Traumatic Brain Injury

Paddiley Natalie Schwendiman Tangy Taradita Subiantoro Kristi Wasabi Wasano

Brigham Young University - Fall 2016

Table of Contents

What is TBI? 2

Who has TBI? 4

Causes 4

Types and Definitions 6

Characteristics & Symptoms 7

Prognosis 10

Specific Tests 16

Medication 17

Recovery 18

Specific Needs & Support 19

TR implications 20

Prevention 24

Resources 25

References 27

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What is TBI?

Traumatic Brain Injury (TBI) is a subset of ABI

(Acquired Brain Injury) and is caused by trauma to the

brain from an external force. TBI is one of the more

common threats to normal brain function. TBI can

result when the head suddenly and violently hits an

object, or when an object pierces the skull and enters

brain tissue. Every TBI is different, and symptoms of a

TBI can be mild, moderate, or severe, depending on the

extent of the damage to the brain.

Damage to brain cells may be limited to the area directly below the point of impact on the skull.

However, a severe blow or jolt can cause multiple points of damage because the brain may move

back and forth in the skull. A severe rotational or spinning jolt can cause the tearing of cellular

structures. A blast, as from an explosive device, can cause widespread damage. An object

penetrating the skull can cause severe, irreparable damage to brain cells, blood vessels and

protective tissues around the brain. Bleeding in or around the brain, swelling, and blood clots can

disrupt the oxygen supply to the brain and cause wider damage.

A brain injury is different from a broken limb or punctured lung. An injury in these areas limit

the use of a specific part of your body, but your personality and mental abilities remain

unchanged. Since our brain defines who we are, the consequences of a brain injury can affect all

aspects of our lives, including our ability to think, to communicate and to connect with other

people.

Brain injuries do not heal like other injuries. Recovery is a functional recovery, based on

mechanisms that remain uncertain. No two brain injuries are alike and the consequence of two

similar injuries may be very different.

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The Brain

Weighing in at a mere 3 pounds (1.4 kilograms), the human brain is far more complex than any

computer that scientists could ever build. The brain holds one billion nerve cells - about the same

as the number of stars in our galaxy. These nerve cells are called neurons. They transmit and

process information between parts of the brain.

The brain makes up only 2 percent of a person’s

total body weight. Yet the brain uses one-fifth

of the body’s oxygen and one-fourth of the

body’s energy-producing glucose. The energy

used by the brain is enough to light up a 25-watt

light bulb.

The brain is an incredibly powerful organ, but it is also one of the most delicate parts of the

body. The brain is three-fourths water with a little fat, protein, and carbohydrate thrown in. The

brain’s texture is similar to gelatin or custard. It comes with its own protective system. The hard

bones of the skull are the first line of defense, and between the skull and the brain itself are 3

layers of membranes called meninges. The meninges are separated by a clear liquid called

cerebrospinal fluid, which cushions the brain. Yet even with these built-in safeguards, the brain

is easily injured.

Who has TBI?

At least 2.5 million children and adults sustain TBIs in the US each year:

2.2 million are treated in emergency departments for TBI each year

280,000 are hospitalized for TBI each year

50,000 die because of TBI each year

That means every 13 seconds, someone in the US sustains a TBI. One of every 60 people in the

US lives with a TBI-related disability. Every day, 137 people in the US die because of a

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TBI-related injury. The number of people who sustain TBIs and do not seek treatment is

unknown. But according to Brain Injury Association of America, at least 5.3 million Americans

live with TBI-related disabilities.

TBI happens most often among children from birth to 4 years old, adolescents aged 15-19, and

adults 65 years and older. Statistics have also shown that males are about 1.5 times as likely as

females to sustain a TBI.

When someone sustains a brain injury, many people around them are also affected, such as: their

parents, spouses, siblings, extended families, and friends. The process of recovery for TBI

patients will not only involve healthcare providers, such as: surgeons, physicians, counselors,

therapists, social workers, personal care attendants, but also insurance companies, attorneys,

educators, government agencies, and employers.

