Mayo Clinic | TBI Rehabilitation

Answered Questions is a monthly resource for the Spanish language Disability Community that fills an information need. This month’s question is: My cousin has a traumatic brain injury (TBI) and our family wants to help them live as independently as possible. What resources, information, and research are available on independent living for people with TBI? This edition of Answered Questions includes items that discuss NIDILRR-funded research on TBI and independent living; NIDILRR-funded resources for people living with TBI; returning to productivity after TBI; online socialization and community participation; brain rehabilitation; children and teens with TBI; and more. More about Answered Questions.

NIDILRR-Funded Projects:

The Rocky Mountain Regional Brain Injury System (RMRBIS) (in English) provides a comprehensive multidisciplinary specialty system of TBI care in the Rocky Mountain region and its research focuses on the health and function and community living and participation of people with moderate to severe TBI. The Center’s research activities include a site-specific randomized controlled trial of a group intervention to improve Self-Advocacy for Independent Life (SAIL) after TBI, among others.

The Model Systems Knowledge Translation Center (MSKTC) (in English) works with the NIDILRR-funded TBI Model System Centers to develop resources for people living with TBI (in English), their families, friends, and other stakeholders. These evidence-based resources are available in a variety of formats and cover a variety of topics related to living with TBI, including sleep after TBI, seizures, balance and cognitive problems, and topics related to independent living. The MSKTC also provides factsheets in Spanish that discuss a variety of TBI-related topics, including those related to independent living after TBI.

From the NARIC Collection:

The article, Return to productivity projections for individuals with moderate to severe TBI following inpatient rehabilitation: A NIDILRR TBIMS and CDC interagency collaboration (in English), discusses a study that estimated the probability of return to productivity during a period of 5 years after a moderate to severe TBI. The results of this study highlight the importance of a person’s preinjury occupational status and level of education in their return to productive activity after experiencing a moderate-to-severe TBI. The study was a collaboration between the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and the Centers for Disease Control and Prevention (CDC).

The MSKTC has published an evidence-based factsheet, Social Skills After Traumatic Brain Injury, that explains what social skills are, describes how a TBI may affect them, and offers some tips to improve social skills after a TBI. This factsheet is also available in English.

Research In Focus:

The article, People with Traumatic Brain Injuries Who Socialize Online May Be More Involved In Their Communities Than Those Who Did Not, discusses a study by the TBI Model System Centers (in English) in Colorado, Pennsylvania, Massachusetts, Texas, Minnesota, and Alabama that looked at the associations between social participation and social Internet use among people with TBI. The researchers found that after accounting for demographics and injury variables, the social Internet users reported engaging in community activities outside the home more often and reported higher levels of engaging in relationships than the nonusers. The authors suggest that people with TBI may benefit from instruction on the use of smart phones and social media applications, perhaps during inpatient rehabilitation, and support to troubleshoot technical challenges so that they can become comfortable using these tools for social connection.

To learn more about NIDILRR-funded research on TBI and independent living, please visit our Research In Focus series.

Rehabilitation:

The Mayo Clinic has published a factsheet on Brain Rehabilitation, which provides a general definition of brain rehabilitation and describes the reasons why a person with TBI may participate in this type of rehabilitation. It also describes what a participant may expect from this multidisciplinary approach and how brain rehabilitation helps people with TBI to return home and live as independently as possible. Brain rehabilitation is specific to the needs of each person and can include speech therapy, treatments for concussion, cognitive therapy, and support groups that assist people with TBI with the skills they need to live independently.

Education:

The article, Traumatic Brain Injury from the Center for Parent Information and Resources (in English), provides information on TBI with a focus on children and youth, including a definition of TBI and its signs and symptoms. It also includes tips for parents of children with TBI and educators. The article provides a case study, references, and resources and discusses how laws such as IDEA apply to children with TBI.

