremely active in its quest to educate families as well as the public. With car accidents as a leading cause of brain injury, the auto manufacturers in Michigan have a strong force to assist them with regard to safety and prevention. Providing statistical information is critical to everyone who drives, is a passenger, or is a pedestrian on any road in America.

Other groups and organizations that can provide information on an almost “firsthand” basis with regard to brain injury awareness are residential post-acute rehabilitation facilities such as assisted living programs, supported living programs, specialized group homes, and apartment programs.  These organizations provide specialized neurological rehabilitation as well as long term residences for individuals who are not able to live independently as they had before they suffered a traumatic brain injury.  There are brain injury groups and associations that have annual injury statistics recording new injuries, but there is no national group reporting the number of individuals who have an entirely different life than anyone can imagine while living with a brain injury.

The majority of individuals residing or participating in supported living programs have ongoing behavioral difficulties as a result of a traumatic brain injury.  Barriers to living independently or with family members include aggressive behaviors, issues with uncontrolled anger, and some have a history of substance abuse, or substance abuse is a newly acquired habit.  Those individuals with brain injury who are unable to work or maintain an active daily schedule on their own, or while living with family members, are at risk of significant decline when left alone and without some type of coaching or supervision. Exploring options and activities of interest that can be incorporated into a daily schedule is most important no matter the environment in which an individual with brain injury resides.  Everyone wants to have and deserves a good life doing things they enjoy.  This can be realized in independent settings as well as in specialized residential post-acute supported living environments.

Input from individuals residing in supported living programs would be beneficial to educating the public with regard to brain injury awareness and what it’s like to live with a brain injury over an extended period of time.

March is “Brain Injury Awareness Month.”  Hopefully those living in Florida, New York, Michigan, New Jersey, Colorado, and California, as well as those in workers’ compensation and in the no-fault auto industry, are much more aware than the general public.  How much more does the public know now than 20 years ago?  It would be interesting to set up a table at the local supermarket for a day to ask people going in and coming out to share their knowledge or understand of traumatic brain injury.  Unless you are related to a person or living with a person who sustained a brain injury, or you work with individuals diagnosed with brain injury, it is likely the average person is unaware of the realities of brain injury.

Individuals living with traumatic brain injury who have behavioral issues, such as aggression, anger, and inappropriate social skills, are often mistaken by the public as being drunk or on drugs.  This is magnified when the individual has slurred or impaired speech as a residual of brain injury.  While we don’t want to believe this is still quite common, it is.  Even among seasoned police officers who arrive on the scene of a car accident and trained paramedics who respond when a person is injured in a fall, a mild brain injury and even a traumatic brain injury can be completely overlooked.

Famous people who have sustained a brain injury could help tremendously in the area of brain injury awareness.  However, it appears when a famous person suffers a brain injury, what that person actually endures is often downplayed by the media and the word “recovered” or “recovery” is used very loosely.  The public sees how well the famous person looks and interacts on television.  Often there is no sound in the media coverage of the famous person, and the newscast is providing its own voice overlay.  It would be truly beneficial to see a recurring educational program on mainstream television filming a “regular” person going through the medical stages in the trauma center all the way through residential post-acute rehabilitation, an apartment program, receiving assisted living or supported living services, and, if able, going home if that is the true outcome.

Showing the positive outcome of an individual diagnosed with a traumatic brain injury going home with family and back to work is most often what we see in the media.  The person with the brain injury is surrounded by a loving family and everyone is happy and smiling.  What about the case of the “regular” person who does not have the benefit of being famous, having a “glamorous” story, a loving and close family, or being able to participate in the rehabilitation program he or she needs.

“Brain Injury Awareness” includes all examples of signs and symptoms of mild brain injury, how to assess if a brain injury may have occurred, how to prevent brain injury, and what individuals encounter following the diagnosis of traumatic or mild brain injury.  In all cases, information should be geared toward educating the public on the long-term aftereffects of brain injury, meaning years post-injury as that is the true reality.  More will follow in our blog.

