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What is an acquired brain injury (ABI)?




       Jayar La Fontaine
       System Navigator
What is an acquired brain injury (ABI)?
What is an acquired brain injury (ABI)?
What is an acquired brain injury (ABI)?
     ABI is damage to the brain which
     occurs after birth, either:
What is an acquired brain injury (ABI)?
     ABI is damage to the brain which
     occurs after birth, either:

            traumatically, i.e. motor vehicle
            accident, fall, assault or sports injury
What is an acquired brain injury (ABI)?
     ABI is damage to the brain which
     occurs after birth, either:

            traumatically, i.e. motor vehicle
            accident, fall, assault or sports injury

            through a medical problem or
            disease process which causes
            damage to the brain, i.e. aneurysm,
            stroke, or tumour
What is an acquired brain injury (ABI)?
     ABI is damage to the brain which
     occurs after birth, either:

            traumatically, i.e. motor vehicle
            accident, fall, assault or sports injury

            through a medical problem or
            disease process which causes
            damage to the brain, i.e. aneurysm,
            stroke, or tumour

            But not:
               Progressive neurological diseases
               such as Parkinson’s or Alzheimer’s
The Human Brain
The Human Brain   The Frontal Lobe

                  planning           decision making
                  organizing         selective attention
                  problem solving    problem solving
                  memory             behavioural control
                  impulse control    emotional control
The Human Brain   The Frontal Lobe

                  planning            decision making
                  organizing          selective attention
                  problem solving     problem solving
                  memory              behavioural control
                  impulse control     emotional control


                  When injured:

                  emotions
                  impulse control
                  language
                  memory
                  social and sexual behaviour
The Human Brain   The Parietal Lobe

                  integrate sensory information from
                  different parts of the body
                  controls sensation (touch, heat, pain)
                  tells us which way is up
                  helps to keep us from bumping into
                  things when we walk
The Human Brain   The Parietal Lobe

                  integrate sensory information from
                  different parts of the body
                  controls sensation (touch, heat, pain)
                  tells us which way is up
                  helps to keep us from bumping into
                  things when we walk

                  When injured:

                  inability to locate parts of your body
                  inability to recognize parts of your body
The Human Brain   The Occipital Lobe

                  receive and process visual information
                  contain areas that help in perceiving
                  shapes and colours
The Human Brain   The Occipital Lobe

                  receive and process visual information
                  contain areas that help in perceiving
                  shapes and colours




                  When injured:

                  visual field defects
                  distorted perceptions of size, colour, and
                  shape
The Human Brain   The Temporal Lobe

                  recognizing and processing sound
                  understanding and producing speech
                  various aspects of memory
The Human Brain   The Temporal Lobe

                  recognizing and processing sound
                  understanding and producing speech
                  various aspects of memory




                  When injured:

                  hearing loss
                  language problems
                  sensory problems like the inability to
                  recognize a familiar person’s face
The Human Brain   The Cerebellum

                  balance
                  movement
                  coordination
The Human Brain   The Cerebellum

                  balance
                  movement
                  coordination




                  When injured:

                  uncoordinated movement
                  loss of muscle tone
                  an unsteady gait
The Human Brain   The Brain Stem

                  heart rate
                  breathing
                  blood pressure
                  swallowing
The Human Brain   The Brain Stem

                  heart rate
                  breathing
                  blood pressure
                  swallowing



                  When injured:

                  heart rate
                  breathing
                  swallowing
NEURON: brain cell
NEURON: brain cell




                     Soma
NEURON: brain cell




           Axon

                     Soma
NEURON: brain cell




           Axon         Dendrite

                     Soma
Motor Vehicle Collision                        ABI by Cause*
   Bicycle Crash
   Pedestrian struck by motor vehicle
   Illness affecting the brain                          11%
   Anoxia
   Motorcycle Collision                      3%
   Recreational Vehicle
   Fall
   Assault                          12%                                 40%
   Other


                                   2%

                                    3%
                                        2%




                                                  17%              3%
Source: OBIA Impact Report 2012
* N=592                                                       7%
invisible
invisible
no outward signs of trauma
invisible
   no outward signs of trauma

dismissed as a knock on the head
invisible
   no outward signs of trauma

dismissed as a knock on the head
high likelihood of being diagnosed
        late, or misdiagnosed
invisible
      no outward signs of trauma

   dismissed as a knock on the head
   high likelihood of being diagnosed
           late, or misdiagnosed
cognitive and behavioural issues blamed
 on the individual rather than the injury

                  ...
invisible
      no outward signs of trauma

   dismissed as a knock on the head
   high likelihood of being diagnosed
           late, or misdiagnosed
cognitive and behavioural issues blamed
 on the individual rather than the injury