Causes

War, sports, car and motorcycle accidents, and physical violence are some of the most common

circumstances in which TBI might happen. TBI is caused by:

● Falls - 40.5%

Falling out of bed, slipping in the bath, falling down steps, falling from ladders and related

falls are the most common cause of traumatic brain injury overall, particularly in older

adults and young children.

● Struck by/against - 15.5%

TBI is most prevalent in contact sports, such as: football, ice hockey, and soccer.

● Motor vehicle - 14.3%

Collisions involving cars, motorcycles or bicycles — and pedestrians involved in such

accidents — are a common cause of traumatic brain injury.

● Assaults - 10.7%

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About 20 percent of traumatic brain injuries are caused by violence, such as gunshot

wounds, domestic violence or child abuse. Shaken baby syndrome is traumatic brain injury

caused by the violent shaking of an infant that damages brain cells.

● Unknown - 19%

In recent years, 2 types of TBIs have become big news:

1. Sports-related concussion are being recognized as a serious problem among athletes of all

ages. In the past, professional athletes often ignored concussions because most people

don’t lose consciousness when they suffer a concussion. In a Purdue University study,

researchers placed sensors that measure impact inside the helmets of high school football

players. Some of the helmet-to-helmet hits reached 100 Gs or more. That’s one hundred

times the force of gravity. All levels of concussion requires immediate attention and

treatment. Centers for Disease Control and Prevention has been encouraging the practice

of “It’s better to miss one game than the whole season.” The sporting activities that most

often send children and teens to the emergency room are bicycling, football, playground

accidents, and basketball.

2. Shrapnel and bombs are causing large numbers of brain injuries among American

soldiers in Afghanistan and Iraq. Explosive blasts are a common cause of traumatic brain

injury in active-duty military personnel. Although the mechanism of damage isn't yet

well understood, many researchers believe that the pressure wave passing through the

brain significantly disrupts brain function.

Types and Definitions

Traumatic Brain Injury (TBI) is a subset of Acquired Brain Injury (ABI). ABI includes all brain

injuries other than congenital, birth trauma, hereditary or degenerative. In the non-traumatic

types of acquired brain injury, the brain is usually diffusely injured. These injuries are usually

not included in traumatic brain injury but the symptoms span the same spectrum. TBI ranges

from concussions to penetrating head injuries to life-threatening brain-swelling and coma.

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Closed Head Injuries - The brain is injured at the point of impact. The brain bounces inside the

skull and can be injured opposite the point of impact. The brain may twist as it rebounds inside

the skull, damaging huge numbers of axons.

Open/penetrating Head Injuries - Brain imaging results are always abnormal and show the

object, e.g.: bullet, shrapnel, knife, bone fragments, etc. In most cases, the foreign body will have

fractured the skull on entry. The protrusion may cause serious bleeding, permanent damage to

large portions of the brain, and serious infection problem. Bullets might cause extensive injury as

they plow through delicate brain tissue.

Diffuse Axonal Injury - Diffuse cellular injury to the brain from rapid rotational movement.

This is often seen in motor vehicle accidents or shaking injuries. The axons are the projections

of the brain’s nerve cells that attach to other nerve cells. They are damaged or torn by the rapid

deceleration. The injury is from the shearing force disrupting the axons which compose the

white matter of the brain. As tissue slides over tissue, a shearing injury occurs. This causes the

lesions that are responsible for unconsciousness. A diffuse axonal injury also causes brain cells

to die, which cause swelling in the brain.

Contusion - A region of injured tissue or skin in which blood capillaries have been ruptured, or a

bruise to a part of the brain. Like a bruise on the body, this is bleeding into the tissue. Swollen

brain tissue mixes with blood released from broken blood vessels. A contusion can occur from

the brain shaking back and forth against the skull, such as from a car collision or sports accident

or in shaken baby syndrome.

