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ACQUIRED BRAIN INJURY

ACQUIRED BRAIN INJURY. presented by FRANCESCA A. LaVECCHIA, Ph.D. Chief Neuropsychologist Brain Injury & Statewide Specialized Community Services Massachusetts Rehabilitation Commission. AGE of ONSET. CONGENITAL (PRENATAL) Genetic Chromosomal Multifactorial Unknown

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ACQUIRED BRAIN INJURY

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  1. ACQUIRED BRAIN INJURY presented by FRANCESCA A. LaVECCHIA, Ph.D. Chief Neuropsychologist Brain Injury & Statewide Specialized Community Services Massachusetts Rehabilitation Commission

  2. AGE of ONSET • CONGENITAL (PRENATAL) • Genetic • Chromosomal • Multifactorial • Unknown • ACQUIRED (PERINATAL GERIATRIC)

  3. LOCUS of CNS DISORDERS • INTRINSIC vs. EXTRINSIC • FOCAL vs. MULTIFOCAL vs. DIFFUSE

  4. VELOCITY of CNS DISORDERS • STATIC • PROGRESSIVE • RAPID • SLOW • INTERMITTENT

  5. ETIOLOGY OF ACQUIRED ENCEPHALOPATHIES INFECTIOUS NEUROTOXIC METABOLIC TRAUMATIC NEOPLASTIC VASCULAR DEGENERATIVE/DEMENTING

  6. NEUROEPIDEMIOLOGY: STUDY POPULATIONS • INTERNATIONAL • NATIONAL • REGIONAL • FACILITY/AGENCY-BASED

  7. NEUROEPIDEMIOLOGY: METHODOLOGY • Uniform Hospital Discharge Data Set (UHDDS) • Sampling • Survey Studies • Registries • Surveillance Studies (e.g., Centers for Disease Control)

  8. FACTORS AFFECTINGRECOVERY and OUTCOME • AGE • SEVERITY of NEUROLOGICAL INSULT • DISORDER/DISEASE-SPECIFIC DETERMINANTS • PROGNOSIS

  9. FACTORS AFFECTINGRECOVERY and OUTCOME • NATURE of COMPLICATIONS • PREMORBID CONDITIONS (e.g., Psychiatric Disorder, Developmental Disorder) • TIMELINESS, ACCURACY, and ACCESS to DIAGNOSTIC and TREATMENT SERVICES

  10. FACTORS AFFECTINGRECOVERY and OUTCOME • PARTICIPATION in REHABILITATION • OTHER POST-INJURY RISKS/FACTORS (e.g., substance abuse) • SUPPORT of FAMILY/SIGNIFICANT OTHERS

  11. LONG-TERM SEQUELAE • NEUROCOGNITIVE COMPROMISE • Dementia (progressive disorders) • Mental Retardation (e.g., Shaken Baby Syndrome) • Specific Neuropsychological Deficits (e.g., aphasia, memory disorder) • NEUROBEHAVIORAL/NEUROPSYCHIATRIC DISORDER • Personality Change • Depression

  12. LONG-TERM SEQUELAE • MOTOR DEFICITS and PHYSICAL DISABILITY • Paralysis (pyramidal disorder) • Extrapyramidal disorder (e.g., Parkinsonism) • SENSORY IMPAIRMENT • Visual (e.g., visual field impairment) • Auditory • Other sensory impairment

  13. OTHER ASSOCIATED CHALLENGES • COMPROMISED EDUCATIONAL OUTCOME • COMPROMISED VOCATIONAL OUTCOME • SOCIAL ISOLATION

  14. OTHER ASSOCIATED CHALLENGES • SUBSTANCE ABUSE • INSTITUTIONALIZATION • INCARCERATION • HOMELESSNESS

  15. CONTINUUM of SERVICE NEEDS

  16. ACUTE INTERVENTIONS(Disease/Disorder-Specific) • EMERGENCY DEPARTMENT SERVICES • SPECIALIZED INPATIENT CARE (e.g., Trauma Unit) • EVALUATION and TREATMENT by MEDICAL SPECIALISTS (e.g., Neurosurgery, Neuro-oncology)

  17. POST-ACUTE INTERVENTIONS • INPATIENT/OUTPATIENT REHABILITATION • SKILLED NURSING/LONG-TERM CARE FACILITY • Persistent Disorder of Consciousness • Slow to Recover • Progressive Disorder • Homeless with significant residual sequelae • COMMUNITY-BASED SUPPORTS (e.g., VNA, Home Health Care)

  18. ONGOING TREATMENT NEEDS • NEUROLOGY • NEUROPSYCHOLOGY • SUBSTANCE ABUSE • NEUROPSYCHIATRY • REHABILITATIVE THERAPIES (e.g., maintenance PT/OT, cognitive remediation)

  19. COMMUNITY-BASED SUPPORT NEEDS • SPECIAL EDUCATION • VOCATIONAL REHABILITATION/EMPLOYMENT • AVOCATIONAL SERVICES (e.g., Day Program, Volunteer Opportunities, Club house) • COMMUNITY LIVING SUPPORTS (e.g., Personal Care, Supported Living Services, 24/7 residential) • ACCESSIBLE/AFFORDABLE HOUSING

  20. COMMUNITY-BASED SUPPORT NEEDS • COMMUNITY INTEGRATION (e.g., access via transportation) • CASE MANAGEMENT (e.g., advocacy; linkage to resources and entitlements) • SOCIAL/RECREATIONAL/LEISURE OPPORTUNITIES • ASSISTIVE TECHNOLOGY • SUPPORT SERVICES for FAMILY/SIGNIFICANT OTHERS (e.g., respite, BIA Support Groups)

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