                  ...
Mental
Illness
Mental
  Illness
Personality Disorders
Mental
  Illness
Personality Disorders


     66%

           Hibbard M.R. et al.
           Axis II psychopathology in
           individuals with traumatic brain injury.
           Brain Injury. 2000 Jan;14(1):45-61.
Mental
Illness
Major Depression
Mental
Illness
Major Depression


39%
Mild ABI
Mental
Illness
Major Depression


39% 77%
Mild ABI          Severe ABI



           Malaspina, D. et al.
           Brain Injury and Schizophrenia in
           Members of Schizophrenia and
           Bipolar Disorder Pedigrees. Am J
           Psychiatry 158:440-446, March
           2001
Homelessness
Homelessness
                                                  53%



 Hwang et al. (2008) The effect of traumatic brain injury on the health of homeless people. CMAJ • October 7, 2008; 179 (8).
Incarceration
Substance Abuse




Pre-ABI History of
Substance Use Disorder:
Substance Abuse




Pre-ABI History of
Substance Use Disorder:                                                     60%
     Corrigan et al. (1995). Substance abuse as a mediating factor in outcome from traumatic brain injury.
                                           Archives of Physical Medicine and Rehabilitation 76(4): 302-9.
Substance Abuse



Post-ABI Development of
First Substance Use
Disorder:
Substance Abuse



Post-ABI Development of
First Substance Use
Disorder:
                                                                      20%
       Ashman et al. (2004) Screening for substance abuse in individuals with traumatic brain injury.
                                                                         Brain Injury: (18),191-202
FATIGUE
9%
FATIGUE   45%

                            46%




                None of the Time
                Some of the Time
                Most of the Time
SLEEP   40%
                       21%




                       39%




              None of the Time
              Some of the Time
              Most of the Time
Memory
Memory
             5%



51%                 44%




      None of the Time
      Some of the Time
      Most of the Time
Concentration
Concentration
DECISION MAKING
None of the Time
      9%                Some of the Time
                        Most of the Time
46%
           45%




      DECISION MAKING
Mood
Work
Work           25%


Prior to ABI
                     75%   Employed for Pay
                           Not Employed
Work              13%



After ABI
            87%         Employed for Pay
                        Not Employed
hearing                        dizziness

                         anxiety
                                         seizures
         disinhibition
                                   temper
         akrasia

                                            mobility
vision
CAREGIVER BURDEN
CAREGIVER BURDEN
                  Employment Status




      46%
54%




            Yes     No
CAREGIVER BURDEN
                  Change in Family
                   Circumstances



33%



      67%



            Yes   No
CAREGIVER BURDEN
                  Change in Residence




      41%

59%




            Yes     No
CAREGIVER BURDEN
                  Access to Respite




37%


      63%



            Yes    No
CAREGIVER BURDEN
                  Concerns about Behaviour




48%
      52%




            Yes        No
Wear a
helmet.
Wear a
Seatbelt.
Be smart
about risk.
"Back when I was coming up, it
was like the Dark Ages. You get a
ding, you clear the cobwebs, and
you skate right back out there."

- Pat LaFontaine
Injury causes drastic changes in
people’s lives.
Well informed people do better.
Most people want or wish for
their old life back.
Most people want productive
and meaningful lives.
Every person deserves respect.
People have the right to make
choices, good and bad.
Empowerment
communIty
     Empowerment
Empowerment
EDUCATION
psychological
   support
cognitive therapy
!ank y"!
ABI Presentation - Aphasia Institute
ABI Presentation - Aphasia Institute

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ABI Presentation - Aphasia Institute