Secondary Injury - Swelling and release of chemicals that promote inflammation and cell injury

or death. This causes swelling in the brain which may increase the intracranial pressure and

prevent the cerebrospinal fluid from draining out of the skull. This causes further increase in

pressure and brain damage. If this is not controlled or prevented the brain can herniate (push

through) the base of the skull and cause respiratory failure and death. The only way to prevent

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the primary injury is to prevent the trauma. The prevention of this secondary injury is the focus

of the acute medical care after injury.

Skull Fracture - Pieces of broken skull may cut into the brain and injure it, or an object such as a

bullet may pierce the skull and enter the brain.

Intracranial Hematoma - Damage to a major blood vessel in the brain or between the brain and

the skull causing internal bleeding.

Anoxia - Absence of oxygen to the brain, causing damage to the brain tissue.

Characteristics & Symptoms

TBI produces symptoms ranging from mild concussions to comas. The symptoms cover all

physical, sensory, and cognitive aspects.

4 categories of TBI symptoms:

1. Problems with thinking and memory

a. Difficulty thinking clearly

b. Feeling slowed down

c. Difficulty concentrating and remembering new information

2. Physical signs

a. Headache

b. Nausea or vomiting

c. Balance problems and dizziness

d. Fuzzy or blurry vision

e. Feeling tired, having no energy

f. Sensitivity to noise or light

3. Changes to emotion and mood

a. Irritability

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b. Sadness

c. More emotional

d. Nervousness or anxiety

4. Problems with sleep

a. Sleep more than usual

b. Sleep less than usual

c. Trouble falling asleep

These symptoms can also help identify if the brain injury falls under the mild, moderate, or

severe category.

Concussion can be considered as mild TBI . The symptoms, such as headache, nausea, fatigue,

blurred vision, and ringing in the ears, usually don’t last long. Mild TBI might also cause:

● Difficulty sleeping

● Sleeping more than usual

● Loss of balance

● Bad taste in the mouth

● Changes in the ability to smell

● Sensitivity to light or sound

● Memory problems

● Mood changes

● Feeling of depression

● Anxiety

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Moderate TBI is characterized by:

● Persistent headache or headache that

worsens

● Repeated vomiting or nausea

● Convulsions or seizures

● Clear fluids draining from the nose or

ears

● Inability to awaken from sleep

● Weakness or numbness in fingers or toes

● Loss of coordination

● Profound confusion

● Agitation

● Slurred speech

● Coma

● Dilation of one or both pupils of the eyes

Severe TBI shows similar symptoms as moderate TBI, but these symptoms will last longer, at

least for more than seven days.

TBI in children might show special

symptoms too, such as:

● Change in eating or nursing

habits

● Unusual or easy irritability

● Change in ability to pay

attention

● Change in sleeping habits

● Sadness

● Loss of interest in favorite toys

● Persistent crying and inability to be consoled

FAQs

● People who survive penetrating brain injuries are likely to be left with personality changes

or problems with vision, memory, thinking or moving.

● Each brain injury is different, depending on which part of the brain the penetrating object

injured.

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● Half of patients who survive a penetrating brain injury develop permanent seizures.

● Sometimes closed head injuries are harder to figure out because the area of the brain that is

injured is unknown.

Prognosis

The aftereffects of TBI can be devastating, including compromised memory and concentration,

loss of hearing, physical disabilities, depression, brain disorders, and, in the worst-case scenario,

death. Traumatic Brain Injury is considered to be one of the leading causes of death and

disability worldwide. Severe injuries increase the risk of a greater number of complications and

more-severe complications.

Coma - A person in a coma is unconscious, unaware of anything and unable to respond to any

stimulus. This results from widespread damage to all parts of the brain. After a few days to a few

weeks, a person may emerge from a coma or enter a vegetative state.

Vegetative state - Widespread damage to the brain can result in a vegetative state. Although the

person is unaware of his or her surroundings, he or she may open his or her eyes, make sounds,

respond to reflexes, or move. It's possible that a vegetative state can become permanent, but

often individuals progress to a minimally conscious state.

