Training ObjectivesTraining Objectives Describe TBI. Explain how the brain may be affected by...

Training Objectives

Describe TBI.Explain how the brain may be affected by different types of injuries.Explain the significance of TBI.Describe TBI in Michigan.Explain the possible long-term impacts of TBI to individuals.Explain the possible long-term impacts of TBI to family members.Recognize some of the changes or issues that may arise due to a TBI.Identify strategies to handle people with TBI appropriately.Recall that each letter in the HELPS acronym stands for a question in theTBI screening tool.Recall how to score the TBI screening tool positive or negative.Identify when a referral for further assessment for TBI is appropriate.List appropriate referrals to public agencies for services from which peoplewith TBI may benefit and for which they may be eligible.

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Common physical, behavioral and cognitive impairments and interaction strategiesObjectives of Module 2 are to:

Learn how to interact effectively with all people with TBI 1.Learn how you can recognize issues that may arise due to a TBI and strategies to handle them in the most appropriate manner

2.

When you complete this module, you should know:

Possible physical, behavioral, and cognitive consequences of TBI •Interaction strategies for working with persons with TBI •Communication suggestions for working with persons with TBI •Awareness of cultural differences among persons with TBI •

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Brain injury affects who we are, the way we think, act, and feel. It can change everything in a matter of

seconds.

Important Things to remember from Module 1Many changes can occur after a person experiences a brain injury. When you are working with a person with TBI, try to remember the following:

The effects of a brain injury depend on such factors as cause, location, and severity of injury

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No two brain injuries are exactly the same •Brain injury is unpredictable in its outcomes, and functioning may change over time

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The effects of a brain injury are complex and vary greatly from person to person

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A person with a brain injury is a person first •

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Note that only a minority of survivors have obvious long-term, physical signs of injury. Many

of the symptoms of TBI are not visible.

Consequences of TBIConsequences of brain injuries can be categorized into the following areas:

Physical •Cognitive •Behavioral•

Physical changes caused by brain injury may be more visible than cognitive and/or behavioral changes. Cognitive and/or behavioral changes can easily be overlooked once the physical injuries have healed. Moreover, people with cognitive changes may be less aware of their cognitive and behavioral limitations than their physical limitations.


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Certain physical deficits may pose a risk for further injury. Be sure to assess and attend to risk for falls or choking when

motor abilities are impaired.

Section A: Physical consequences & strategiesPhysical changesCommon physical changes after a brain injury include:

Impairment of body movement •Speech and swallowing problems •Pain as a result of TBI •Sensory difficulties •Fatigue and sleep disturbances •Spasticity and tremors •Seizures•

Unless otherwise cited, the information presented in Section A is based on the work of Beckwith et. al, 1999-2002, and Black, 1998.


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Possible Symptoms Strategies

Poor balance •Reduced motor coordination

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Weakness on one or both sides of the body

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Fatigue or reduced endurance

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Encourage client to take his/her time and move slowly

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Be sure client is following the instructions of a physical therapist

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Promote use of adaptive equipment

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Section A: Physical consequences & strategiesImpairment of body movementMotor impairment varies greatly among injured individuals, but may include weakness of one or both sides of the body, poor balance, and lowered endurance, or ataxia, which is the inability to coordinate voluntary muscle movements.


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Slow speech •Slurred speech •Difficulty swallowing

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Encourage client to take his/her time and articulate

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Utilize written communication if clarity is very poor

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Be sure client is following the instructions of a speech and language therapist

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Use assistive technology •

Section A: Physical consequences & strategiesSpeech and swallowing problemsA person with brain injury may have a difficult time speaking clearly and swallowing due to motor impairments. Because the ability to communicate is important for psychosocial well-being, it is very important to help persons with brain injury to achieve successful communication (Prigatano et al., 1986).


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Severe headaches •

- Can be episodic or continuous

- Can affect cognitive emotional status

Neck pain•

Recommend a pain management program that includes:

Psychological/behavioral strategies

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Medication •Physical modalities, such as massage or exercise

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Section A: Physical consequences & strategiesPain as a result of TBIPost injury headaches have been reported in many cases of TBI and can continue long after the injury. While headaches are the most frequently reported source of pain, other sources of pain may result from TBI, such as back pain. Chronic pain can affect a person’s ability to concentrate and process information (Martelli et al., 1999).

For people who are non-verbal, motor restlessness or agitation may be a sign of pain.


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Double vision, loss of visual fields, or issues with depth perception

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Sensitivity to light and noise

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Decreased sense of taste and smell

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Encourage client to turn his/her head to compensate for loss of visual field

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Assist with completion of paperwork if necessary

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Be aware of the light and noise level in the environment – ask the client if he/she is comfortable

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Assess safety risks due to sensory losses

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Section A: Physical consequences & strategiesSensory difficultiesAll senses may be affected by a TBI, producing changes in hearing, vision, taste, smell, and touch. Changes may involve an increase, decrease, or loss of sensitivity.


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Lack of energy

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Daytime sleepiness

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Insomnia •Changes in sleep routines

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Consult with a physician regarding possible medications

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Review sleep routines •Take breaks •Consider recommending a sleep study •

Section A: Physical consequences & strategiesFatigue and sleep disturbancesFatigue and sleep disturbances are common following a TBI and can disrupt recovery and rehabilitation. Early identification and treatment can improve rehabilitation potential and enhance productivity.

Want to know more about the physical consequences of TBI? Click here to link to

the MDCH TBI Provider Training Manual


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Section A: Physical consequences & strategiesMotor coordination - it’s harder than you think!Try this exercise to get a feeling for how difficult everyday motor functions can be for persons with brain injury.

Slightly lift your right foot off the floor 1.Begin circling that foot clockwise 2.Continue circling your foot while you write your whole name in cursive 3.

If you thought that exercise was difficult, imagine how frustrated you would feel if every task throughout the day was this hard to complete!


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Section B: Cognitive consequences & strategiesCognitive changesDamage to the brain can compromise the execution of cognitive functions. Cognitive limitations must be taken into account when supporting individuals in achieving their targeted outcomes. Common cognitive changes after a brain injury include:

Memory impairments •Slowed processing speed •Attention/concentration deficits •Language comprehension difficulties •Expressive language difficulties •Impaired executive functioning:abstract reasoning •Impaired executive functioning: sequencing, planning, and problem solving •Inability to initiate •

Unless otherwise cited, the information presented in Section B is based on the work of Braunling-McMorrow et al., 2000, and Beckwith & Dimambro, 1996-2002


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Use repetition for learning new tasks if appropriate

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Help client adopt processes to aid his/her memory:

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Use notes, lists, tape recorders, planners

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Write down appointment dates and times

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Avoid teaching multiple new things at once

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Client may need reminder calls for appointments

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Decreased ability to store/retrieve new information

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Forgets details easily

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Section B: Cognitive consequences & strategiesMemory impairmentsMemory refers to the process of organizing, storing, and recalling information. The strategies listed here assist with both the storing and retrieving of information.


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Slow reaction time •Slow decision making

•Give plenty of time to process information

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Do not jump in when waiting for a response

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Section B: Cognitive consequences & strategiesSlowed processing speedThe rate at which information is processed within the central nervous system can decrease after a TBI.


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Easily distractible •Cannot sustain attention to new task

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Cannot pay attention to two things at once

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Difficulty filtering out irrelevant information or activity

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Control environmental distractions; keep working areas clean and quiet

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Use notes and lists to assist in shifting/dividing attention

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Avoid "overload" •Use a timer to cue new tasks •Consult a physician regarding possible medications

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Note that fatigue and sleep disturbance can affect attention and concentration.

Section B: Cognitive consequences & strategiesAttention/concentration deficitsAn individual must be able to attend to information and concentrate on tasks. Concentration requires screening out all irrelevant information and activity and sustaining that focus for a period of time.


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Difficulty understanding spoken or written language

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Difficulty holding a conversation

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Break long sentences into multiple shorter sentences

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Encourage individual to ask for clarification when needed

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Support information with simple gestures, such as pointing to an object mentioned

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Ask: "Did I make sense?" (Not: "Did you get that?")

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Section B: Cognitive consequences & strategiesLanguage comprehension difficultiesComprehension difficulties affect the ability to understand what is said or even read. The speed with which information is taken into the brain can also be affected.


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Word finding difficulties

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Disorganized communication

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Rambling off topic •Difficulty talking to more than one person at the same time

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Allow extra time for processing and expression

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Set up a discrete cueing system to let the person know if he/she is wandering from the topic of conversation

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Encourage/promote more one-on-one conversations

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Section B: Cognitive consequences & strategiesExpressive language difficultiesSeveral cognitive processes are required for successful language production: expressing one’s own thoughts, attention/concentration on the information coming in, understanding the information, remembering the information, formulating an appropriate response and finally, speaking it.


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Gets "stuck" on one view •Difficulty understanding theoretical concepts

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Concrete thinking style •Difficulty understanding double meanings, sarcasm, humor

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Speak in concrete terms •Use cues to direct to alternate viewpoints

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Give examples •Avoid or explain double meanings, as necessary

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Section B: Cognitive consequences & strategiesImpaired executive functioning: abstract reasoningAbstract thought requires analyzing situations at both the face content level and the metaphoric level. Abstraction requires a high level of cognitive functioning and is therefore quite vulnerable to impairment after a brain injury (O'Shauick & O'Shauick, 2005).