  • 1. What is an acquired brain injury (ABI)? Jayar La Fontaine System Navigator
  • 2. What is an acquired brain injury (ABI)?
  • 3. What is an acquired brain injury (ABI)?
  • 4. What is an acquired brain injury (ABI)? ABI is damage to the brain which occurs after birth, either:
  • 5. What is an acquired brain injury (ABI)? ABI is damage to the brain which occurs after birth, either: traumatically, i.e. motor vehicle accident, fall, assault or sports injury
  • 6. What is an acquired brain injury (ABI)? ABI is damage to the brain which occurs after birth, either: traumatically, i.e. motor vehicle accident, fall, assault or sports injury through a medical problem or disease process which causes damage to the brain, i.e. aneurysm, stroke, or tumour
  • 7. What is an acquired brain injury (ABI)? ABI is damage to the brain which occurs after birth, either: traumatically, i.e. motor vehicle accident, fall, assault or sports injury through a medical problem or disease process which causes damage to the brain, i.e. aneurysm, stroke, or tumour But not: Progressive neurological diseases such as Parkinson’s or Alzheimer’s
  • 9. The Human Brain The Frontal Lobe planning decision making organizing selective attention problem solving problem solving memory behavioural control impulse control emotional control
  • 10. The Human Brain The Frontal Lobe planning decision making organizing selective attention problem solving problem solving memory behavioural control impulse control emotional control When injured: emotions impulse control language memory social and sexual behaviour
  • 11. The Human Brain The Parietal Lobe integrate sensory information from different parts of the body controls sensation (touch, heat, pain) tells us which way is up helps to keep us from bumping into things when we walk
  • 12. The Human Brain The Parietal Lobe integrate sensory information from different parts of the body controls sensation (touch, heat, pain) tells us which way is up helps to keep us from bumping into things when we walk When injured: inability to locate parts of your body inability to recognize parts of your body
  • 13. The Human Brain The Occipital Lobe receive and process visual information contain areas that help in perceiving shapes and colours
  • 14. The Human Brain The Occipital Lobe receive and process visual information contain areas that help in perceiving shapes and colours When injured: visual field defects distorted perceptions of size, colour, and shape
  • 15. The Human Brain The Temporal Lobe recognizing and processing sound understanding and producing speech various aspects of memory
  • 16. The Human Brain The Temporal Lobe recognizing and processing sound understanding and producing speech various aspects of memory When injured: hearing loss language problems sensory problems like the inability to recognize a familiar person’s face
  • 17. The Human Brain The Cerebellum balance movement coordination
  • 18. The Human Brain The Cerebellum balance movement coordination When injured: uncoordinated movement loss of muscle tone an unsteady gait
  • 19. The Human Brain The Brain Stem heart rate breathing blood pressure swallowing
  • 20. The Human Brain The Brain Stem heart rate breathing blood pressure swallowing When injured: heart rate breathing swallowing
  • 21.
  • 22.
  • 23.
  • 26. NEURON: brain cell Axon Soma
  • 27. NEURON: brain cell Axon Dendrite Soma
  • 28.
  • 29. Motor Vehicle Collision ABI by Cause* Bicycle Crash Pedestrian struck by motor vehicle Illness affecting the brain 11% Anoxia Motorcycle Collision 3% Recreational Vehicle Fall Assault 12% 40% Other 2% 3% 2% 17% 3% Source: OBIA Impact Report 2012 * N=592 7%