Minimally conscious state - A minimally conscious state is a condition of severely altered

consciousness but with some evidence of self-awareness or awareness of one's environment. It is

often a transitional state from a coma or vegetative condition to greater recovery.

Locked-in syndrome - A person in a locked-in state is aware of his or her surroundings and

awake, but he or she isn't able to speak or move. The person may be able to communicate with

eye movement or blinking. This state results from damage limited to the lower brain and

brainstem. This rarely occurs after trauma and is more commonly due to a stroke in that area of

the brain.

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Brain death - When there is no measurable activity in the brain and the brainstem, this is called

brain death. In a person who has been declared brain dead, removal of breathing devices will

result in cessation of breathing and eventual heart failure. Brain death is considered irreversible.

Seizures - Some people with traumatic brain injury will have seizures within the first week.

Some serious injuries may result in recurring seizures, called post-traumatic epilepsy.

Fluid buildup - Cerebrospinal fluid may build up in the spaces in the brain (cerebral ventricles)

of some people who have had traumatic brain injuries, causing increased pressure and swelling

in the brain.

Infections - Skull fractures or penetrating wounds can tear the layers of protective tissues

(meninges) that surround the brain. This can enable bacteria to enter the brain and cause

infections. An infection of the meninges (meningitis) could spread to the rest of the nervous

system if not treated.

Blood vessel damage - Several small or large blood vessels in the brain may be damaged in a

traumatic brain injury. This damage could lead to a stroke, blood clots or other problems.

Nerve damage - Injuries to the base of the skull can damage nerves that emerge directly from the

brain (cranial nerves). Cranial nerve damage may result in paralysis of facial muscles and

damage to the nerves.

Aphasia - Communication disorder that results from damage or injury to language parts of the

brain. Aphasia gets in the way of a person's ability to use or understand words. Common types of

aphasia include the following:

● Expressive aphasia (nonfluent): The person knows what he or she wants to say, yet has

difficulty communicating it to others.

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● Receptive aphasia (fluent): The person can hear a voice or read the print, but may not

understand the meaning of the message.

● Anomic aphasia: The person struggles to find the right words for speaking and writing.

● Global aphasia: The person has difficulty speaking and understanding words. In addition,

the person is unable to read or write.

● Primary progressive aphasia: People slowly lose their ability to talk, read, write, and

comprehend what they hear in conversation over a period of time.

Social problems

● Trouble with turn taking or topic selection

● Problems with changes in tone, pitch or emphasis to express emotions, attitudes or subtle

differences in meaning

● Difficulty deciphering nonverbal signals

● Trouble reading cues from listeners

● Trouble starting or stopping conversations

● Inability to use the muscles needed to form words (dysarthria)

Behavioral changes - People who've experienced brain injury often experience changes in

behaviors. These may include:

● Difficulty with self-control

● Lack of awareness of abilities

● Risky behavior

● Inaccurate self-image

● Difficulty in social situations

● Verbal or physical outbursts

Emotional changes - Emotional changes may include:

● Depression

● Anxiety

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● Mood swings

● Irritability

● Lack of empathy for others

● Anger

● Insomnia

● Changes in self-esteem

Chronic Traumatic Encephalopathy (CTE) is a brain disease that causes brain tissue to die. It’s

found in athletes such as boxers and in other people with a history of repeated brain trauma.

Brains showing degenerative changes of CTE resemble those of elderly people with degenerative

diseases of the brain and nervous system. Untreated TBI and careless prevention of repeated TBI

might lead to CTE and thus, dementia in younger age.

Degenerative brain diseases - A traumatic brain injury may increase the risk of diseases that

result in the gradual degeneration of brain cells and gradual loss of brain functions, though this

risk cannot yet be determined with any certainty for an individual. These include:

● Alzheimer's disease, which primarily causes the progressive loss of memory and other

thinking skills

● Parkinson's disease, a progressive condition that causes movement problems, such as

tremors, rigidity and slow movements

● Dementia pugilistica, most often associated with repetitive blows to the head in career

boxing which causes symptoms of dementia and movement problems

The area of the brain that get injured also determines the prognosis of the TBI.