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Decreased flexibility •Difficulty understanding cause & effect

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Difficulty prioritizing and organizing tasks

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Difficulty with problem solving

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Be patient - allow time to work through difficult situations

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Break down large tasks into smaller tasks and address every step in order

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Explain alternate solutions •Establish routines •Provide structure or framework for problem solving (walk through problem solving step-by-step)

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Section B: Cognitive consequences & strategiesImpaired executive functioning: sequencing, planning and problem solvingAttention, concentration, memory, sequencing, and planning all come into play when we attempt to solve problems. These steps, which are often unconscious and happen in a split second, may become very challenging for a person with a TBI.


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No forward action on tasks (simple or complex)

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Needs constant prompts to start

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Sits on couch/in front of TV all day

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Difficulty with activities of daily living (ADLs)

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Use checklists to cue tasks and to break tasks into steps

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Suggest using a timer as a cue to begin tasks

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Provide verbal cues as needed

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Section B: Cognitive consequences & strategiesInability to initiateFollowing a TBI, some people may have a difficult time starting new tasks, may seem expressionless, and may not seem to have the inner drive and direction that they used to have.

If your client shows these symptoms, he or she should be screened for depression and

treated if necessary.


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Section B: Cognitive consequences & strategiesThings to consider

Individuals with brain injury probably remember how they used to function, and the present challenges may frustrate them.

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They should be treated like any other person of the same age. Do not speak down to a client or "baby" him or her. Treat people with TBI with dignity and respect, just as you would want to be treated if you had the same injury.

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Want to know more about the cognitive consequences of TBI? Click here to link to the MDCH TBI Provider

Training Manual


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Section B: Cognitive consequences & strategiesProcessing speedThe following exercise will help you understand the cognitive issues that people with brain injury face every day. Quickly state the WORDS:

Pink Black OrangeBlue Yellow Blue Red Orange BlackYellow Red YellowBlack Blue Green Orange Orange RedYellow Black Yellow


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Section B: Cognitive consequences & strategiesProcessing speed (continued)Now, quickly state the COLORS:

Pink Black Orange

Blue Yellow Blue

Red Orange Black

Yellow Red Yellow

Black Blue Green

Orange Orange Red

Yellow Black Yellow Were you slower this time? The difficulty and extra time that it took you to change your processing from stating the word to stating the color gives you a feeling for the cognitive effort that many people with TBI cope with all day long.


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Section C: Behavioral consequences & strategiesBehavioral changesCommon behavioral changes after a brain injury include:

Inability to control emotions •Social inappropriateness •Difficulty with relationships •Lack of response to social cues •Mood swings •Stress, anxiety, and frustration •Posttraumatic depression •Mental health issues •

Unless otherwise cited, the information presented in Section C is based on Braunling-McMorrow et al., 2000 and Beckwith & Dimambro, 1996-2002

Some emotional or behavioral issues may require

professional monitoring and medication. Clients with

depression, anxiety, paranoia, or mania should be referred to a mental health professional with expertise in brain injury.


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Overreacts to situations

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Frustration tolerance is reduced

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Mood swings •Temper outbursts/irritability

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Remain calm •Give suggestions for regaining control

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Praise once in control •Review consequences of behavior •Avoid situations that trigger uncontrollable emotional reactions

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Model appropriate behavior •Encourage rest breaks•

Section C: Behavioral consequences & strategiesInability to control emotionsThe ability to control one’s own emotional reactions requires the capacity to inhibit one’s behavior when appropriate. A person with TBI may lose the ability to inhibit emotional outbursts. Episodes of uncontrolled emotions are often associated with fatigue or complex social situations.


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Rude, selfish, and childlike behavior

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Lack of responsiveness to social cues

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Acting out in sexual or other inappropriate ways

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Violating others’ personal space

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Praise positive behaviors •Model or substitute appropriate behaviors

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Recommend group/peer activities to facilitate appropriate behaviors

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Focus on progress•

Section C: Behavioral consequences & strategiesSocial inappropriatenessPersons with brain injury may display inappropriate behavior due to an inability to accurately assess social situations. Reacting appropriately to a social situation requires quick and accurate retrieval of information about similar situations from long-term memory and basing behavior on this information. Impairments in retrieval speed, memory, and language may all contribute to socially inappropriate behavior (O'Shauick & O'Shauick, 2005).


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Inability to express empathy

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Inability to maintain social boundaries

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Boastful •Focused on self •

Redirect disrespectful behavior •Encourage cooperative behavior •Use role-playing to practice relationship skills

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Don’t make comparisons to how they were before

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Section C: Behavioral consequences & strategiesDifficulty with relationshipsThe many changes faced by a person with TBI can dramatically change relationships with family members and friends. Additionally, inappropriate behavior, such as childishness or selfishness, combined with a lack of control over emotions can make it very difficult for persons with TBI to form new relationships and maintain old ones.


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Section C: Behavioral consequences & strategiesBasic behavior strategiesHuman behavior is very complex. Researchers have been studying our behavior for centuries – what we do, why we do it, and how we do it. Because every interaction with individuals with brain injuries may have a direct impact on their behavior, as a professional you should become alert to your behavior, making sure that both your responses and interactions support the individual and the outcomes he/she desires.


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Section C: Behavioral consequences & strategiesUsing antecedents and consequences to elicit appropriate behaviorAs you observe specific behaviors, both positive and negative, try to understand the factors that contribute to them. Look at what is happening both before and after the behavior of interest. The A-B-C method of observation will help you do this:

A = Antecedents: events that occur prior to a behavior B = Behavior of interest C = Consequences: results of the behavior

Identify antecedents that trigger negative behaviors and try to avoid them in the future.

Make sure that behaviors you exhibit are not negative antecedents! •Reinforce antecedents that trigger positive behaviors. •

Consequences serve to reinforce behavior. If the consequence is positive, the behavior is likely to be repeated (positive reinforcement). If the consequence resulted in the individual getting out of an unpleasant situation or helped him/her to avoid the situation altogether, the behavior will likely be repeated (negative reinforcement). If the behavior leads to unwanted consequences (punishment), it is less likely to occur again.

To learn more consult the MDCH TBI Provider Training Manual.


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Medication side effects

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Relationship issues •Disappointment related to losses

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Sleep irregularity

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Sexual history

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Addictions•

Seizure activity •Pain •Other mental health issues

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Section C: Behavioral consequences & strategiesOther influencesThere are conditions that individuals with TBI experience that reduce the ability to respond in a desired manner. For example, if an individual is in pain, she or he might be irritable or resistant to touch in a particular area. Or, if an individual did not sleep well the night before, she or he might have difficulty performing job tasks satisfactorily the next day. The following influences can affect individuals with TBI:

While not directly responsible for producing unwanted behaviors, any of these factors can increase the likelihood that an individual will have problems handling difficult situations. Your attention to such conditions could provide the support the individual needs to avoid unwanted behaviors during a challenging moment.

Want to learn more about the behavioral consequences of TBI? Click here to link to the MDCH TBI

Provider Training Manual.


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Section C: Behavioral consequences & strategiesSubstance abuse

Persons who are recovering from a TBI may turn to alcohol or drugs to numb the physical pain, the pain of lost relationships, or the pain of a lost job

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Persons who used alcohol or drugs before a TBI are more likely to turn to alcohol or drugs after a TBI. Knowing a person’s pre-injury alcohol and drug use can facilitate the most effective intervention after an injury (Turner et al., 2003)

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Some studies have indicated that between 10% and 20% of persons with traumatic brain injury develop a substance abuse problem for the first time after their injury (Corrigan et al., 1995)

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Memory problems can result in missed appointments and should not be interpreted as resistance to substance abuse treatment

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Substance abuse treatment providers will need to assess and accommodate cognitive impairments during treatment

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Section D: Cultural CompetenceCultural competenceWhat is culture? An integrated pattern of socially transmitted human behavior that includes thoughts, communication, actions, customs, beliefs, values, institutions, and all other products of human work or thought, characteristic of a particular community or population (Cross et al., 1989).

Culture is more than race or ethnicity: many groups (such as the poor, homeless, disabled) exhibit distinct cultural characteristics, which may present special service delivery issues, and which may engender culture-like responses from others.

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It is important to remember that individuals within a culture can be very different from one another.

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What is cultural competence? Cultural competence or culturally competent means the ability and the will to respond to the unique needs of an individual client or family that arise from the client's culture and the ability to use the person's cultural strengths as resources or tools to assist with the treatment, intervention or helping process.

Cultural competence is a journey; not a destination that one can ever fully attain.

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Section D: Cultural CompetenceHow can you pursue cultural competence?

Use state demographic information to learn the cultural makeup of your community

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Ask about your client’s culture (way of life, beliefs about family and mental health, values, customs, disease incidence and prevalence, etc.). Remember, families and loved ones are one of the most significant factors influencing recovery.

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Learn skills and behaviors that enable you to provide services that are appropriate for various populations

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Provide a culturally "friendly" office environment (e.g., linguistically appropriate forms and vital documents, pictures and wall hangings that reflect cultures in the community)

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Distribute translated materials when appropriate (Click here for a list of TBI materials that are available in Spanish and Arabic )

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Learn how to communicate effectively with your client about his or her disability, as well as how to appropriately relay any necessary information or instructions

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Make connections and establish relationships in the community that will allow you to refer clients to more culturally appropriate services

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Do Don't

Do be accepting •Do take every issue seriously •Do convey respect •Do assist with problem-solving •Do state relevant facts to those who need to know

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Do remember that you don’t know how they feel

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Do get all the facts •Do be their equal •Do be sincere •Do pursue cultural competence •

Don’t be blaming/fault finding •Don’t ignore an issue •Don’t talk down to anyone •Don’t patronize •Don’t take responsibility for their situation

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Don’t gossip •Don’t make promises you can’t keep

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Avoid saying things like "I know", "I know how you feel"

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Avoid being too directive•

Section E: ConclusionRecap: Tips for working with people with TBI

Remember: People with TBI may have difficulty understanding and processing information.