  • 30.
  • 33. invisible no outward signs of trauma dismissed as a knock on the head
  • 34. invisible no outward signs of trauma dismissed as a knock on the head high likelihood of being diagnosed late, or misdiagnosed
  • 35. invisible no outward signs of trauma dismissed as a knock on the head high likelihood of being diagnosed late, or misdiagnosed cognitive and behavioural issues blamed on the individual rather than the injury ...
  • 36. invisible no outward signs of trauma dismissed as a knock on the head high likelihood of being diagnosed late, or misdiagnosed cognitive and behavioural issues blamed on the individual rather than the injury ...
  • 37.
  • 38.
  • 41. Mental Illness Personality Disorders 66% Hibbard M.R. et al. Axis II psychopathology in individuals with traumatic brain injury. Brain Injury. 2000 Jan;14(1):45-61.
  • 44. Mental Illness Major Depression 39% 77% Mild ABI Severe ABI Malaspina, D. et al. Brain Injury and Schizophrenia in Members of Schizophrenia and Bipolar Disorder Pedigrees. Am J Psychiatry 158:440-446, March 2001
  • 45.
  • 46.
  • 48. Homelessness 53% Hwang et al. (2008) The effect of traumatic brain injury on the health of homeless people. CMAJ • October 7, 2008; 179 (8).
  • 49.
  • 50.
  • 52.
  • 53.
  • 54. Substance Abuse Pre-ABI History of Substance Use Disorder:
  • 55. Substance Abuse Pre-ABI History of Substance Use Disorder: 60% Corrigan et al. (1995). Substance abuse as a mediating factor in outcome from traumatic brain injury. Archives of Physical Medicine and Rehabilitation 76(4): 302-9.
  • 56. Substance Abuse Post-ABI Development of First Substance Use Disorder:
  • 57. Substance Abuse Post-ABI Development of First Substance Use Disorder: 20% Ashman et al. (2004) Screening for substance abuse in individuals with traumatic brain injury. Brain Injury: (18),191-202
  • 58.
  • 59.
  • 61. 9% FATIGUE 45% 46% None of the Time Some of the Time Most of the Time
  • 62. SLEEP 40% 21% 39% None of the Time Some of the Time Most of the Time
  • 63.
  • 64.
  • 66. Memory 5% 51% 44% None of the Time Some of the Time Most of the Time
  • 67.
  • 70.
  • 72. None of the Time 9% Some of the Time Most of the Time 46% 45% DECISION MAKING
  • 73.
  • 74.
  • 75. Mood
  • 76.
  • 77.
  • 78.
  • 79. Work
  • 80. Work 25% Prior to ABI 75% Employed for Pay Not Employed
  • 81. Work 13% After ABI 87% Employed for Pay Not Employed
  • 82.
  • 83.
  • 84. hearing dizziness anxiety seizures disinhibition temper akrasia mobility vision
  • 85.
  • 86.
  • 88. CAREGIVER BURDEN Employment Status 46% 54% Yes No
  • 89. CAREGIVER BURDEN Change in Family Circumstances 33% 67% Yes No
  • 90. CAREGIVER BURDEN Change in Residence 41% 59% Yes No
  • 91. CAREGIVER BURDEN Access to Respite 37% 63% Yes No
  • 92. CAREGIVER BURDEN Concerns about Behaviour 48% 52% Yes No
  • 93.
  • 94.
  • 96.
  • 97.
  • 99.
  • 100.
  • 102.
  • 103.
  • 104. "Back when I was coming up, it was like the Dark Ages. You get a ding, you clear the cobwebs, and you skate right back out there." - Pat LaFontaine
  • 105.
  • 106. Injury causes drastic changes in people’s lives. Well informed people do better. Most people want or wish for their old life back. Most people want productive and meaningful lives. Every person deserves respect. People have the right to make choices, good and bad.
  • 108. communIty Empowerment
  • 110.
  • 111.
  • 112.
  • 114.
  • 115.
  • 116. psychological support
  • 117.
  • 118.
  • 120.
  • 121.
  • 122.
  • 123.