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Following are real life examples of the aftereffects of TBI:

Phineas Cage of Vermont (1848)

He was a foreman on a railroad construction crew in 1848. The crew was blasting rocks in

Vermont and an explosion sent a pointed

iron rod through his skull and brain. The

rod flew 80 feet after leaving Gage’s skull

and the doctor could see his brain pulsating

through the hole. Miraculously, Gage

survived and lived for nearly 12 years after

the accident. However, related personality

changes impacted him for the rest of his

life. He died of seizures caused by his injury.

Gabrielle Giffords of Arizona

A US congresswoman, in January 8, 2011, stood on a small stage in the parking lot of a Safeway

grocery store near Tucson, Arizona. A gunman in the crowd started shooting. The bullet entered

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the left side of her skull, travelled through her brain, and went out the other side. Doctors

removed the skull fragments and a small area of the damaged brain. They removed a piece of her

skull to allow her brain to swell

without further injury. They

began her rehabilitation early

and within days, she was sitting

and standing with help. She

resigned from the Congress for

further rehabilitation but she

has been speaking on the

importance of tougher gun

control laws. Her mental

abilities are intact, her speech is slow but clear. She walks with a limp because her right leg is

weak. Her right arm also only has little movement because of her left brain injury.

Taylor Twellman

He is a retired American international soccer player and best known for his play with the New

England Revolution of Major League Soccer (MLS) from 2002 to 2009, during which time he

proved himself to be New

England's all-time leading goal

scorer. On August 30, 2008,

Twellman collided mid-air against

Los Angeles Galaxy goalkeeper,

Steve Cronin. He suffered a neck

injury and a subsequent serious

concussion from the collision.

Twellman couldn’t play soccer

much in the year following his injury and finally announced his retirement from soccer in 2010

due to lingering symptoms from his head injury. Twellman has been active in promoting

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awareness of concussions ever since. Taylor Twellman is one of more than 500 athletes who will

donate their brains to Boston University’s Center for the Study of Traumatic Encephalopathy

(CSTE) when they die.

Specific Tests

Glasgow Coma Scale - This

15-point test helps a doctor or

other emergency medical

personnel assess the initial

severity of a brain injury by

checking a person's ability to

follow directions and move

their eyes and limbs. The coherence of speech also provides important clues. Abilities are scored

numerically in the Glasgow Coma Scale. Higher scores mean less severe injuries. 13-15 = mild;

9-12 = moderate; below 8 = severe.

Computerized Tomography (CT) scan - A CT scan uses a series of X-rays to create a detailed

view of the brain. A CT scan can quickly visualize fractures and uncover evidence of bleeding in

the brain (hemorrhage), blood clots (hematomas), bruised brain tissue (contusions) and brain

tissue swelling.

Magnetic Resonance Imaging (MRI) - An MRI uses powerful radio waves and magnets to

create a detailed view of the brain. This test may be used after the person's condition has been

stabilized.

Intracranial Pressure Monitor - Tissue swelling from a traumatic brain injury can increase

pressure inside the skull and cause additional damage to the brain. Doctors may insert a probe

through the skull to monitor this pressure. To keep the pressure down doctors and staff might do

the following things:

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● Controlling body temperature (keeping the temperature low to normal)

● Elevating the head of the bed

● Using controlled narcotic sedation to cause paralysis, keeping the person still and

comfortable

● Ensuring proper breathing

● Administering medication including Mannitol

● Performing hypertensive therapies

Treatment for mild to moderate TBI most of the time includes:

● X-Rays to check skull and neck for bone fractures and spinal instability

● Over-the-counter (OTC) pain relievers for headaches

● Rest

Moderate to severe TBI requires a more detailed examination, including:

● MRI/Computed Tomography (CT) scan

● EEG: a test used to record brain wave patterns and to detect abnormalities related to

electrical activity of the brain. This test helps to determine the possibility of seizures

● Surgery for damaged brain tissue and skull fracture

● Equipment for breathing, heart rhythm, blood pressure, pulse and intracranial pressure

(catheter)

● Dilantin for seizures

Medication

OTC anti-inflammatory - Drugs designed to reduce inflammation. Some of the more common

examples are aspirin, ibuprofen, and naproxen. In inflammation, a substance called

prostaglandins sensitizes your nerve endings and enhances pain.