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Section E: ConclusionRecap: Tips for working with people with TBI (continued)

Be consistent •Treat the individual as an adult •Remember that recovery from brain injury is a learning process •Be patient •Be cautious of over stimulation •Model calm and controlled behavior •Expect the unexpected •Remember that people with brain injury are more sensitive to stress •Keep in mind that the individual may get worse before getting better •Redirect problematic behavior •Remember that the person may not be able to respond quickly•


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Section E: ConclusionWhat you can personally do to help people with TBI

Share what you have learned about TBI with your coworkers •Volunteer to be the “TBI Expert” in your office and offer advice to coworkers on how to work with individuals with TBI

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Act as an advocate for your clients with TBI by helping them navigate the system and get appropriate services

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Become involved in your local TBI support group or the Brain Injury Association of Michigan

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Section E: ConclusionCase studiesThe theoretical case studies of Mary and Justin will allow you to explore this module's topics further. Below you will find a brief description of each study. Use the next button at the bottom of the page to begin the first case study. Case study: Mary – This study describes the situation of a woman who sustained a moderately severe TBI in a car crash, resulting in several cognitive and other issues. Case study: Justin – This case study illustrates the situation of a young man with a TBI, which resulted from an off road vehicle accident. Since then he has been experiencing several behavioral and other issues.


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Case Study - MaryMary’s backgroundMary is a 48 year old woman who sustained a brain injury in a car crash three years ago. Mary was a homemaker at the time of her injury. When she did recognize that she was having some ongoing problems, she sought an auto insurance settlement. Her husband quickly spent the settlement and left her. Their three teenage children (ages 13 – 17) have been living with Mary. Her son reports that he discovered her following an apparent suicide attempt using drugs prescribed for pain management. This resulted in a three day psychiatric admission for Mary for observation and follow-up counseling. Mary says she wasn’t trying to commit suicide. She just didn’t realize she had taken so many pills.


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Case Study - MaryMary’s background (continued)Mary’s ex-husband did care for the children during her most recent hospital stay, but he has a generally unsupportive relationship with Mary. Mary’s ex-husband has been unemployed for a number of years and is on disability due to a back injury. Mary reports that she is getting medical follow-up from her local Medicaid funded health clinic to address injury related issues. She has not seen any specialists because she couldn’t find one that accepts Medicaid.


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Case Study - MarySummary of Mary's Issues

Mary has frequent, severe headaches •She has poor follow through due to a variety of factors, including short-term memory problems, visual problems, and reading comprehension problems

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She complains of fatigue and sleep disturbance •She sometimes feels depressed •She rarely leaves her home and is afraid to drive •


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Case Study - MaryYou now have the option to view an expert's solution to this case scenario on video or to view a transcript of this solution. Please make your selection below. View the Video View the Transcript


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Possible strategies to address Mary’s issues - transcript There are some ways that Mary can get assistance. First, in order to address some of Mary’s needs, she may want to consider having an assessment by a neurologist to help develop an effective treatment plan to address her headaches. She must learn different pain management techniques such as visualization and medication management. She should be referred to physical therapy or a pain management program to assist with pain management and to establish a physical conditioning program. Mary should seek treatment from her local Community Mental Health Services Programs (CMHSP) for her depression and possible suicide attempt. Mental health also may be able to provide case management services. Mary needs a sleep evaluation from a certified sleep clinic because Mary’s problems might be worse because she can’t sleep. She will need to establish a structured sleep pattern and keep a log of sleep habits to assure she is receiving enough sleep each night. Other services also might help. Mary might like to see an occupational therapist to address her visual problems and her reading comprehension and memory problems. Some compensatory strategies might include, getting large print books or tapes from the Library for the Blind. Using a planner might help and writing down a “to-do list” to prioritize what should be done each day might help. Mary may also benefit from a medication reminder program that could be as simple as a pill box with dates and times. Mary should attend a drivers evaluation and perhaps speak to a counselor to address her fears about driving. She and her children should attend a brain injury support group, such as those offered through the Brain Injury Association of Michigan or other locally sponsored support groups. A support group will help Mary realize that she is not alone in her recovery and, as her children become aware of the need for them to support her treatment plan, the family can heal together. Mary may then realize that her issues are not purely psychiatric in nature and that there are real reasons she experiences her symptoms. This will help her regain confidence.

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Case Study - JustinJustin’s backgroundJustin is a 16-year old with a TBI that resulted from an off road recreational vehicle accident at the age of 14. Justin had bilateral frontal brain contusions and was unconscious for one day. He spent five days in the hospital and two weeks in a rehabilitation hospital. He was discharged home independent in walking, talking, and the basic Activities of Daily Living including feeding, dressing, and bathing. Justin’s parents divorced shortly before the accident. There was a history of domestic abuse and intense arguing. Justin lives with his mother in government subsidized housing for families with low incomes and has limited contact with his father.


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Case Study - JustinJustin’s background (continued)A limited neuropsychological evaluation was completed in the hospital and showed moderate to severe impairments in social judgment, impulsivity, attention, and short-term memory. Justin has difficulty with social interactions, problem-solving, attending to tasks, and exhibits poor judgment. He has not accepted that he has disabilities due to his injury. He also had a pre-injury history of depression and marijuana smoking, and both have increased in frequency. Upon his return to school he was tested, and psychological counseling and speech therapy were arranged for him. He was provided with a planner to help him remember his schedule and his assignments, but he did not use it. Justin had aggressive episodes with his teachers, coaches, and other students. When Justin was 15, he dropped out of high school and stopped getting the therapy he needed.


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Case Study - JustinSummary of Justin’s issues

Justin does not recognize his deficits•He may be depressed•He uses drugs•He requires the use of a day planner to prioritize assignments and manage his time, but he will not use one

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He has aggressive social interactions•He dropped out of school•


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Case Study - JustinYou now have the option to view an expert's solution to this case scenario on video or to view a transcript of this solution. Please make your selection below. View the Video View the Transcript


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Possible strategies to address Justin’s issues There are ways that Justin could get back on a better track. Justin dropped out of school – lost this lost opportunity, which is serious, as school could be the one setting where he could receive high quality education and rehabilitation services at no cost to him or his family. Options should be explored for getting Justin back in school, such as alternative schools. An updated educational assessment and a complete neuropsychological evaluation are needed to establish an educational plan for Justin. Justin’s Mom also needs to be educated about TBI and how she can help Justin be more successful. Justin needs the structure of living with his mother and establishing a routine that helps him compensate for his cognitive issues. Due to the nature of his injury, his frontal lobe injury, making sure that his living environment is structured is important to support appropriate behavior. There are also programs and services that could help. Justin needs testing and evaluations in addition to services that might be provided by the educational system to see if he qualifies for Community Mental Health Services Programs or vocational services. He needs counseling to address his behaviors and lack of disability awareness. Justin’s depression needs to be evaluated to see if medications and treatment would be helpful. And he also needs to address his drug use. Both Justin and his mom should attend a brain injury support group, such as those offered through the Brain Injury Association of Michigan. Meeting and talking with other people with similar problems could help Justin and his Mom understand the effects of brain injury on their lives.

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Test your knowledgeThis final section of Module 2 consists of ten questions.

You must complete the questions to receive a score for this module on your training transcript.

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When you submit an answer for each question, a box will appear stating whether or not your answer was correct, along with an explanation of the correct answer.

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Once you submit an answer for each question, it cannot be changed. However, you may return to the assessment section of this module on another day and retake the test. Your most recent score will appear on your transcript.

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Begin Test

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Test your knowledge1. When a client has difficulty focusing on something a service provider is

saying, the provider should:

(a) Assume that the client is drunk and tell them to go home and come back later. (b) Show sympathy by saying, "I know how you feel." (c) Give them a lot of information in a short amount of time. (d) Reduce distractions and write out instructions step by step.

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Test your knowledgeThat is correct. A difficulty in focusing could be the result of the brain’s difficulty filtering out irrelevant information. A person with a brain injury might be bothered by things someone else would not even notice: such as the buzzing of a fluorescent light, lighted signs, etc. Making notes or lists can help in shifting attention.

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Test your knowledge2. A person with a TBI can be easily recognized by his or her physical

symptoms.

(a) True (b) False

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Test your knowledgeThat is correct. In fact most people who suffer from mild or moderate TBI will show no physical effects.

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Test your knowledge3. Which of the following deficits may be due to brain injury?

(a) Storing and retrieving information (b) Difficulty filtering out distractions (c) Fatigue (d) All of the above

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Test your knowledgeThat is correct. All of the above are possible problems following brain injury.

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Test your knowledge4. If a person with TBI does not follow through with submitting paperwork or

showing up for appointments, it may mean:

(a) The person no longer needs or wants services (b) The person suffers memory problems (c) Both A and B are likely (d) Neither A nor B is likely

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Test your knowledgeThat is correct. Memory impairment is considered the most common deficit that results from a brain injury. People with traumatic brain injury will need extra follow up to ensure they do not fall through the cracks of the social service agency. Nor should lack of follow-up on the part of the client indicate a lack of desire or readiness for services.

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Test your knowledge5. When working with a person with a TBI whose speech is slowed and slurred,

a service provider should:

(a) Discourage the person from talking because talking may cause further damage. (b) Avoid asking the person questions because he or she may become frustrated. (c) Facilitate communication by being patient and encouraging the person to take his or her time. (d) Identify family members to talk with instead.

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Test your knowledgeThat is correct. When a TBI causes slow and slurred speech, service providers should be patient during the communication process and encourage their client to take his or her time.