Resources:

The Texas Department of Health and Human Services has a webpage that discusses and defines TBI. The webpage includes links to educational videos, crucial information one needs to know when a TBI first occurs, preparing for emergencies, finding support and assistance, a program for Veterans with TBI, and more.
The American Occupational Therapy Association (AOTA) (in English) has created a factsheet that discusses how occupational therapists (OTs) can help people with TBI live as independently as possible. The factsheet also discusses what symptoms people with TBI may experience, provides tips to help relieve the symptoms, and describes what OTs can do to help.
The Brain Injury Alliance of New Jersey (BIANJ) (in English) has published a guide, Behavior After a Brain Injury: Challenges for Children and Adolescents, that discusses TBI in children and adolescents and how TBI affects them emotionally, physically, mentally, and cognitively. This guide for parents also discusses how a child’s or teen’s behavior may change after TBI and what parents can do to assist their children in monitoring their behavior at home, school, or in the community.

Tools:

Cognitopia Platform (in English) is a suite of web-based self-management tools for students with disabilities, including TBI. The platform includes libraries on routines that provide a starting point for support; a goal guide that helps students create goals, track their progress, and share their accomplishments with others; and a tool, MyLife, for IEP self-direction that builds students’ self-advocacy. This suite was developed under several NIDILRR grants.

Further Research:

REHABDATA:

PubMed:

International:

About Answered Questions

Each month, we look through the searches on our blog and through the information requests made by our patrons who speak Spanish and pick a topic that fills the largest need. Each resource mentioned above is associated with this month’s information need. We search the various Spanish language news sources and feeds throughout the month to bring you these articles. With the exception of the NIDILRR Projects, From the NARIC Collection, and Further Investigation, all the linked articles and resources are in Spanish – any that are in English will be clearly marked.

Overview

Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness.

Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages.

Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn’t mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.

Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age.

Epilepsy care at Mayo Clinic

Symptoms

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

Temporary confusion
A staring spell
Uncontrollable jerking movements of the arms and legs
Loss of consciousness or awareness
Psychic symptoms such as fear, anxiety or deja vu

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.

Focal seizures

When seizures appear to result from abnormal activity in just one area of your brain, they’re called focal (partial) seizures. These seizures fall into two categories:

Focal seizures without loss of consciousness. Once called simple partial seizures, these seizures don’t cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
Focal seizures with impaired awareness. Once called complex partial seizures, these seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.

Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders.

Generalized seizures

Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist.

Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness.
Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down.
Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms.
Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs.
Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

When to see a doctor

Seek immediate medical help if any of the following occurs:

The seizure lasts more than five minutes.
Breathing or consciousness doesn’t return after the seizure stops.
A second seizure follows immediately.
You have a high fever.
You’re experiencing heat exhaustion.
You’re pregnant.
You have diabetes.
You’ve injured yourself during the seizure.

If you experience a seizure for the first time, seek medical advice.

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Causes

Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including:

Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it’s likely that there’s a genetic influence.
Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause epilepsy.
Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.
Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.
Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.

Risk factors

Certain factors may increase your risk of epilepsy:

Age. The onset of epilepsy is most common in children and older adults, but the condition can occur at any age.
Family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.
Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet, and exercising regularly.
Dementia. Dementia can increase the risk of epilepsy in older adults.
Brain infections. Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk.
Seizures in childhood. High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won’t develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy.

Complications

Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.

Falling. If you fall during a seizure, you can injure your head or break a bone.
Drowning. If you have epilepsy, you’re 15 to 19 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.
Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment.
Many states have driver’s license restrictions related to a driver’s ability to control seizures and impose a minimum amount of time that a driver be seizure-free, ranging from months to years, before being allowed to drive.
Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you’re considering becoming pregnant, talk to your doctor as you plan your pregnancy.
Most women with epilepsy can become pregnant and have healthy babies. You’ll need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It’s very important that you work with your doctor to plan your pregnancy.
Emotional health issues. People with epilepsy are more likely to have psychological problems, especially depression, anxiety and suicidal thoughts and behaviors. Problems may be a result of difficulties dealing with the condition itself as well as medication side effects.

Other life-threatening complications of epilepsy are uncommon, but may happen, such as:

Status epilepticus. This condition occurs if you’re in a state of continuous seizure activity lasting more than five minutes or if you have frequent recurrent seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
Sudden unexpected death in epilepsy (SUDEP). People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows it may occur due to heart or respiratory conditions.
People with frequent tonic-clonic seizures or people whose seizures aren’t controlled by medications may be at higher risk of SUDEP. Overall, about 1 percent of people with epilepsy die of SUDEP.

By Mayo Clinic Staff

TBI Rehabilitation