BH Rehabilitation Institute - Little Rock
Brain Injury
The Brain Injury Program at BAPTIST HEALTH Rehabilitation Institute (BHRI) is designed for individuals who have experienced an injury to their brain resulting in problems which may include coma, movement and sensory impairment, communication deficits, memory and cognitive deficits, swallowing problems, visual impairment, behavioral changes, seizures, and confusion. BHRI has the only acute rehabilitation program in Arkansas which is accredited in the treatment of brain injury patients by the Commission on Accreditation of Rehabilitation Facilities. In 2009 BHRI treated 95 individuals in our inpatient program who had sustained a traumatic brain injury. 71% of these patients were able to return home after an average of two weeks of treatment..
The trauma of brain injury may cross the entire spectrum of medical, physical, cognitive, behavioral, emotional, and psychological problems. Therefore, BHRI provides a team of rehabilitation professionals who have specialized training in the treatment of individuals with brain injuries and work together to meet the needs of each patient and family. We have a comprehensive team approach which includes patient and family, physicians, nursing, care coordinator, physical therapy, occupational therapy, speech-language pathology, respiratory therapy, dieticians, therapeutic recreation, chaplains, neuropsychology, and driver rehabilitation instructors. The goal of our program is to minimize the disability and help each patient achieve the highest possible level of independence. We also place a high priority on helping the patient’s family deal with the effects of the injury.
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-What is a Brain Injury? -Recovery from Brain Injury -Behavior Management -Bowel and Bladder Management -Skin Management and Pressure -Transfer Training |
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A traumatic brain injury (TBI) is an insult to the brain caused by external forces such as motor vehicle accident, fall, or assault. Non-traumatic brain injuries are also insults to the brain by internal factors such as cancer, toxicity, or lack of oxygen to the brain called anoxia. TBI can be classified as mild or severe, and often causes an altered state of consciousness, which may lead to cognitive, physical, and behavioral changes. TBI can result in short term and long-term problems.
The brain is a very complex organ and is responsible for many important functions. The brain is responsible for obtaining and remembering information, interpreting incoming stimuli or sensations (smell, touch, sight, taste, and hearing), controlling movement and muscles, communication, eating and swallowing, and social interactions. After a traumatic brain injury, many of these functions may be compromised.
A traumatic brain injury may cause bleeding in one area of the brain. However, due to the blunt forces to the head, a TBI may often cause the brain to move around in the skull, causing multiple areas of injury or even swelling throughout. Similarly, a non-traumatic brain injury may be focal (tumor or aneurysm) or may affect many areas of the brain (infection, lack of oxygen, etc). Therefore, everyone with a brain injury will present differently.
Recovery from Brain Injury No two individuals are alike and no two injuries are alike. Stages of recovery range from coma level to purposeful and appropriate ( [PDF] the Rancho Los Amigos scale ). As the brain heals after TBI, it may progress through these stages. Some individuals progress quickly through these stages, while others may progress slowly and even remain in an early stage long after the injury.
Individuals with TBI may experience behavioral changes. As the brain heals from TBI, it is often difficult for the brain to organize information or interpret incoming stimuli. As a result, the brain’s automatic reaction is often to respond in anger. The team at BHRI is trained to assist the patient with more appropriate responses while helping to reduce the amount of incoming stimuli.
Some complications of TBI may include increased muscle tone, coma, and decreased movement which can all be prone to skin breakdown if not managed properly. The team at BHRI will assist patients in proper seating and wheelchair cushions to provide even/low pressure when in the wheelchair. For individuals who are unable to readjust in the chair, it is important to provide pressure relief in the wheelchair for one minute every 15 minutes. Likewise, it is important to turn the patient in the bed every two hours in order to provide pressure relief and change position.
Speech, Language, and Cognitive Training
When caring for a patient with brain injury, the term “cognition” is frequently used. Cognition simply means “understanding” or “knowing”. It is the process by which we acquire knowledge. At BHRI all members of the team work together to improve the patient’s cognitive skills. This skill levels include:
Attention - Being alert and aware
Selective Attention - Being able to tune out distractions and background noises
Discrimination - Knowing how items are the same or different
Sequencing - Putting thoughts and activities in their proper order
Memory - Being able to recall events, names, etc. over short and long periods of time
Categorization - Being able to sort information correctly
Thought Organization - Being able to add newly learned information to old information
Reasoning, Problem Solving, and Judgment - Being able to think through and make decisions in a difficult or abstract situation
Baptist Health Rehabilitation Institute sponsors the Central Arkansas Brain Injury Support Group. This group, which is lead by BHRI staff, is made up of individuals who have in some way been touched by a traumatic brain injury. It includes survivors of brain injury as well as their friends, family, and caregivers.
The Brain Injury Support Group meets at BHRI on the second Tuesday of each month at 6:00. It is an opportunity to join others from the community who are dealing with similar challenges and obtain information on resources, etc. as well as being strengthened by conversation, friendship, group problem solving, and common bonds.
For more information or to be included in the monthly mailing list, please contact Diane Gottsponer, Brain Injury Team Care Coordinator at 501-202-7047.
Training to Compensate for Visual Impairment
Problems such as a loss of part of the visual field and problems with eye movements are common with brain injuries. At BHRI individuals who are affected by such impairments are involved in a variety of activities to learn methods to compensate. Several computers are equipped with programs that involve visual tracking activities including Dynavision. In addition, recommendations on how to adapt the individual’s environment to accommodate for impairments in visual function will be provided.
Specialized Feeding and Swallowing Program
Survivors of brain injury sometimes experience a swallowing problem known as dysphagia. When an individual has a swallowing disorder, there is always the danger that food or liquid will go into the lungs rather than into the stomach. This is known as aspiration, which can cause pneumonia. Dysphagia also makes it more difficult for patients to get their nutritional needs met.
BHRI utilizes an interdisciplinary team, led by Speech-Language Pathologists, to provide comprehensive services for dysphagia patients and their families. Some treatments are as simple as changing the patient’s head or body position when they swallow, or changing the types of foods the patient eats. Others may involve the patient’s learning new ways to swallow. The professionals at BHRI have the training and expertise to assess the swallowing disorder and determine the proper treatment regimen for each individual.
Many patients with brain injury have increased muscle tone, which can cause very tight muscles and stiff extremities, making it difficult for joints to move. Increased muscle tone can be a hindrance to walking, getting dressed, or even sitting upright. In some select cases, serial casting may be used to stretch tight muscles to allow for increased range of the joints. The physical and occupational therapists will assess for serial casting needs.