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Test your knowledge6. Jessica suffered a TBI last month that has impacted her abstract reasoning

ability. In addition, her relationship with her father has become strained because her father makes jokes that she finds upsetting and frightening. How should a service provider address this situation?

(a) Ask Jessica’s father to stop interacting with his daughter because it is impairing her recovery. (b) Encourage Jessica’s parents to reward her when she does not become upset and to punish her when she does become upset. (c) Help Jessica’s father understand that, because of her injury, Jessica may have difficulty understanding the double meanings or sarcasm used in jokes, and that he may need to explain his jokes so that she understands his meaning. (d) It is not necessary to address this situation because it will resolve itself over time.

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Test your knowledgeThat is correct. Jessica’s injury has made it difficult for her to understand double meanings, sarcasm, and humor, such that she interprets her father’s jokes literally. Her father can help Jessica by noticing when she seems confused or upset and explaining his jokes.

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Test your knowledge7. Since his TBI, Alex has had difficulty initiating and completing tasks. He

watches television for most of the day, and recently he left the burner on the stove on for three hours because he lost track of what he was doing while cooking dinner. What could Alex do to help himself initiate and complete tasks?

(a) Write out task lists, breaking each task into small, manageable steps. (b) Find himself a full time caregiver because he has become a danger to himself. (c) Use a timer as a cue that a task needs to be completed. (d) Both 'a' and 'c.'

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Test your knowledgeThat is correct. Alex’s injury has made it difficult for him to keep track of what he is doing and what he needs to do. By writing out task lists and using a timer to prompt Alex to think about what he needs to do, Alex can help himself stay active and safe.

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Test your knowledge8. Which of the following may NOT lead to a positive interaction between a

service provider and individuals with cognitive TBI-related impairments:

(a) Speaking in concrete terms using shorter sentences (b) A stimulating environment: lots of bright lights and background noise (c) Establishing routines and avoiding change (d) Extensive use of reminders, planners and checklists

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Test your knowledgeThat is correct. Many people who have suffered from traumatic brain injury may have difficulty filtering out irrelevant information from the environment, and can become distracted by things that others would not even notice.

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Test your knowledge9. Cultural competence is defined as knowing how individuals will act based

on knowing what racial/ethnic group they belong to.

(a) True (b) False

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Test your knowledgeThat is correct. In fact, characterizing individuals based on racial or ethnic group is called stereotyping and is inappropriate. Cultural competence is defined as the will to respond to the unique needs of an individual client arising from his/her culture, and using the person’s culture as a resource to help meet the person’s needs.

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Test your knowledge10. Which of the following is not an example of providing culturally competent

services?

(a) Learning about the cultural groups served by your agency. (b) Identifying how your clients’ culture might impact how you are perceived, and finding ways to overcome these cultural barriers. (c) When working with a client from a culture that is different from your own, trying to behave as though you share your client’s culture. (d) Reaching out to the various cultural and linguistic groups in your community, and establishing relationships with these groups.

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Test your knowledgeThat is correct. Cultural competence involves becoming conscious of cultural differences, challenging our own biases, and addressing cultural barriers; however, cultural competence does not involve pretending to share a client’s culture. Congratulations! You have successfully completed the test.

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Navigation TipsThis course contains four modules plus supplementary information. You may complete the modules atyour own pace. You must complete each module and spend at least three hours studying coursematerial to receive CE credit. Please see Continuing Education (CE) Credit Requirements for moreinformation.

Throughout this course, you may have five main windows open in your browser at any given time. If youhave a window open but in the background, and click on a link that would normallyopen in that background window, it will not automatically come to the fore. The linkwill open, but you will have to use your program buttons at the bottom of yourscreen to switch to that window. Training content that will appear in each of the windows is asfollows:

1. Main menu

The first window, the Main menu, will remain open while you are logged into this course,unless you use your browser buttons to move forwards, backwards, or exit. From the Mainmenu you may access any module by clicking on the module number. You may also accesssupplementary materials from the sidebar at the left of the screen.

2. Modules

The modules will open in a second window. You will not have access to your browser buttonsfrom this window. To advance through these modules, click on the arrows on the bottom, rightcorner of the screen. You may exit a module at any time by selecting Exit from the sidebar onthe left. If from the Main menu you select a module other than one that is already open, themodule you select will replace the open one in this window.

Each module concludes with a series of Assessment or quiz questions. Once you get tothe quiz questions, select your answer choice and then click submit . When you havecompleted the self assessment questions, you will be able to view your quiz results andadvance to the next content area of the course. The results of the assessment will be savedonce you have submitted an answer to the last question in each module.

In Module 4 only, numerous acronyms are used for state agencies and non-profitorganizations. Positioning your curser/pointer over an acronym will cause the full name of theagency or organization to appear on the screen.

At the end of Module 4 , you will be asked to give us feedback by filling out a briefEvaluation form. This is required for CE credits.

3. Supplementary information

Supplementary information will appear in a third browser window. This information will beavailable from the sidebar on the left of the Main menu screen and the modules.

1. Navigation tips: This document.

2. Glossary: You may also access the glossary by selecting any underlined word inthe modules.

3. References: You may also access references by clicking on any referencesthroughout the modules.

4. Resource links: List of links to additional information available from otheragencies/organizations on the World Wide Web.

In addition, the following supplementary material is available from the Main menu screen:

5. Course outline: Lists the content contained in each module.

6. Update registration/password information: Update the information on youremail address, place of work, etc., so that we may notify you in the case of majorchanges in course content. Also, you may change your password for purposes ofcourse login from this page.

7. Course transcript: View the results of your quiz scores for each module, updateyour time log, or submit for SB CE credit once all necessary requirements are met.

8. Continuing Education (CE) Credit Requirements (click here): Explains therequirements that must be met in order to earn CE credits for completion of this TBItraining course.

4. Case studies

At the end of each module you will have the opportunity to view case studies relating to thetopics covered. These case studies will open up in a fourth window. Please note: If you arecurrently using Mozilla or Firefox you may need to reopen the training site in Netscape orInternet Explorer in order to view these case studies. Also, if you have difficulty viewing thevideos or hearing the audio, you will have the option to read the video transcript.

5. Websites outside of the training course

Throughout the modules and on the Resource Links page you will have the chance toaccess information from many websites outside of the training course. These external sites willopen up in a fifth window. Only one external site may be opened at a time, with each new sitereplacing the one that was opened last.

If you are having technical difficulties, please report them to us at: [email protected].

mailto:[email protected]

Continuing Education (CE) CreditRequirementsIn order to activate the training with the correct features for earning CE credit, you must FIRST indicate your interest inearning CE credit on the Course Registration page. If you have not already done this, go back to the Main Menu pageand select "Update Registration/Password Information" from the blue bar on the left. On the Course registration page youmust select yes for earning CE credits, indicate the type of profession, update all necessary information, and then click"Submit" at the bottom of the page.

Professionals in the areas of

Nursing (3 Contact Hours available)Education (3 SB-CEU available)Case Management (3 Clock Hours available)Social Work (3 Instructional Continuing Education Hours available)Nursing Home Administrators (3 Credit Hours available)Licensed Professional Counselors (3 Clock Hours available)Disability Management Specialists (4 Clock Hours available)Rehabilitation Counselors (4 Clock Hours available)Adult Foster Care (3 CEU's available)Certified Health Education Specialists (3 CECH)

have the opportunity to earn continuing education (CE) credits toward their respective Michigan licenses for completion ofthe “Traumatic Brain Injury and Public Services in Michigan” training course. In order to earn CE credits toward one ofthese licenses, each participant must meet the following requirements:

(1) Time Log: You must record all time spent on the “Traumatic Brain Injury and Public Services in Michigan” training inthe online time log. This time log is available from the Main Menu page of the training by clicking the “Course Transcript”link in the blue bar at the left. The instructions on the course transcript will ask you to enter the date and the number ofhours/minutes spent going through the TBI training materials. You will need to add an entry to your time log each time youaccess the training and review more materials, and then save the changes by clicking the “Save Time Log Updates”button at the bottom of that page. Because this is an online training and can be completed in multiple sessions, you mayneed to make several entries into your time log before finishing the entire training. The time log will serve as a personalaccount of your efforts put toward this training and must be completed for CE credit. Note: to earn the number ofhours/credits listed above you must spend at least three hours studying the curriculum.

(2) 84% Cumulative Quiz Score (Total Score): You must complete the multiple choice quiz at the end of each ofthe four training modules and obtain a Total Score of 84%. Each quiz contains 8-10 questions – there are 37 questionstotal. To obtain the necessary 84% Total Score, you must answer at least 31 questions correctly. This means you canmiss a total of six questions.

Upon completion of a quiz, the score and the date of the quiz will be recorded into your course transcript. Quizzes may beretaken as many times as desired. Your Total Score will be calculated on your course transcript once all four modulequizzes have been completed.

(3) Evaluation: You must complete an online evaluation of the TBI training course. When you have completed theModule 4 quiz, you will be directed to this evaluation. Completion of this evaluation will also be recorded on your coursetranscript and is required for CE credit.

When you have met the above requirements, please review the information on your course transcript one last time. If allinformation is correct and complete, please print by clicking the “Print Course Transcript” button toward the bottom of thecourse transcript page and save this copy for your records.

In order to submit your completed course transcript for credit toward your professional license, you will need to click the“Submit for CE credit” button at the bottom of the course transcript page. Clicking this button indicates that you agree thatall the information on the course transcript is correct, complete, and meets the above requirements. Once you haveclicked the submit button you will receive a confirmation that your course transcript has been submitted successfully.Assuming all requirements were met, you can expect to receive your Course Completion/CE Credit Certificate in the mailwithin 4-6 weeks following submission.

