Chapter 9 Report

Physical
Disabilities
Chapter 9
TRAUMATIC BRAIN
INJURY (TBI)
A fall, car accident, gunshot wound, and a blow to the head are just a few
potential causes of traumatic brain injury (TBI). Falls are the leading cause of TBI.
The potential long-term effects of TBI are significant and can seriously affect the
quality of life of those affected.
Although anyone can sustain a TBI, in recent years awareness has increased
about the risks for TBI associated with military service and sports.
Likewise, football players, skiers, cheerleaders, and others involved in high school,
college, professional, and recreational sports are at greater risk than the general
population for TBI.
TBI includes two specific types:

1.Closed head injury
Refers to non-penetrating injury
2. Open head injury
Refers to penetrating injury resulting in brain tissue exposure and disruption of
normal protective barriers.
GUIDELINES FOR EFFECTIVE
TEACHING OF THE BRAIN-INJURED
PATIENT
DO DON'T
Use simple rather than complex Stop talking or give up trying to
statements. communicate.
Use gestures to enhance what you are Speak too fast.
saying. Talk down to the person.
Give step-by-step directions. Talk to others as if the patient is not
Allow time for responses. there.
Recognize and praise all efforts to
communicate.
Use listening devices.
Keep written instructions simple, with as
small an amount of information as
possible.
Memory Disorders
Memory is a complex process that allows people to retrieve
information that has been encoded and stored in the brain (Cherry,
2017). Typically, most people can retrieve information quite quickly
and without much effort from either their short-term or long-term
memories.
Short Term Memory - Refers to information that is

remembered if one is attending to it.
Long Term Memory - Long-term memory consists of information

that has been repeated and stored and becomes available
whenever the individual thinks about it.
Brain injury often results in a memory disorder referred to as amnesia.
Anterograde Amnesia
Retrograde Amnesia
The following strategies may be helpful when working with patients who have memory loss:
To relearn the memory process, emphasize memory techniques that focus on the need
for attention, the benefit of repeating information, and the importance of practicing
recall to grasp the information being taught (Thomas, 2009).
If the patient has intact communication skills, encourage him or her to take notes during
teaching sessions or the session can be audiotaped to provide the patient and his or her
family with reinforcement of information.
If a patient has minor memory problems, assist him or her to create a system of
reminders, such as use of a personal digital assistant (PDA), calendar, or sticky notes.
Use vivid pictures or have patients draw pictures to help them visualize concepts
(Wadsley, 2010).
Teach patients to “chunk information.”
Structure teaching sessions to allow for brief, frequent repetitive sessions that provide
constant reinforcement of learning.
Involve the family or caregiver in the teaching session whenever possible to support the
patient and reinforce information.
- Communication disorders can affect an
Communication individual’s ability to both send and
Disorders receive messages. A cerebrovascular
accident is the most common cause of
impaired communication and is the
leading cause of long-term disability in
the United States.
APHASIA
- One of the most common residual
deficits of a stroke is aphasia. Aphasia
results from damage to the language
center of the brain and is not the result
or cause of an impairment in intelligence.
2.Expressive Aphasia
1.Global Aphasia - Affects the dominant cerebral
- The most severe form of hemisphere and results in
aphasia and produces patients having difficulty
deficits in both the ability conveying their thoughts,
Types of to speak and understand

language as well as to
speaking haltingly, and using
sentences consisting of a few
Aphasia:
disjointed words, but they
read and write.
understand what is being said
to them.
3.Receptive aphasia 4. Anomic Aphasia

- Is a result of damage to - Individuals with anomic
Wernicke’s area of the temporal aphasia understand what is
lobe and affects auditory and being said to them and can
reading comprehension. Although
speak in full sentences, but
the hearing in patients is not
impaired, they are nevertheless
they have difficulty finding the
unable to understand the right noun or verb to convey
significance of the spoken or their thoughts. thoughts.
written word. Circumlocution is common.
AUGMENTATIVE AND
ALTERNATIVE COMMUNICATION
(AAC)
Be sure you have the Teach the patient to point Avoid jumping from topic to
patient’s attention, and to certain objects to topic.
that he or she is quickly express common Teach the patient to use
exaggerated facial
comfortable and is ready needs.
expressions, hand
to attempt to engage in Use simple sentence
movements, or tone of voice
interaction before you structure, speak slowly,
to improve speech
begin communication. and emphasize important
comprehension.
Establish a consistent words. Repeat significant
Make use of available
system for everyone to points using different communication boards that
use that allows patients to words or phrases. Ask only provide a platform for
respond to yes/no one question at a time. pictures, letters, or other
questions. It is critical that Break questions down into symbols to be displayed so a
all staff use the same parts so that simple patient can point or gesture
system. answers are acceptable. to convey a message.
DYSARTHRIA
- A neuro-motor disorder that is caused by damage to the

nerves or muscles associated with eating and speaking,
including the mouth, tongue, larynx, or vocal cords. Individuals
with dysarthria have problems that range from mild to severe
with their speech being unintelligible, audible, natural, and
efficient the type and severity of dysarthria depend on which
area of the nervous system is affected.
To improve communication with people with
dysarthria, the nurse should implement the following
strategies (ASHA, 2017a; Yorkston et al., 2001):
Control the communication environment by reducing distractions.
Pay attention to the patient and watch him or her while speaking.
Be honest and let the patient know when understanding him or
her is difficult.
Encourage the patient to speak more slowly if he or she is hard to
understand.
Convey the part of the message that is not understandable so
that the patient does not have to repeat the entire message.
Ask questions that require a “yes” or “no” answer or have the
patient write out his or her message when the patient cannot be
understood.
Conduct teaching sessions when the patient is rested because
fatigue causes speech to become more difficult to understand.
THANK YOU!
Do you have any questions
for me before we go?

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Physical

TBI includes two specific types:

Short Term Memory - Refers to information that is

Long Term Memory - Long-term memory consists of information

Types of to speak and understand

3.Receptive aphasia 4. Anomic Aphasia

- A neuro-motor disorder that is caused by damage to the

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