Anti-seizure drugs - People who've had a moderate to severe traumatic brain injury are at risk of

having seizures during the first week after their injury.

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Coma-inducing drugs - Doctors sometimes use drugs to put people into temporary comas

because a comatose brain needs less oxygen to function.

Diuretics - These drugs reduce the amount of fluid in tissues and increase urine output.

Diuretics, given intravenously to people with traumatic brain injury, help reduce pressure inside

the brain.

Tetanus shot - Tetanus is a rare disease caused by bacteria known as Clostridium tetani. These

bacteria infect humans via cuts or puncture wounds.

Recovery

The brain has an amazing ability to repair itself. There are several theories that demonstrate how

the brain might repair itself:

● Diaschisis - Depressed areas of the brain that are not injured but linked to injured areas

begin functioning again.

● The function is taken over by a part of the brain that does not usually perform that task.

● Redundancy in the function performed so another area of the brain takes over.

● Behavioral substitution - The individual learns new strategies to compensate for deficits.

Rehabilitation is the process of giving patients the treatment they need to help them recover. The

goal of rehabilitation is to return patients to normal or as near normal as possible. With TBI,

most improvement occurs during the first year after injury. But improvement can be seen days,

weeks, months, or years after the injury.

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Rehabilitation usually starts immediately after the injury, even if the patient is in coma. Physical

therapists exercise the patient’s arms and legs to preserve muscle function. They help patients

improve their movement so they can sit, stand, and walk. Occupational therapists assist patients

to relearn everyday activities such as eating and dressing. Speech therapists help patients regain

their speech. Psychologists who specialize in brain injury help patients with problems such as

depression and anger.

Specific Needs & Support

● Ensuring proper oxygen supply to the brain and the rest of the body

● Maintaining adequate blood flow

● Controlling blood pressure

● Love and support from family and friends

When a loved one sustains a traumatic brain injury, becoming a caregiver can happen suddenly

without warning. The person with the injury may look the same but think and behave differently.

When one member of a family changes, the entire family changes. Research has shown that

people with brain injury who have more support from family and friends — something called

family-centered care — tend to have a better outcome and reintegrate into their community with

more ease.

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The following are important points for caregivers:

● Take time for yourself to avoid compassion fatigue. You can’t take care of a loved one

if you are physically and emotionally exhausted yourself.

● Don’t ignore intense feelings like depression or anxiety.

● Find a caregiver support group.

● Keep a regular schedule for yourself.

● Be assertive about getting the support and help you need.

● Educate yourself about available resources.

● Get ideas from someone you know and trust, maybe someone who has experience as a

caregiver.

● Be creative about changing roles and responsibilities within your family.

For most people with TBI, you can’t really see something wrong with them. Be sensitive. It’s

usually hard for people with TBI to form strong relationships.

TR implications

Traumatic Brain Injuries pose a unique challenge for therapists in rehabilitation settings, because

head injuries result in a variety of functional deficits, depending on the location and extent of the

brain damage. Recreational Therapists must be aware of the nature and types of head injury as

well as how to adequately assess function and implement appropriate programs.

Therapeutic Recreation is an important service for a person who has sustained a Traumatic Brain

Injury. A person may experience various lifestyle changes which may include a decrease in

leisure participation, increase in free time, loss of income, decrease in social skills which affects

old friendships and establishing new ones, a shift to more sedentary activities, and less social

activities. Experiencing these changes can have a negative impact on life satisfaction.Using

meaningful, functional, and satisfying activities/ interventions to address lifestyle changes and

deficits sustained from a TBI can affect the recovery process in a positive way as it pertains to

improving participation and life satisfaction.