Additional Information on Nursing Contact Hours

This continuing nursing education activity was approved by the Ohio Nurses Association (OBN-001-91), anaccredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Approval valid through July 15, 2012. Assigned ONA #14,391-I3.0 nursing contact hours will be provided.This continuing education activity will be available to nurses until July 15, 2012.

Criteria for successful completion include finishing all four training modules and receiving a cumulative quiz average of atleast 84%. Participants must also complete the evaluation survey at the end of the training. Certificates of completion willbe mailed to eligible training participants.

The authors and planning committee have declared no conflict of interest. There is no commercial support orsponsorship for this event.

If you have any questions or problems, please contact [email protected].

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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Acquired brain injury (ABI): An acquired brain injury is an injury to the brain,which is not hereditary, congenital, degenerative, or induced by birth trauma. Anacquired brain injury is an injury to the brain that has occurred after birth.

Activities of daily living (ADLs): Basic tasks that a person performsthroughout the course of his/her day, such as: eating, bathing, toileting,grooming, transferring and moving about. Tasks that are related to independentliving are called instrumental activities daily living and include: takingmedications, preparing meals, laundry, housework, shopping, and errands.

Acute: In reference to healthcare for TBI, describes the medical proceduresundertaken to stabilize a patient in a hospital; care that is provided on a short-term basis for an immediate need, usually right after the injury occurred. Postacute care is care provided after initial stabilization on a longer-term basis.

Advocate: To argue for a cause, or plead on another’s behalf for education,legal, personal, or vocational rights, or a person who argues for their own, oranother person’s rights.

Anoxia: The cessation of oxygen supply to the brain -- can lead to brain celldeath and loss of function.

Assistive technology (assistive devices, adaptive technologies, adaptiveequipment): Any technology that enables someone to do something that s/henormally cannot do. A special device that assists in the performance of self-care,work, play/leisure, or physical exercise. Some assistive technologies can beuseful in compensating for cognitive deficits. Examples include: personal digitalassistants, voice organizers and recorders, reminders, watches, and smartphones.

Antecedents: Factors or events that occur prior to a current situation. Attentionto antecedents can assist in promoting desired behaviors and avoiding negativebehaviors.

Ataxia: Inability to coordinate voluntary muscle movements.

Axonal shearing: When the brain is moved back and forth against the skullafter a head trauma, it is alternatively compressed and stretched because of itssoft, gelatin-like structure. The long, fragile axons of the neurons that make upthe brain are also compressed and stretched. If the impact is severe enough,axons can be stretched until they are torn. This is called axonal shearing. Whenthis happens, the neuron dies. An injury with substantial axonal shearing is morediffuse -- spread throughout the brain.

Axons: Long nerve fibers that conduct impulses away from the cell body of aneuron.

Glossary

Brain injury: Any injury that results in brain cell death and loss of function.

Brain Injury Association of Michigan (BIAMI): A non-profit consumerorganization that works to improve the lives of those affected by brain injurythrough education, advocacy, research and local support groups.

Brain swelling (cerebral edema): The brain swells after a severe trauma, justlike any other part of the body. This is also a major cause of damage after braininjury. Very severe swelling can cause death by compressing the brain stem.Brain swelling can lead to neuronal damage by squeezing the cells or fromanoxia caused by disrupting the flow of blood and oxygen to the brain.

Centers for Disease Control and Prevention (CDC): One of 13 majoroperating components of the Department of Health and Human Services; andleads the nation’s public health efforts to prevent and control infectious diseases,injuries, workplace hazards, disabilities, and environmental health threats.

Centers for Independent Living (CILs): Centers located throughout Michiganto provide services designed to maximize self-sufficiency and independence ofpeople with disabilities.

Cognitive functioning: A function of the brain that refers to how one thinks,reasons, stores, and processes information.

Community Mental Health Services Programs (CMHSP): Programscontracted by the Michigan Department of Community Health to provide a fullarray of community-based support services for eligible individuals (persons witha qualifying developmental disability or mental illness) and their families. Whilesome CMHSPs may directly operate treatment programs, most CMHSPs establisha network of agencies and professionals to provide treatment services.

Congenital condition: Circumstance that is present at birth.

Contusion (of the brain): Bruising and bleeding of the brain due to the tearingof small blood vessels upon impact. It can lead to the death of neurons. Smallcontusions (as in concussion) are not usually treated unless blood flow isinterrupted.

Coordinating Agency (CA): Agencies contracted by MDCH, Office of DrugControl Policy, to provide access to publicly funded substance abuse services.They have administrative responsibility for an Access Management System thatdetermines eligibility, manages resources and assures quality of care.

Coup-contracoup: A pattern of contusion whereby one contusion occurs at thesite of the initial impact on the brain ("coup") and another at the site directlyopposite ("contracoup"). This pattern is the result of the brain moving back andforth inside the skull upon impact.

Culture: An integrated pattern of socially transmitted human behavior thatincludes thoughts, communication, actions, customs, beliefs, values, institutions,and all other products of human work or thought, characteristic of a particularcommunity or population (Cross et al., 1989). Though culture is often viewed assimply race and ethnicity, the term encompasses much more. Other groups of

people display distinct cultural characteristics and in turn receive culturallyinsensitive responses from society. Examples of such groups include the poor,the homeless, and the disabled.

Cultural competence: The ability and the will to respond to the unique needs ofan individual client or family that arise from the client’s culture and the ability touse the person’s cultural strengths as resources or tools to assist with thetreatment, intervention or helping process. Cultural competence is generallyregarded as a long term process towards which one strives. In addition, culturalcompetence can be thought of as an attribute of an individual provider and as anattribute of an organization.

Department of Human Services (DHS) (formerly Family IndependenceAgency or FIA): Michigan state agency that directs the operations of publicassistance and service programs in every county in Michigan. In particular, DHSdetermines eligibility for the Medicaid insurance programs and provides AdultServices to persons who are Medicaid eligible.

Depressed skull fracture: This is when bones of the skull are broken orcracked with loose bone fragments actually placing pressure or penetrating thebrain, thereby causing damage.

Developmental disability (DD) -- According to the Michigan Mental HealthCode, a developmental disability is a severe mental or physical impairment that:1) occurs before an individual is 22 years old; 2) is likely to continue indefinitely;3) results in substantial functional limitation in three or more of the followingareas of major life activities: self care, mobility, learning, self direction, receptive& expressive language, capacity for independent living, and economic selfsufficiency; and 4) reflects the individual’s need for special, interdisciplinarytreatment, or other services that are of lifelong or extended duration. For minorsfrom birth to age five, a developmental disability is a substantial developmentaldelay or a specific congenital or acquired condition with a high probability ofresulting in developmental disability if services are not provided.

Diffuse injury: An injury to the brain in which damage is not limited to onelocation in the brain, but affects multiple areas.

Eligibility: Requirements that need to be met by the applicant, in order toreceive services or enroll in a program.

Executive functioning: Cognitive functions having to do with planning, abstractreasoning, problem-solving, information processing, judgement,workingmemory, etc.

Glasgow Coma Scale (GCS): The GCS is commonly used for initial assessmentof brain injury severity. The GCS uses a 15 point scale to rate eye opening,motor, and verbal response functions. Unfortunately in practice, the time of theassessment can vary (e.g., at the scene of injury, upon arrival in the emergencydepartment, etc.) -- making results from one patient to the next difficult tocompare. Moreover, GCS results may not be valid for children, people under theinfluence of alcohol, or people with language differences.

HELPS: Acronym for the brain injury screening tool described in this training.Each letter of the acronym stands for one of the five questions of the tool.

Hematoma: If the blood vessels damaged by the impact inside the skull arelarge enough, they may bleed enough to create a pool of blood or hematoma. Ahematoma can cause brain injury by directly damaging the neurons it comes incontact with or by squeezing neurons through increased pressure in the braindue to its volume. The treatment for a hematoma is to surgically drain it, ifpossible.

Hypovolemic shock: After injury, loss of blood volume can further compromisehealthy brain tissue.

Incidence: In reference to TBI data, incidence refers to the number of a giventype of events, or new instances of TBI, in a year.

Increased intracranial pressure: intracranial pressure occurs because of abuild-up of pressure within the skull. Because the brain, membranes andcerebrospinal fluid are encased with the bones of the skull, the fluid formed as aresult of swelling or bleeding "backstop" in the brain causing increased pressureinside the brain which results in further damage to brain tissue.

Individualized Education Program (IEP): A written plan for a child or studentwho has a disability and who qualifies for special education services. The IEPmust include, among many other specific features, measurable annual academicand functional goals; and the types of special educational and related servicesand supplementary aids and services that the child will receive (such as speechand language services, or physical or occupational therapy) to enable the child orstudent to be involved in and make progress in the general educationcurriculum. The IEP is developed, reviewed and revised in a meeting consistingof a team that includes school personnel, family members, and other individuals.

Individuals with Disabilities Education Act (IDEA): A federal law, firstenacted in 1975 and most currently re-authorized and revised in 2004, thatrequires public schools to determine whether a child has a disability, develop aplan that details the education and support services that children and studentswill receive, provide the services, and re-evaluate the plan periodically. There isfederal funding available for some of these responsibilities.

Initiation: The act of beginning a task or setting in motion a course of events.

Long Term Care services: Long term care (LTC) services are the medical,social, personal care, and supportive services needed by people who have lostcapacity for self-care due to a chronic illness or condition. It's different fromacute health care because assistance is required for an indefinite period of time,and because recovery of function may be incomplete.

