Download Traumatic Brain Injury

Traumatic Brain Injury
TRAUMATIC BRAIN INJURY ― RESOURCE GUIDE
When your loved one is hospitalized with a Traumatic Brain Injury (TBI), you have many questions and concerns. What
care will they be receiving? What does the future hold? Coping with TBI is a lifelong experience for both patients and
families. This handout was created to help you locate answers to many of those questions.
Many websites are available that can provide you with information regarding TBI. However, the information may not
always be current or appropriate for your particular situation. The following are some websites that have been
chosen for their accuracy and professionalism. They address recovery time in the hospital as well as long-term
rehabilitation. Finally, we encourage you to bring your questions to the nurses, physicians, therapists, and other
health care workers who are caring for your loved one.
GENERAL INFORMATION AND SUPPORT
Brain Injury Association of America
Centre for Neuro Skills
www.biausa.org
www.neuroskills.com
Phone: 1-800-444-6443
Phone: 1-800-922-4994
This is the premier site for information and references on
TBI. Medical, rehabilitative, and support information are
just a few of the things you can find on this very
comprehensive site.
This site is provided by a rehabilitation
center and is medically oriented, but
provides a lot of useful current information about neurological
injuries.
Brain Injury Association of Virginia
Headinjury.com
www.biav.net
www.headinjury.com
Phone: 703-761-0750
Phone: 206-621-8558
This is the state affiliation of the Brain Injury Association of
America. Educational and support information specific to
Virginia is provided. It also has a listing of Virginia support
groups.
This is a non-profit site operated by head injury survivors. It
provides information, discussion groups, and self-assessments.
Traumatic Brain Injury Survival Guide
Brainline
www.tbiguide.com
www.brainline.org
Phone: 231-929-7358
Phone: 703-998-2020
This site is written by Dr. Glen Johnson, a
This site offers information and resources about preventing,
neuropsychologist. It is written in plain
language and addresses the medical aspects of TBI, the
types of symptoms the injured person may experience in
the future, and how to deal with those symptoms.
treating, and living with TBI. Webcasts and a newsletter are
available. This site serves anyone whose life has been affected
by TBI.
LOCAL BRAIN INJURY REHABILITATION RESOURCES
Charlottesville - Brain Injury Support Team
Contact Carol Ragland: [email protected]
Meets the 3rd Tuesday of the month from 6:30-8:00pm @ UVA Health South Rehab Hospital - 1st floor conference
room at 515 Ray C. Hunt Dr. - Charlottesville, VA.
Virginia Department for Aging and Rehabilitative Services (DARS)
www.vadrs.org/cbs/biscis.htm -- Phone: 1-800-552-5019
The Brain Injury Services Coordination (BISC) Unit, located within DARS' Community Based Services Division, serves as
a point of contact for customers seeking general or agency-specific information about brain injury resources in
Virginia. There are multiple state-funded Brain Injury Services programs overseen by DARS. Refer to the website for
more specific information on current programs and types of services provided.
The Bridge Line (formerly Virginia NeuroCare and Building Bridges)
Leigh Wion – Program Administrator
Daniela Pretzer – Executive Director
Physical Offices/Clubhouse Program: 953 2nd St. SE, Suite 410 – Charlottesville, VA
www.thebridgeline.org -- Phone: 434-989-1274
The mission of The Bridge Line, a non-profit organization, is to support and facilitate vocation training, residential
living, and successful community re-entry, as well as to enrich the lives of persons impacted by brain injuries.
Wilson Workforce Rehabilitation Center
www.wwrc.net/braininjuryservices.htm -- Phone: 1-800-345-9972
This Rehabilitation facility is located in Fishersville, VA. They provide residential and
outpatient programs including rehabilitation therapy/assessments, vocational training, driving evaluations,
wheelchair assessments, brain injury clinics, neuropsych assessments, support groups, and more.
Crossroads to Brain Injury Recovery
[email protected] -- Phone: 540.568.8923
This agency provides community-based services for individuals in the Shenandoah Valley who are affected by brain
injury. Services include but are not limited to case management, life skills training, education, outreach, and
advocacy. Serves children, youth, and adults with a documented brain injury affecting two or more life areas. Free of
cost but a limited number of slots are available.