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Everyone starts at a different cognitive level:

1. Acute Rehabilitation

Goal: To reach maximum independence functioning

2. Day Treatment

Goal: To maximize recovery and development of wide range of skills

3. Transitional Living

Goal: Self-care, independent living skills, reestablishment of self, and vocational return

4. Long-Term Care

Goal: To become a participating member of the community

When planning activities for recovering people with TBIs, consider the following factors:

1. The severity

2. The setting

3. The assessment

Recreational therapists must address functional and psychosocial outcomes by engaging the

patient in enjoyable activities that increase function skills.

Possible activities :

1. Improving problem solving skills:

a. Playing UNO, or activities that require strategy

2. Improving memory:

a. Matching game, leisure diary, memory book, scrapbooking

3. Improving levels of attention:

a. Basic, fun, not over stimulating activities such as puzzles or music, discussion

groups, movies with questions

4. Improving physical ability/muscle strength:

a. Biking, hiking, going on walks

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Soon after the injury, most people tend to focus on the abilities that have been lost. Emotionally,

the experience can be overwhelming, confusing, and frustrating. But as time goes on, everyone

begins to grapple with their injury in both productive and nonproductive ways. One common

response is to deny the significance of the injury; unfortunately, a brain injury can’t simply be

“walked off.” Brains are notoriously slow to heal, which only compounds the frustrating aspects

of TBI. This is where TR comes in. TR can help with focusing on abilities they still have.

Some other interventions are:

Relaxation Therapy

In relaxation therapy sessions, patients learn stress management techniques that help to prevent

or alleviate a variety of symptoms that may occur with illness or injury. Techniques include

guided imagery, progressive relaxation, breathing techniques and various types of meditation.

Practicing these relaxation techniques may result in a strengthened immune system, improved

physical performance, reduced pain, better sleep, and improved quality of life.

Get Ahead Cognitive Stimulation Therapy

This group intervention addresses cognition, orientation, memory, social interaction and

communication skills. Designed primarily for patients who have experienced a stroke or brain

injury, this therapy helps patients make practical improvements and gain confidence.

Group Humor Therapy (Humor is Good for Health)

HIGH (Humor Is Good for Health) therapy uses the power of laughter, humor, and positive

attitude to bring about physical and emotional benefits. Negative emotions can have a

detrimental effect on the physical and emotional quality of life, and can negatively impact the

full benefit of a physical rehabilitation program. Humor therapy sessions help patients build

healthier habits through a positive outlook and positive behaviors.

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Complementary Therapy and Therapeutic/Adaptive Yoga

A variety of gentle interventions are used to enhance and encourage the body’s ability to reduce

pain, heal, and relax. Modalities offered include acupressure, biosonic repatterning, polarity,

reflexology, visualization, massage therapy and bodywork. Benefits of complementary therapies

can include: deep relaxation and rejuvenation, tension reduction, better posture, improved

self-awareness, better sleep, reduction and management of stress and enhanced connection of the

mind and body to restore wholeness.

Adaptive Yoga follows the same principles as traditional yoga but also provides the participant

specific instruction in the use of props and modifications for poses. Therapeutic Yoga (TY) uses

16 supported yoga poses, breath work, guided meditation to help individuals nurture their bodies,

allowing health and wellness to blossom. It is a gentle and safe way to encourage balance in the

body and mind.

Children and Adults Recreating Equally Group (CARE)

This intergenerational program was developed in conjunction with the Montessori Children’s

Center on Burke’s campus. CARE provides supported opportunities for patients with physical

disabilities to engage in recreational activities with children. One-to-one and group activities

include story time, music, crafts, games, art, and horticulture. In addition to enhancing positive

feelings, self-esteem and body image, adults and kids have the opportunity to build relationships

and foster socialization skills.

