March Is TBI Awareness Month

March is TBI awareness month, which is something that is very near and dear to me.  In January of 1998, I suffered a TBI, and the repercussions have been trying, to say the least.  But that is a post for later this week.  This post is for awareness, resources, and advocacy.  Enough said.

What is a TBI?

TBI (traumatic brain injury), as defined by the Centers for Disease Control and Prevention (2015), is caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.  While not all bumps or blows to the head result in a TBI, it is estimated that approximately 2.5 million hospital visits are associated with a TBI which contribute to more than 50,000 deaths per year.

Diagnosis a TBI

TBIs are diagnosed using one of two main systems: The Glasgow Coma Scale or the Ranchos Los Amigos Scale.   The Glasgow Coma Scale is based on a 15-point scale and describes the level of consciousness of a person after a TBI and used to describe the severity of the injury.  It measures the functions of eye opening, verbal response, and motor response.  (To see a more detailed breakdown of these functions, please click here.)  The Ranchos Los Amigos Scale measures the levels of awareness, cognition, behavior, and interaction with the environment.  It uses eight different levels ranging from Level 1: No Response to Level VIII: Purposeful-appropriate.  (To see a more detailed breakdown of these levels, please click here.) 

For simplicity purposes, I am choosing to elaborate using the Glasgow Coma Scale.  Using this scale, the severity can be described as mild, moderate, or severe.

Mild TBI 

• brief loss of consciousness ranging from a usually few second to a few minutes OR no loss of consciousness but some confusion
• post-traumatic anmesia (PTA) for less than 1 hour of the TBI
• normal brain imaging results 

Moderate TBI 

• loss of consciousness for a few minutes to a few hours
• confusion lasts from days to weeks
• PTA for 1-24 hours
• abnormal brain imaging results
• physical, cognitive, and/or behavioral impairments last for months or weeks

Severe TBI

• loss of consciousness for more than 24 hours
• PTA for more than 24 hours
• abnormal brain imaging results
• may affect short or long-term cognition, sensation, language, and emotional impairments 

Causes of TBIs

According to the CDC, TBIs between 2006-2010 were results of the following:

Long-Term Effects

Long-term effects of TBIs are variable and depend on the severity.  Individuals with a mild TBI will most often have no long-term effects.  For those that do, the symptoms may be longer lasting or even permanent including irritability, anxiety, and depression.  Other challenges may also include balance, movement, attention, concentration, judgement, and reaction time.  For many individuals with a moderate to severe TBI, the long-term effects can lead to life-long challenges.  Physical changes can include sleep disorders, changes in appetite, paralysis, seizures, difficulty regulating body temperature, and hormonal challenges.  Cognitive changes can include difficulty with attention, concentration, memory, processing speed, perseveration, confusion, impulsivity, and executive functions.  Speech-language challenges may include understanding spoken words or generating words, slurred speech, reading and writing problems.  Social-emotional challenges may include fluctuating emotions, lack of motivation, irritability, aggression, depression, and and lack of inhibition.  Additional challenges may include sensory, perception, vision, hearing, smell, and taste.  The list is even more extensive, however, these highlight the most common.

Resources

CEMM (Center of Excellence for Medical Multimedia) has great resources for TBI.  Please visit their website to find an interactive brain, videos, and information on caregiver and personal journeys.

The CDC has a four-minute podcast about The Dangers of Brain Injuries that is also a great resource.  You can check it out here. 

References:

BrainLine.org (2015).  Retrieved from http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html

Northern University: Traumatic Brain Injury Resource for Survivors and Caregivers (2010).  Retrieved from http://www.northeastern.edu/nutraumaticbraininjury/what-is-tbi/severity-of-tbi/

Brain Injury Alliance (nd.) Retrieved from http://biau.org/types-and-levels-of-brain-injury/

Center for Disease Control and Prevention (2015).  Retrieved from http://www.cdc.gov/traumaticbraininjury/get_the_facts.html

Center of Excellence for Medical Multimedia (nd.) Retrieved from http://www.traumaticbraininjuryatoz.org

2SpeakRight's ALS (Minus the Ice) Challenge!

We did it…without the ice :)  We took the challenge and donated. We laughed at our friends and colleagues dowsing themselves in freezing, cold water.  We laughed a lot. We still laugh at the new posts, but after the laughter, there is still the underlying fact that ALS is a devastating disease, which led us to this post.

ALS (Amyotrophic lateral sclerosis) is a progressive neurodegenerative disease that affects nerve cells in the spinal cord and brain.  Motor neurons that run from the brain to the spinal cord and from the spinal cord to the muscles in the body begin to degenerate.  Initially, individuals with ALS have variable symptoms, with nearly 60% having some type of muscle weakness such as tripping, dropping things, arm/leg fatigue, slurred speech, and twitches.  As the motor neurons continue to degenerate and die, advanced stages of the disease include shortness of breath, difficulty breathing and swallowing.  Eventually, the brain is no longer able to control muscle movement, leading to possible paralysis and eventually death.  According to the ALS Association, nearly 5,600 people in the US are diagnosed with ALS each year with a life expectancy averaging from two to five years from the time of diagnosis. 

If ALS is a degenerative disease, then what role does a speech-language pathologist play?  ASHA shares that direct speech intervention is not recommended due to fatigue (and resulting difficulty in using communication in other settings after therapy), the possibility of quicker advancement of deterioration, and a reminder of the ongoing loss of skills.  Instead, they share that augmentative and alternative communication (AAC) is a means for people to maintain their lines of communication.  In general, individuals in the initial stages of ALS prefer using light tech AAC aids to communicate basic wants and needs and as the disease progresses they prefer to use high-tech aids to express more detailed wants and needs.

What can you do to help?  Donate.  We challenge YOU!  And if you want to do the ice thing too, go for it!  Here are a few of our favorites!

Parkinson's Awareness Month

April is Parkinson's Awarness Month and I feel a great empathy to the 7-10 million worldwide who suffer with it. My experience with patients of Parkinson's began several years ago. I was asked to talk at a local support group for patients and families about affects of the disease on speech and swallowing. I was so moved by this group that I eventually began volunteering to be their facilitator during the summer months when school was out.

What is Parkinson's, What causes it? and How is it treated?

Parkinson's disease progresses over many years for most sufferers. Most sufferers start noticing a twinge in their fingers or toes, or sometimes differences in their digestion as the first signs. What is happening is that the neurons that produce dopamine in their brain do not produce as much or then stop producing it. Dopamine is a very important neurotransmitter for movement and without it the nerves have trouble sending messages to the muscles. What happens is that muscle movements become erratic and a struggle to control. Patients who have it can have trouble completing every day tasks. Some Patients (but not all) may experience memory problems, altered speech, insomnia, digestive problems and depression. So far treatments do alleviate the symptoms but do not slow the progression of the disease. There is no cure but research continues to be conducted to determine a cause and more effective treatments. 

The best resource I have found was the Davis Phinney Foundation located at http://www.davisphinneyfoundation.org/. Their mantra is live every day well and to celebrate everyday victories. They offer several free webinars to help to educate sufferers about treatment, ways to stay positive, and research that is being conducted. They also host a victory summit every year for patients and their families to attend and celebrate the victory of living everyday.


Here are other resources that you may also find helpful:

 http://www.pdf.org/en/parkinson_statistics

http://well.blogs.nytimes.com/2012/07/09/keeping-parkinsons-disease-a-secret/

https://www.michaeljfox.org