It’s no surprise that the top two causes of TBI are falls and car accidents, and these statistics hold true for Florida and Michigan. Falls have always been an injury statistic held by the elderly, but considering the do-it-yourself aging baby boomers taking care of their residential homes or apartments, this cause of TBI is expected to increase. The statistics of falls does include the elder population including falls within elder assisted living and elder supported living facilities, elder group homes, and skilled nursing facilities. Ladders come with all sorts of safety recommendations that most often aren’t heeded. This is a concern for those working on personal projects and for those who make a living working on ladders or scaffolds. As workers continue to use ladders, their behavior becomes increasingly confident. They mistakenly believe they can run up and down ladders quickly, without holding onto the ladder, and without precautions. A fall from a ladder can result in an extremely severe TBI, even from the lowest rung of the ladder. When reviewing medical records and the workers’ compensation Notice of Injury, the words “fall of three feet” do not accurately reflect the significance of the fall. In actuality, a person diagnosed with a TBI fall of three feet suffered a blow to his or her head from nine feet if he or she is six feet tall. Through no fault of the hospital, the distance of the fall is not clearly reflected in medical records as the hospital is using the same information in its report that the paramedics used to describe the injury. Another consideration of the severity of the blow to the head is if the head is the only part of the body that sustained an injury. The implication is that the person’s head hit the ground with the full force of the fall, without any means of breaking the fall. When a person loses balance on a ladder, his or her equilibrium is off and it can become impossible to determine the direction of up and down. Even putting one’s hands out does not necessarily break the fall. Individuals using a ladder at work or for a residential project should not drink alcohol, engage in substance abuse, work when angry, and never work aggressively when trying to meet a deadline. These behaviors can lead to more serious injuries. Caution should always be used not only when climbing and descending the ladder but while working on the ladder.

Family members have a number of responsibilities with regard to supporting a loved one with TBI who is receiving neurorehabilitation in a residential program or specialized assisted living facility, or support services in a supported living program or group home. Whether located in Florida or Michigan, families can find themselves in unchartered territory when a loved one demonstrates inappropriate behaviors, such as aggression, anger, and substance abuse as the result of the TBI. Understanding and supporting the neurobehavioral plan while encouraging goals toward increased independence is a big responsibility for families. It can create a conflict of emotions for some families as the need to protect a loved one is so primary in familial relationships.

Finding a balance is key. Individuals who progress from a residential program or group home to a supported apartment program or to an apartment with wrap-around support services are on their way to total independence. It is up to the rehab team working with the workers’ compensation (workman’s compensation) or no-fault professionals to help educate and support the families throughout the entire process and beyond.

Cross William Flannery

Helmet Awareness: Prevent TBI, Wear a Helmet

With driver distractions at an all time high, safety outside the vehicle is more important than ever.

Statistics show that 85% of bike-related injuries and 75% of fatalities are preventable if riders wear a helmet. With those staggering statistics people still choose to not wear helmets. We encourage riders to wear helmets with the goal of preventing Traumatic Brain Injuries (TBI’s) from motorcycle, biking, skateboarding and other recreational and work activities.

Help prevent Serious Brain Injuries, buy a helmet and wear it.

NeuroInternational participates in brain injury educational conferences in Michigan, Florida, and many other states.

Please contact NeuroInternational if you know of a traumatic brain injury rehabilitation or neurobehavioral conference we may be interested in attending. We regularly attend a variety of National conferences to train our staff and promote our services. We also provide free CEU inservices to hospitals, adjusters, and case managers.

Through daily work, family, and recreational activities people place themselves at risk for a variety of injuries including a TBI. Certain individuals will even sustain mild TBIs but be unaware of their injury due to limitations in depth of assessment and/or current neuroimaging techniques. An untreated TBI can, however, inflict severe consequences in various areas of one’s life. Unfortunately, treatment options (for mild, moderate, and severe TBI cases) are often strongly influenced by personal financial resources, auto/car or work injury insurance, health care policies, state and federal rules and regulations, etc.

This remains a daunting challenge not only for families and survivors, but also for TBI professionals as they attempt to provide the highest quality of care through comprehensive services which often cannot be funded. TBI education and awareness remain fundamental in ensuring personal and societal protections. Specifically, education can help individuals evaluate their behaviors in a manner that helps manage TBI risk. Additionally, TBI awareness can foster continued research and advocacy which may facilitate ease of access to services as well as improved services. Overall, TBI education and awareness can provide clarity and understanding which serves to empower patients, families, and treatment providers.