General Recreation

General recreation programs which may be therapeutic, such as entertainment, social programs,

horticulture activities, music, games, crafts and a variety of other activities. These programs are

available during the late afternoon, evenings and on weekends, after therapy has ended for the

day. Family and friends are invited to participate with the patient. In addition, the TR department

offers a range of "in-room" resources for our patients, including a movie library, music library,

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games, books on tape and specialized adolescent-oriented resources. There are several patient

areas dedicated to leisure, such as our library, computer areas, atrium, Harris Parlor, greenhouse,

and a rec room on our Brain Injury Unit with basketball, air hockey, two computers, a variety of

games and a flat screen TV.

Prevention

Prevention methods:

● Always wear a seatbelt in a motor vehicle

● Use an appropriate child safety seat or a booster

● Never drive under the influence of alcohol or drugs

● Always wear a helmet when on a bicycle, motorcycle, scooter, snowmobile and other

open unrestrained vehicles

● Wear a helmet when participating in contact sports

● Wear a helmet when horseback riding

● Wear a helmet while skiing, snowboarding, skating and skateboarding

Fall Prevention:

● Use the rails on stairways

● Provide adequate lighting, especially on stairs for people with poor vision or who have

difficulty walking

● Place bars on windows to prevent children from falling

● Sit on safe stools

● Do not place obstacles in walking pathways

Gun Safety:

● Keep guns locked in a cabinet

● Store guns unloaded

● Store ammunition apart from guns

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Many TBI can be prevented or their effects greatly lessened by sticking to sports guidelines,

using proper equipment, and following medical advice when a concussion occurs.

Resources

Providing and coordinating care can be overwhelming. It helps to know there are resources you

can turn to. Families can also learn more about TBI and what types of things they might

experience. There are also resources for parents where they can help their children learn how to

cope with a loved one being affected by a TBI.

Local

Stroke & Brain Injury Support Group Provo UT

Rocky Mountain University - Building C 122 E 1700 S, Provo, UT 84606

Website: https://intermountainhealthcare.org/

Email: byutbigroup@gmail.com

State

Brain Injury Alliance Utah

Address: 5280 So.Commerce Dr. Suite E-190, Murray, UT 84107

Phone: 801-716-4993 Toll Free: 1-800-281-8442

Email: info@biau.org

Facebook: https://www.facebook.com/BIAUtah

National

Brain Injury Association of America, Inc.

Address: 1608 Spring Hill Road, Suite 110, Vienna, VA 22182

Phone: 703-761-0750

Website: biausa.org

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International

IBIA - International Brain Injury Association (Virginia, USA)

Mailing Address:

IBIA

MCC Association Management

5909 Ashby Manor Place, Alexandria, VA 22310

Website: http://www.internationalbrain.org/

Email Addresses:

General Inquiries: congress@internationalbrain.org

Donations: mjroberts@internationalbrain.org or mbell@internationalbrain.org

Exhibits and Support: mbell@internationalbrain.org

Membership: clogrande@internationalbrain.org

Phone Numbers:

703-960-0027 (Alexandria, Virginia, USA -- US Eastern Time Zone)

713-526-6900 (Houston, Texas, USA -- US Central Time Zone)

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References

Traumatic Brain Injury: from concussion to coma - Connie Goldsmith

Brain Injury Association of America - www.biausa.org

http://www.traumaticbraininjury.com/understanding-tbi/what-is-traumatic-brain-injury/

http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/causes/con-200293

02

https://medlineplus.gov/traumaticbraininjury.html

http://www.traumaticbraininjury.com/prevention/

http://www.traumaticbraininjury.com/treatments-for-tbi/recovery/

http://www.ninds.nih.gov/disorders/tbi/tbi.htm

http://js.sagamorepub.com/trj/article/view/4509/3884

http://www.brainline.org/landing_pages/categories/caregiving.html

http://www.burke.org/rehab/patientinfo/therapeutic-recreation

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