Editor's Notes

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  92. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  93. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  94. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  95. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  96. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  97. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  98. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  99. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  100. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  101. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  102. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  103. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  104. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  105. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  106. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  107. Give the spaghetti and meatball example. \nBrain injury is a diffuse axonal injury caused by shearing forces in the brain.\nAcceleration causes shearing injury, which refers to damage inflicted as tissue slides over other tissue. When the brain is accelerated, parts of differing densities and distances from the axis of rotation slide over one another, stretching axons that traverse junctions between areas of different density, especially at junctions between white and grey matter.[2] Two thirds of DAI lesions occur in areas where grey and white matter meet.\nCerebral cortex is a common site of injury with diffuse axonal injury. \n
  108. Other here refers to a collection of: sports, childbirth, operations, health complications, radiation therapy, toxic chemicals, and workplace incidents. \n\nThis is from OBIA 2012 Impact Report, so it reflects Canadian data. U.S. data differs significantly with the inclusion of one category? Any guesses? It’s armed conflict. Acquired brain injury has been called the signature injury of modern conflict. There may be as many as half a million servicemen and women returning from overseas conflict areas with acquired brain injury. \n
  109. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  110. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  111. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  112. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  113. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  114. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  115. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  116. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  117. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  118. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  119. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  120. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  121. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  122. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  123. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  124. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  125. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
  126. Nearly 15% of respondents of the OBIA Impact report said that it took up to six months for their ABI to be diagnosed. \n
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  182. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  183. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  184. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  185. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  186. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  187. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  188. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  189. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  190. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  191. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  192. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  193. So, I’m going to go a few of the major problems that people with ABI can be expected to encounter as a result of their ABI. \n\nTwo problems, fatigue AND disrupted sleep. You can imagine how frustrating it would be to become fatigued by 6 o clock every day and then toss and turn all night. \n
  194. \n
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  208. Problems with decision making can leave individuals with ABI vulnerable to exploitation of various kinds. \n
  209. Problems with decision making can leave individuals with ABI vulnerable to exploitation of various kinds. \n
  210. Problems with decision making can leave individuals with ABI vulnerable to exploitation of various kinds. \n
  211. Problems with decision making can leave individuals with ABI vulnerable to exploitation of various kinds. \n
  212. Problems with decision making can leave individuals with ABI vulnerable to exploitation of various kinds. \n
  213. Problems with decision making can leave individuals with ABI vulnerable to exploitation of various kinds. \n
  214. Problems with decision making can leave individuals with ABI vulnerable to exploitation of various kinds. \n
  215. Problems with decision making can leave individuals with ABI vulnerable to exploitation of various kinds. \n
  216. I could also have put here ‘Anxiety’ and ‘Losing One’s Temper’; the rates are fairly similar. \n
  217. I could also have put here ‘Anxiety’ and ‘Losing One’s Temper’; the rates are fairly similar. \n
  218. I could also have put here ‘Anxiety’ and ‘Losing One’s Temper’; the rates are fairly similar. \n
  219. I could also have put here ‘Anxiety’ and ‘Losing One’s Temper’; the rates are fairly similar. \n
  220. I could also have put here ‘Anxiety’ and ‘Losing One’s Temper’; the rates are fairly similar. \n
  221. I could also have put here ‘Anxiety’ and ‘Losing One’s Temper’; the rates are fairly similar. \n
  222. I could also have put here ‘Anxiety’ and ‘Losing One’s Temper’; the rates are fairly similar. \n
  223. I could also have put here ‘Anxiety’ and ‘Losing One’s Temper’; the rates are fairly similar. \n
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  238. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  239. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  240. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  241. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  242. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  243. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  244. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  245. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  246. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  247. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  248. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  249. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  250. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  251. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  252. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  253. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  254. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  255. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  256. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
  257. The list of secondary effects from brain injury goes on, and on, and on. It’s also important to remember that because of the various causes of brain injury, the effects are pretty variable. \n
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  303. People who work in aphasia know very well that information is not just inert. It’s not just something that we do to justify our existence. Informing clients, caregivers, and health professionals is the most important thing we do. Like aphasia, many of the problem stemming from brain injury are caused by improper perceptions. \n
  304. After an ABI, many people report feeling a loss of control over their lives. Coupled with increased emotional arousal, this can make people with ABI feel frustrated and angry with their caregivers and health care providers. Teaching individuals with ABI to be good self-advocates can help to cope with these feelings. \n
  305. After an ABI, many people report feeling a loss of control over their lives. Coupled with increased emotional arousal, this can make people with ABI feel frustrated and angry with their caregivers and health care providers. Teaching individuals with ABI to be good self-advocates can help to cope with these feelings. \n
  306. After an ABI, many people report feeling a loss of control over their lives. Coupled with increased emotional arousal, this can make people with ABI feel frustrated and angry with their caregivers and health care providers. Teaching individuals with ABI to be good self-advocates can help to cope with these feelings. \n
  307. After an ABI, many people report feeling a loss of control over their lives. Coupled with increased emotional arousal, this can make people with ABI feel frustrated and angry with their caregivers and health care providers. Teaching individuals with ABI to be good self-advocates can help to cope with these feelings. \n
  308. After an ABI, many people report feeling a loss of control over their lives. Coupled with increased emotional arousal, this can make people with ABI feel frustrated and angry with their caregivers and health care providers. Teaching individuals with ABI to be good self-advocates can help to cope with these feelings. \n
  309. After an ABI, many people report feeling a loss of control over their lives. Coupled with increased emotional arousal, this can make people with ABI feel frustrated and angry with their caregivers and health care providers. Teaching individuals with ABI to be good self-advocates can help to cope with these feelings. \n
  310. After an ABI, many people report feeling a loss of control over their lives. Coupled with increased emotional arousal, this can make people with ABI feel frustrated and angry with their caregivers and health care providers. Teaching individuals with ABI to be good self-advocates can help to cope with these feelings. \n
  311. After an ABI, many people report feeling a loss of control over their lives. Coupled with increased emotional arousal, this can make people with ABI feel frustrated and angry with their caregivers and health care providers. Teaching individuals with ABI to be good self-advocates can help to cope with these feelings. \n
  312. Some brain basics really helps individuals with ABI sort through their feelings, understand their capabilities, and transfer the “blame” from the personally to their injury. \n
  313. Some brain basics really helps individuals with ABI sort through their feelings, understand their capabilities, and transfer the “blame” from the personally to their injury. \n
  314. Some brain basics really helps individuals with ABI sort through their feelings, understand their capabilities, and transfer the “blame” from the personally to their injury. \n
  315. Some brain basics really helps individuals with ABI sort through their feelings, understand their capabilities, and transfer the “blame” from the personally to their injury. \n
  316. Mindfulness and talk therapy.\n
  317. Mindfulness and talk therapy.\n
  318. Mindfulness and talk therapy.\n
  319. Mindfulness and talk therapy.\n
  320. Mindfulness and talk therapy. \n
  321. Mindfulness and talk therapy. \n
  322. Mindfulness and talk therapy. \n
  323. Mindfulness and talk therapy. \n
  324. Mindfulness and talk therapy. \n
  325. Mindfulness and talk therapy. \n
  326. \n
  327. \n
  328. \n
  329. \n
  330. \n
  331. \n