BOOKS RECOMMENDED BY FAMILIES
Living with Brain Injury: A Guide for Families, by Richard Senelick. 3rd ed, HealthSouth Press, 2013. Also available in
the UVa Health Sciences Library.
Over My Head: A Doctor’s Own Story of Head Injury From the Inside Looking Out by Claudia Osborn. Published by
Andrews McMeel Publishing, 2000
Where is the Mango Princess? A Journey Back from Brain Injury by Cathy Crimmins.
Published by Vintage Books, 2001.
UVA BRAIN INJURY RESOURCES
Acquired and Traumatic Brain Injury Clinic – Pediatrics
UVA Battle Building, 4th Floor - 1204 W.
Main St.
www.uvahealth.com (search for Acquired Brain Injury
Clinic)
Phone: 434.924.5272
Pediatric patients are seen for evaluation and treatment of acquired or traumatic brain injuries.
Brain Injury and Sports Concussion Clinic
Dr. in Charlottesville,
VA
www.uvahealth.com (search for Brain Injury Concussion Clinic)
7246)
UVA Neurology Clinic – 500 Ray C. Hunt
Phone: 434-98-BRAIN (434-982-
This interdisciplinary clinic provides comprehensive care for those with mild TBIs/concussions.
Neurobehavioral Intervention Team
This informal, multidisciplinary consult
service assists in the management of neurological or neurosurgical patients whose behaviors make them a danger to
themselves or others, or otherwise prevent them from basic participation in nursing or therapy services. Teams are
coordinated by the Unit Manager, and include representatives as needed from multiple disciplines. Behavioral
management plans are developed for patients and family training is completed as needed.
Brain Injury Quality Support Team
This is a multidisciplinary group
dedicated to improving the care of patients with brain injuries. The group’s mission is to promote optimal treatment
and offer support to UVA patients with brain injuries and their families, as well as promoting community education
and awareness. “Like” us on Facebook at www.facebook.com/BIQST!
Virginia Driving Safety Laboratory
Lee Street
Phone: 434-924-5314
UVA West Complex, Barringer IV - 1335
This lab provides comprehensive driving assessments for aging drivers and people with cognitive or physical
limitations following stroke or traumatic brain injury. Service include vision testing; assessment of driving knowledge,
coordination, and reasoning; driving simulation tests; and therapy for road rage and driving-related phobias. Reports
are not sent to the Department of Motor Vehicles unless requested by the patient.
Possible Procedures Following Brain Injury
There are many procedures that may be needed after a brain injury. Three of the most common procedures are
described below.
Procedures for Measuring and Relieving Intracranial Pressure (ICP)
After a brain injury, the brain may become swollen from excess or blocked fluid. Swelling creates pressure inside the
skull that can cause further injury to brain tissue. The doctors may insert a device to measure this pressure (known as
"intracranial pressure" or ICP). There are two types of devices commonly used to measure pressure. You may hear
these devices called a "bolt" or "venticulostomy." The bolt is a small, narrow piece of tubing with a sensor at the
end. It is placed through a small hole in the skull into the brain tissue. The ventriculostomy, also called an external
ventricular drain or EVD,is placed in one of the fluid-filled pockets in the brain called "ventricles." The doctors decide
which device to use based on scans taken of the patient’s brain. The procedure can be done at the bedside or in the
operating room.
What is the bolt or venticulostomy procedure like?
The skin is numbed with medicine to decrease discomfort. The device is inserted through a small hole made in the
skull. The other end of the catheter is then connected to a bedside monitor that tells the doctors and nurses if the
ICP gets too high. The catheter will be taken out when the pressure no longer needs to be watched.
What can be done to lower intracranial pressure?
The patient’s head will be positioned to decrease pressure inside the skull. It is also important to keep the patient
calm, so the room will be kept quiet and medication may be given to keep the patient calm or to prevent the patient
from moving. If the catheter is placed inside the ventricle, excess fluid can be drained into a small bag. This will help
bring down the pressure inside the skull. The doctor or nurse can tell you more about what is being done to lower
ICP.
Procedure to Assist in Breathing
Initially, a tube may be placed into the trachea (“windpipe”) through the mouth. The tube is attached to a mechanical
pump (“ventilator”) to help with breathing. The tube also allows the nurses and respiratory therapists to remove
secretions (phlegm) from the lungs through a process called “suctioning”.