Medicaid Fee for Service (FFS): A Medicaid service plan in which coveredservices are reimbursed separately. Most individuals in Michigan who are onMedicaid are not covered by Medicaid FFS, but are enrolled in a Medicaid(managed care) Health Plan. (Although most Long Term Care is covered byMedicaid FFS)

Mental illness (MI): A mental condition characterized by a substantial disorderof thought or mood that interferes with an individual’s ability to function in day-to-day life.

Michigan Department of Community Health (MDCH): The department ofstate government that is responsible for health policy and management of thestate's publicly-funded health service systems.

Michigan Department of Education (MDE): The department of stategovernment that is responsible for, or interacts with those responsible for, allaspects of education of the state’s 1.8 million children and students in publicschools. An eight-member elected State Board of Education oversees the work ofthe department.

Michigan Protection and Advocacy Service (MPAS): A private, nonprofitorganization that provides information and advocacy to people with disabilities inMichigan.

Michigan Rehabilitation Services (MRS): Part of the Department of Laborand Economic Growth, MRS offers services necessary to assist eligible individualswith disabilities in preparing for, securing, retaining, or regaining employment.

Mild TBI: Medically defined as any period of loss of consciousness (typically lessthan 15 minutes); any loss of memory for events immediately before or after theaccident; or any alteration in the mental state at the time of the accident (e.g.,feeling dazed, disoriented or confused). Mild TBI generally does not includeposttraumatic amnesia greater than 24 hours (NIH, 1998). Mild TBI is associatedwith a Glasgow Coma Scale score of 13-15.

Moderate TBI: Medically defined as a loss of consciousness that can lastminutes or a few hours and is followed by a few days or weeks of confusion.Persons with moderate TBI may have a longer period of impaired consciousness,more impaired verbal memory shortly after the injury and a lower likelihood ofachieving a good recovery within 6 months than persons suffering mild TBI (NIH,1998). Moderate TBI often is associated with a GCS of 9 -- 12.

Motor functioning: Involving or relating to movements of the muscles.

Multidisciplinary Evaluation Team (MET): The team that assesses studentsto determine eligibility for special education or early intervention services.

Negative reinforcement (escape and avoidance): When the consequence ofa behavior resulted in avoiding or getting out of an unpleasant situation, and theeffect is to encourage the behavior again in the future.

Neurologic: Related to the nervous system and its structure and functions.

Neurologic exam: An examination conducted by a neurologist, which mightinclude the following: a detailed medical history and assessment of neurologicfunctions (reflexes, cranial nerve functioning, gross movements, muscle tone,and perception of sensory stimuli).

Neuropsychological assessment/evaluation: A thorough testing of cognitive,emotional, and intellectual functioning that can assist in diagnosing brain injury

and planning care.

Neurons: Impulse conducting cells that constitute the brain, spinal column, andnerves, consisting of a nucleated cell body with one or more dendrites and asingle axon.

Neuropsychologist: A professional who evaluates the relationship betweenbrain and behavior; conducts extensive testing and counseling; does notprescribe medication.

Occupational therapy (OT): The use of self-care, work and play activities toincrease independent function, enhance development and prevent disability; OTmay include the adaptation of a task or the environment to achieve maximumindependence. An Occupational Therapist is a professional who helps a personto regain skills in activities of daily living (e.g., dressing, eating, bathing, etc.)and routine “occupations” (e.g., cooking, shopping, scheduling, driving, etc.).

Physical Disability Services (PDS): PDS are those necessary services andexpenditures targeted for medically stable persons 18 years of age or older whohave functional limitations which are physical in nature. Services are provided toenable functionally limited people to live as independently as possible.

Physical therapy (PT): Treatment that uses physical agents such as exerciseand massage to restore or facilitate recovery of physical abilities. A PhysicalTherapist is a professional who treats injury or physical dysfunction withexercises and other physical treatments to restore or facilitate recovery ofphysical abilities.

Positive reinforcement (rewards): When good things happen following abehavior and that behavior is repeated in the future in order to achieve thatresult, the behavior is likely to continue -- it has been reinforced.

Posttraumatic amnesia: The loss of memories of events after the brain injury;also refers to the length of time that it takes for the return of full consciousnessand memory for recent events following trauma.

Posttraumatic depression: The occurrence of the psychiatric condition ofdepression following brain injury.

Primary event: In reference to TBI, brain damage, such as contusion andaxonal shearing, that occurs during the initial phase of injury (during impact).The primary event is distinguished from the secondary event, or subsequentbrain damage, that occurs because of the body’s reaction to the primary event(such as brain swelling and anoxia).

Psychiatric evaluation: An assessment of mental, emotional, or behavioraldisorders.

Psychological/behavioral strategies of pain management: Behavioraltechniques to deal with physical pain. The focus of treatment is to increase aperson’s ability to manage, function, and cope with pain. Such techniques mayinclude relaxation training, developing coping skills to deal with emotions such assadness, anxiety, or anger, and to deal with beliefs and expectations related topain. Problem-solving techniques and communication skills regarding expressing

and dealing with pain may also be included.

Psychological testing: Standardized assessment of emotional and intellectualfunctioning, and the personality characteristics of an individual.

Skull fracture: Bones of the skull are broken or cracked. Injury severity canrange from simple, undisplaced fractures to compound fractures which involveloose bone fragments placing pressure on or penetrating the brain.

Secondary event: In reference to TBI, this is the injury or complicationresulting from the reaction of the brain to the primary event, including: brainswelling (edema), pooling of blood (hematoma), increased intracranial pressure,hypovolemic shock, and loss of oxygen (anoxia).

Seizures: Waves of synchronized nerve cell activation that can involve the entirebrain, or can be confined to a particular area of the brain. When the entire brainis involved it is called a generalized seizure or grand mal; and symptomsinclude loss of consciousness, rhythmic jerking body movements, and otherpossible symptoms. If only part of the brain is involved, it is called a partial orfocal seizure; generally the person does not lose consciousness and othersymptoms depend on the area of the brain affected.

Self monitoring: Regarding behavior, the ability to act appropriately and refrainfrom inappropriate behavior based on a given social situation.

Sequencing: The ability to recognize the necessary order of events.

Severe TBI: Medically defined by a loss of consciousness, or coma, for 6 hoursor longer, either immediately after the injury or after an intervening period ofclarity. Severe TBI is often associated with a GCS of 8 or lower.

Sleep routines: The activities and environment surrounding sleep can affect aperson’s ability to get enough rest. The following might have an impact: going tobed on a consistent schedule, limiting sleep during the day, having a relaxingbedtime routine, having a comfortable sleeping environment, etc.

Sleep study: Monitoring the cycles and stages of sleep using direct observationor by using electrodes to make continuous recordings of brain waves, electricalactivity of muscles, eye movement, respiratory rate, blood pressure, bloodoxygen saturation, and heart rhythm. The test is performed for people who sufferfrom insomnia, excessive daytime sleepiness, obstructive sleep apnea, breathingdifficulties during sleep, or behavior disturbances during sleep.

Spasticity: Involuntary increase in muscle tone (energy sent to the musclesfrom the brain and spinal cord) which causes the muscle to resist being stretchedand move in an coordinated fashion.

Special Education and Early Intervention services: The commonly usedphrase that encompasses the wide variety of services and supports availablethrough intermediate, local public school districts and charter schools (PublicSchool Academies) to eligible children and students from the ages of birththrough age 21, who have not earned a regular high school diploma. Servicesavailable are based on federal and state laws and rules and are often consideredaccording to the ages of the youth being served: Early On is a system inMichigan designed to arrange for services and supports for infants and toddlers

ages birth to 3 years and their families; while Special Education in Michiganusually means the wide array of services and supplemental aids and services forchildren and students through ages 25. (See also Individualized EducationProgram and Individuals with Disabilities Education Act).

Speech and language therapist: A professional who evaluates and treatscommunication and cognitive skills including speaking and understanding writtenand spoken language.

Substance Abuse services: Services to treat substance abuse issues that mayinclude types of outpatient therapy, short-term and long-term residentialtreatment, detoxification, and intensive outpatient services.

Traumatic Brain Injury (TBI): TBI is defined as an alteration in brain function,or other evidence of brain pathology, caused by external force.

Beckwith B, Dimambro L. TBI Basics. Brain Injury Association of Michigan AnnualConference. 1996-2002.

Black K. Caregiver college presentation. Michigan: Detroit Medical Center,Rehabilitation Institute of Michigan. 1998.

Brain Injury Association of America website. Acquired Brain Injury. 1997. Availableat: http://www.biausa.org/Pages/types_of_brain_injury.html#aquired. Accessed July15, 2005.

Brain Injury Association of America website. “What is the Difference Between anAcquired Brain Injury and a TBI”. Available at:http://www.biausa.org/FAQRetrieve.aspx?ID=43913&A=SearchResult&SearchID=2840376&ObjectID=43913&ObjectType=9.Accessed September 7, 2011

Brain Injury Association of America website. “BIAA Adopts New TBI Definition”.2011. Available at http://www.biausa.org/AnnouncementRetrieve.aspx?ID=66290&A=SearchResult&SearchID=2840249&ObjectID=66290&ObjectType=7.Accessed September 7, 2011.

Braunling-McMorrow D, Davie C, Ferriera-Bedford T, et al. Acquired Brain InjuryPrograms, Preservice Materials Manual. Illinois: Mentor, 2000.

Centers for Disease Control and Prevention. Heads Up: Facts for Physicians AboutMild Traumatic Brain Injury (MTBI). 2003. Available at:http://www.cdc.gov/ncipc/pub-res/tbi_toolkit/physicians/mtbi/diagnosis.htm.Accessed July 15, 2005.

Centers for Disease Control and Prevention, National Center for Injury preventionand Control. (1999, Dec.) Traumatic Brain Injury in the United States: A Report toCongress.

Center for Disease Control. Report to Congress on Mild TBI in the US: Steps toPrevent a serious Public Health Problem. 2003. Available athttp://www.cdc.gov/traumaticbraininjury/pdf/mtbireport-a.pdf. Accessed onSeptember 7, 2011

Faul M, Xu L, Wald MM, Coronado VG.Traumatic Brain Injury in the United States:Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta(GA): Centers for Disease Control and Prevention, National Center for InjuryPrevention and Control; 2010.

Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulativeeffects of concussion in high school athletes. Neurosurgery. 2002, 51(5), 1175-79.

Corrigan JD, Lamb-Hart GL, Rust E. A program of intervention for substance abusefollowing traumatic brain injury. Brain Inj. 1995 Apr;9(3):221-36.

Corrigan PW, Bach PA. Behavioral Treatment, in Textbook of Traumatic BrainInjury. Edited by Silver JM, McAllister TW, Yudofsky SC. Arlington, VA, AmericanPsychiatric Publishing, Inc.; 2005, pp 661-678.

References

http://www.biausa.org/Pages/types_of_brain_injury.html#aquired

http://www.biausa.org/FAQRetrieve.aspx?ID=43913&A=SearchResult&SearchID=2840376&ObjectID=43913&ObjectType=9

http://www.biausa.org/FAQRetrieve.aspx?ID=43913&A=SearchResult&SearchID=2840376&ObjectID=43913&ObjectType=9

http://www.biausa.org/AnnouncementRetrieve.aspx?ID=66290&A=SearchResult&SearchID=2840249&ObjectID=66290&ObjectType=7

http://www.biausa.org/AnnouncementRetrieve.aspx?ID=66290&A=SearchResult&SearchID=2840249&ObjectID=66290&ObjectType=7

http://www.cdc.gov/ncipc/pub-res/tbi_toolkit/physicians/mtbi/diagnosis.htm

http://www.cdc.gov/traumaticbraininjury/pdf/mtbireport-a.pdf

Cross T, Bazron BJ, Dennis, KW, Isaacs MR. (1989). Toward a CulturallyCompetent System of Care: Vol.1, Washington, DC, National Technical AssistanceCenter for Children’s Mental Health, Georgetown University Child DevelopmentCenter.

Dunn K.A., Thurman D.J., Clinton J.A. (1999). The Epidemiology of Traumatic BrainInjury Among Children and Adolescents. Centers for Disease Control andPrevention.

Faces of Brain Injury. Produced by the Brain Injury Association of Florida, Inc.(www.biaf.org); funded in part by Florida Department of Health, Brain & Spinal CordInjury Program and Health Resources Services Administration Grant #: CFDA#93-234A.

Finkelstein EA, Corso PS, Miller TR, and Associates. The Incidence and EconomicBurden of Injuries in the United States. New York, NY, Oxford University Press, Inc.,2006, p. 136.

Kreutzer JS, Consequences of Traumatic Brain Injury for the Family, NIHConsensus Development Conference on the Rehabilitation of Persons withTraumatic Brain Injury. 1998; Oct 26-28:14.

Langlois JA, Rutland-Brown W, Thomas KE. Traumatic Brain Injury in the UnitedStates: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta (GA):Centers for Disease Control and Prevention, National Center of Injury Preventionand Control; 2004.

Martelli MF, Grayson R, Zasler ND: Post traumatic headache: psychological andneuropsychological issues in assessment and treatment. Journal of Head TraumaRehabilitation. 1999; 1:49-69.

McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, OnateJA, Yang J, Kelly JP. Acute effects and recovery time following concussion incollegiate football players: the NCAA Concussion Study. JAMA, 2003;290(19):2556-63.

National Institute of Health. National Institute of Health Consensus DevelopmentConference on Rehabilitation of Persons with Traumatic Brain Injury; Epidemiologyof Traumatic Brain Injury. U.S. Department of Health and Human Services, 1998.

O’Shauick GJ, O’Shauick AM. Personality Disorders, in Textbook of Traumatic BrainInjury. Edited by Silver JM, McAllister TW, Yudofsky SC. Arlington, VA, AmericanPsychiatric Publishing, Inc.; 2005, pp 245-258.

Picard M, Scarisbrick D, Paluck R. International Center for the Disabled, U.S.Department of Education, Rehabilitation Services Administration. 1991. Grant#H128A00022.

Prigatano GP, Roueche JR, Fordyce DJ. Nonaphasic language disturbances afterbrain injury, in Neuropsychological Rehabilitation after Brain Injury. Edited byPrigatano GP. Baltimore, MD, Johns Hopkins University Press, 1986, pp 18-22.

Rao V, Rollings P, Spiro J. Fatigue and Sleep Problems, in Textbook of TraumaticBrain Injury. Edited by Silver JM, McAllister TW, Yudofsky SC. Arlington, VA,American Psychiatric Publishing, Inc.; 2005, pp 369-384.

TBINET, Research and Training Center on Community Integration of Individuals withTraumatic Brain Injury, Mount Sinai School of Medicine. Available at:www.mssm.edu/tbinet. 2004. http://www.mssm.edu/tbinet/. Accessed July 15, 2005.

http://www.biaf.org/

http://www.mssm.edu/tbinet/

Thurman DJ, Sniezek JE, Johnson D, Greenspan A, Smith SM. Guidelines forSurveillance of Central Nervous System Injury. Centers for Disease Control andPrevention. 1994.

Turner AP, Bombardier CH, Rimmele CT. A typology of alcohol use patterns amongpersons with recent traumatic brain injury or spinal cord injury: implications fortreatment matching. Achives of Physical Medicine Rehabilitation. 2003;Mar:84(3):358-64.

Links and Additional Resources

Additional information on public services for individuals with TBI in Michigan is available atwww.michigan.gov/tbi. If you want more information about a topic you do not see here, try BIAMI firstat www.biami.org. Also see other websites listed below under “General brain injury information,advocacy, and support.”

Try the links below for more detailed information (presented in alphabetical order by topic area):

Assistive technologyAgency/organization websites

Michigan Assistive Technology Loan Fundhttps://www.disability.gov/viewResource?id=1830858Michigan Assistive Technology Programhttp://www.copower.org/assistive-tech.htmlMichigan’s Integrated Technology Supports (for Michigan PK-12 public schools) http://mits.cenmi.org/LendingLibrary.aspx

ChildrenAgency/organization websites

Michigan Department of Education (MDE) http://www.michigan.gov/mdeMichigan Intermediate School District (ISD) – County Office Informationhttp://michigan.gov/cepiNational Dissemination Center for Children with Disabilitieshttp://www.nichcy.org/

Documents/training materialsBack to School [After a TBI] http://www.biausa.org/LiteratureRetrieve.aspx?ID=43317&A=SearchResult&SearchID=1989375&ObjectID=43317&ObjectType=6A Training Program for School Personnel in Indiana http://www.biausa.org/LiteratureRetrieve.aspx?ID=47494&A=SearchResult&SearchID=1989375&ObjectID=47494&ObjectType=6Guidance & Technical Assistance from the Office of Special Education and EarlyIntervention Services http://focus.cenmi.org/wp-content/uploads/2010/08/GATA06-02.pdfTeaching Strategies for Students with Brain Injuries http://www.biausa.org/LiteratureRetrieve.aspx?ID=48657&A=SearchResult&SearchID=1989346&ObjectID=48657&ObjectType=6Traumatic Brain Injury (TBI) Central - Students with Traumatic Brain Injury:Identification, Assessment, and Classroom Accommodations http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/publications/students-with-tbi

Concussion/Mild Traumatic Brain InjuryAgency/organization websites

Centers for Disease Control and Prevention - “Heads Up: Concussion in HighSchool Sports” http://www.cdc.gov/concussion/HeadsUp/high_school.htmlCenters for Disease Control and Prevention - “Heads Up: Concussion in YouthSports”http://www.cdc.gov/concussion/HeadsUp/youth.htmlCenters for Disease Control and Prevention - “Heads Up to Schools: Know YourConcussion ABCs”http://www.cdc.gov/concussion/HeadsUp/schools.html

http://www.michigan.gov/tbi

http://www.biami.org/

https://www.disability.gov/viewResource?id=1830858

http://www.copower.org/assistive-tech.html

http://mits.cenmi.org/LendingLibrary.aspx

http://www.michigan.gov/mde

http://michigan.gov/cepi

http://www.nichcy.org/

http://www.biausa.org/LiteratureRetrieve.aspx?ID=43317&A=SearchResult&SearchID=1989375&ObjectID=43317&ObjectType=6




http://focus.cenmi.org/wp-content/uploads/2010/08/GATA06-02.pdf



http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/publications/students-with-tbi

http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/publications/students-with-tbi

http://www.cdc.gov/concussion/HeadsUp/high_school.html

http://www.cdc.gov/concussion/HeadsUp/youth.html

http://www.cdc.gov/concussion/HeadsUp/schools.html

Centers for Disease Control and Prevention - "Heads Up: Brain Injury in YourPractice Tool Kit" (available to order, free of charge) http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.htmlSports Concussion Information for Athletes - BIAMIhttp://sportsconcussionsmichiganathletes.com/Sports Concussion Information for Coaches - BIAMIhttp://sportsconcussionsmichigancoaches.com/Sports Concussion Information for Parents - BIAMIhttp://sportsconcussionsmichiganparents.com/

Cultural competenceAgency/organization websites

National Center for Cultural Competence http://gucchd.georgetown.edu/nccc/index.htmlNational Library of Medicine – American Indian Health http://americanindianhealth.nlm.nih.gov/National Library of Medicine – Asian American Health http://asianamericanhealth.nlm.nih.gov/