Some patients with brain injury need help with breathing or keeping the throat clear of phlegm for an extended
period of time. In this case, or if the patient also has many broken bones in the face, the doctors may decide that a
tracheostomy tube ("trach") should be inserted.
What is a trach?
A trach is a small opening in the neck through which a tube is passed to the windpipe (trachea). The doctor will make
the incision for the opening and insert the tube either at the bedside in the intensive care unit (ICU) or in the
operating room. Please be aware that the trach tube will make talking difficult. Most people who are awake and have
a trach can only communicate by mouthing words or writing.
Procedure for Feeding
What is a feeding tube?
Initially, a small tube may be passed through the nose or mouth into the patient’s stomach or intestines. This tube,
referred to as an “NG tube” or an “OG tube” can be used to give medications and nutrition (“tube feeds”). Some
people with brain injury are unable to swallow well enough to get good nutrition for an extended period of time. In
this case, the doctors may place a feeding tube directly into the stomach through the abdomen. This procedure may
be done in the ICU or in a special procedure area of the hospital.
FAQ:
http://www.healthsystem.virginia.edu/docs/per/frequently-asked-questions-about-braininjury/at_download/perdocument
Rehabilitation after a Brain Injury
A brain injury can cause physical changes as well as changes in knowing, thinking, learning and judgment. These
changes impair a person's ability to live on his or her own and function as well as prior to injury. Physical,
occupational and speech therapy (together known as "rehabilitation") will be needed to help bring back as much
function as possible. These services usually begin while the person is in the hospital. Depending on the individual's
needs, further rehabilitation after hospital discharge can take place in a variety of settings: in an inpatient
rehabilitation hospital such as UVa-HealthSouth (located 2 miles from UVa Medical Center), in a skilled nursing
facility, in the community as an outpatient, or at home through home health services. The hospital social worker and
therapists can help the family determine the right setting.
Brain injury can result in hospital, rehabilitation and long-term care costs, as well as loss of income from being unable
to work. There are many programs that can help with financial issues:
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Medical and rehabilitation costs may be covered by private insurance, Medicare, Medicaid, and/or Veterans
Affairs benefits. There are also some hospital-based financial assistance programs.
Loss of income can be addressed through programs such as General Relief, Social Security Disability Insurance
(SSDI), and Supplemental Security Income (SSI).
In Virginia, the Department of Rehabilitative Services (DRS) can assist a person with job retraining and other
employment assistance after sustaining a brain injury.
Applying for these programs is complex and time consuming. The hospital social worker can assist the family with
understanding the programs and completing applications.
Why is my loved one acting like this?
Managing agitation in the head injured patient
What is agitation?
Agitation is an excess of one or more behaviors that interfere with functional activities. Behaviors can include:
decreased attention span, impulsiveness, frustration, uncooperativeness, resistance to care, self-stimulating
behaviors (rocking, tapping, rubbing textures, etc.), restlessness, repetitive behaviors, etc. This is a normal part of
recovery after a head injury. Agitation can sometimes result in aggression towards self or others.
What is your team doing to help?
First, we are educating the family and friends of the patient, so that they can be a part of the healing process. We are
making and following recommendations that we know can make a difference (e.g. modifying the environment,
behavior management). Lastly, we are following a medication guideline that can help the patient with their agitation,
so that they can participate in functional activities.
What can family and friends do to help?
During Visits:
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Keep the room and surrounding area quiet.
Turn off the TV and radio when you are visiting, and especially during meals.
No more than 2 visitors at a time.
Keep visits short and focused.
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Only one person should talk at a time.
Observe signs posted in the room placed by your team members. They can help guide you in the care of your
loved one.
Try to keep daily routines the same. The team may have a schedule for daily activities, which may include
therapies, bathing, meals, rest breaks, and visitation times.
There will be scheduled rest breaks during the day. Please respect these and schedule visits accordingly.
Patient Orientation:
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Remind the patient where they are, what the date is, and what happened to them. Don’t quiz them
constantly, as this may increase agitation because they don’t remember the answers.
Bring in familiar items: pictures, 1-2 stuffed animals, etc., but not too much stuff that the room is visually
busy.
In General:
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Note behaviors that increase or decrease agitation. Make your team aware of them.
Give patient time to respond when you ask them a question. It may take them longer to think of answers
after their injury.
For more education, please ask your therapist or nurse.