Documents/training materialsMinnesota Department of Human Services – Guidelines for Culturally CompetentOrganizations https://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-3963-ENG

Defense and veterans' issuesAgency/organization websites

Defense and Veterans Brain Injury Center http://www.dvbic.orgMichigan Department of Military and Veterans Affairs http://www.michigan.gov/dmvaMilitary HOMEFRONT is the central source for Service members and families toobtain information about all Quality of Life programs and services http://www.militaryhomefront.dod.mil/Military Severely Injured Joint Support Operations Center (MSIJSOC) http://www.military.com/supportTraumatic Brain Injury: The Journey Home (for Veterans) http://www.traumaticbraininjuryatoz.org

Documents/training materials“Veterans Health Benefits 101 for TBI Advocates,” Archived webcast, Maternaland Child Health Bureau (MCHB) of the Department of the US Department ofHealth and Human Services, Health Resources and Services Administration http://128.248.232.90/archives/mchb/dcafh/tbi/july2005/mchbtbijuly2005transcript.htmTraumatic Brain Injury Among Veterans http://www.nashia.org/pdf/tbi_among_veterans_may_2011.pdf

Employment and vocational rehabilitation of people with TBIAgency/organization websites

Freedom to Work Web Site http://www.freedomtoworkmedicaid.comMichigan Department of Licensing and Regulatory Affairs - Michigan RehabilitationServices http://www.michigan.gov/mdcd/0,1607,7-122-25392---,00.html

Documents/training materialsAchieving Vocational Success After Traumatic Brain Injuryhttp://www2.ed.gov/rschstat/research/pubs/vrbriefs/vrbrief-success-after-tbi.pdfJob Accommodation Network – Work-site Accommodation Ideas for Persons withBrain Injuryhttp://www.jan.wvu.edu/media/BrainInjury.htmlMichigan Department of Career Development http://www.state.mi.us/career/Core/pdfactsheet/MRS-198.htmlTraumatic Brain Injury Facts: Vocational Rehabilitation and Employment Services

http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html

http://sportsconcussionsmichiganathletes.com/

http://sportsconcussionsmichigancoaches.com/

http://sportsconcussionsmichiganparents.com/

http://gucchd.georgetown.edu/nccc/index.html

http://americanindianhealth.nlm.nih.gov/

http://asianamericanhealth.nlm.nih.gov/

https://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-3963-ENG

http://www.dvbic.org/

http://www.michigan.gov/dmva

http://www.militaryhomefront.dod.mil/

http://www.military.com/support

http://www.traumaticbraininjuryatoz.org/

http://128.248.232.90/archives/mchb/dcafh/tbi/july2005/mchbtbijuly2005transcript.htm

http://128.248.232.90/archives/mchb/dcafh/tbi/july2005/mchbtbijuly2005transcript.htm

http://www.nashia.org/pdf/tbi_among_veterans_may_2011.pdf

http://www.freedomtoworkmedicaid.com/

http://www.michigan.gov/mdcd/0,1607,7-122-25392---,00.html

http://www2.ed.gov/rschstat/research/pubs/vrbriefs/vrbrief-success-after-tbi.pdf

http://www.jan.wvu.edu/media/BrainInjury.html

http://www.state.mi.us/career/Core/pdfactsheet/MRS-198.html

http://nashia.org/pdf/hotopics/vrbrief-success-after-tbi%202010.pdf

General brain injury information, advocacy, and supportAgency/organization websites

Brain Injury Association of Michigan (BIAMI) http://www.biami.orgBrain Injury Association of America (BIAA) www.biausa.orgBrainLine.org www.brainline.orgCDC: Injury Control and Prevention: Traumatic Brain Injury http://www.cdc.gov/TraumaticBrainInjury/Center for Neuro Skills(CNS)www.neuroskills.com/resources.shtmlCommission on Accreditation of Rehabilitation Facilities (CARF)www.carf.orgDepartment of Health and Human Services, Health Resources and ServicesAdministration - Traumatic Brain Injury Program http://www.hrsa.gov/gethealthcare/conditions/traumaticbraininjury/Lash & Associates Publishing / Training, Inc. http://www.lapublishing.com/Michigan Department of Community Health - Injury & Violence Prevention Section

https://www.michigan.gov/mdch/0,1607,7-132-54783_54879---,00.htmlMichigan Disability Rights Coalition (MDRC) http://www.copower.org/Michigan Protection and Advocacy Service (MPAS) http://www.mpas.orgNational Association of State Head Injury Administrators (NASHIA) www.nashia.orgNational Information Rehabilitation Center (NARIC) www.naric.comNational Resource Center for Traumatic Brain Injury http://www.neuro.pmr.vcu.edu/The Southeastern Michigan Traumatic Brain Injury System (SEMTBIS) http://www.semtbis.org/semtbis/The Rehabilitation Research and Training Center on Community Integration ofPersons with TBI at Texas Institute for Rehabilitation and Research http://www.tbicommunity.org/resources/index.htm

Documents/training materialsArchived webcasts of the HRSA-MCHB http://www.mchcom.com (click on ‘Archived webcasts’, then ‘TBI’)Brain Injury Research Center of Mount Sinai School of Medicine http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/publicationsModel Systems Knowledge Translation Center - TBI Consumer Information http://msktc.washington.edu/tbi/factsheets/index.asp

Housing and residential placementAgency/organization websites

Disability Network Michigan http://dnmichigan.org/Department of Human Services, Adult Services http://www.michigan.gov/dhs/0,1607,7-124-5452_7122---,00.htmlDepartment of Human Services, Michigan Community Service Commission http://www.michigan.gov/mcsc/0,1607,7-137-55459---,00.htmlDepartment of Human Services, Statewide Search for Adult Foster Care/Homesfor the Aged Facilities http://www.cis.state.mi.us/brs_afc/sr_afc.aspHabitat for Humanity http://www.habitat.org/local/affiliate.asp?place=59

http://nashia.org/pdf/hotopics/vrbrief-success-after-tbi%202010.pdf

http://www.biami.org/

http://www.biausa.org/

http://www.brainline.org/

http://www.cdc.gov/TraumaticBrainInjury/

http://www.neuroskills.com/resources.shtml

http://www.carf.org/

http://www.hrsa.gov/gethealthcare/conditions/traumaticbraininjury/

http://www.lapublishing.com/

https://www.michigan.gov/mdch/0,1607,7-132-54783_54879---,00.html

http://www.copower.org/

http://www.mpas.org/

http://www.nashia.org/

http://www.naric.com/

http://www.neuro.pmr.vcu.edu/

http://www.semtbis.org/semtbis/

http://www.tbicommunity.org/resources/index.htm

http://www.mchcom.com/

http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/publications

http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/publications

http://msktc.washington.edu/tbi/factsheets/index.asp

http://dnmichigan.org/

http://www.michigan.gov/dhs/0,1607,7-124-5452_7122---,00.html

http://www.michigan.gov/mcsc/0,1607,7-137-55459---,00.html

http://www.cis.state.mi.us/brs_afc/sr_afc.asp

http://www.habitat.org/local/affiliate.asp?place=59

Michigan Home Ownership Coalition - HomeChoice Mortgage http://www.hud.gov/local/mi/homeownership/mihoc.cfmMichigan’s MI Choice Waiver Program http://www.michigan.gov/mdch/0,1607,7-132-2943_4857_5045---,00.htmlMichigan Office of Services to the Aging http://www.miseniors.netMichigan Statewide Independent Living Council http://misilc.org/National Association of Area Agencies on Aging – Links to state specific agencieshttp://n4a.org/about-n4a/?fa=aaa-title-VI#MIRefinance & Mortgage Guide for People with Disabilities http://www.refinancemortgagerates.org/mortgage-guide-for-people-with-disabilities/Tenant-based Section 8 Housing Vouchers: MSHDA http://www.michigan.gov/mshda/0,1607,7-141-5555-22085--,00.htmlTenant-based Section 8 Housing Vouchers: Public Housing Authorities (PHA) http://www.hud.gov/offices/pih/pha/contacts/states/mi.cfmUSDA Rural Development http://www.rurdev.usda.gov/mi/

Management of TBI for cliniciansDocuments/training materials

Centers for Disease Control and Prevention - "Heads Up: Brain Injury in YourPractice Tool Kit" (available to order, free of charge) http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.htmlVeterans Health Initiative - Traumatic Brain Injury, Independent Study CourseReleased: April 2010http://www.publichealth.va.gov/docs/vhi/traumatic-brain-injury-vhi.pdf

Public agencies in MichiganAgency/organization websites

Community Mental Health Services Programs – County Office Informationhttp://www.michigan.gov/documents/cmh_8_1_02_37492_7.PDFDepartment of Human Services (DHS) - Home http://www.michigan.gov/dhsDepartment of Human Services – County Office Information http://www.michigan.gov/dhs/0,1607,7-124-5461---,00.htmlMichigan Association of Community Mental Health Boards (MACMHB) http://www.macmhb.org/Michigan Department of Community Health (MDCH) http://www.michigan.gov/mdchMichigan Department of Education (MDE) http://www.michigan.gov/mdeMichigan Department of Licensing and Regulatory Affairs - Michigan RehabilitationServiceshttp://www.michigan.gov/mdcd/0,1607,7-122-25392---,00.htmlMichigan Rehabilitation Services - Locations by City http://www.michigan.gov/mdcd/0,1607,7-122-25392_41191---,00.html

Screening and assessmentAgency/organization websites

The Center for Outcome Measurement in Brain Injury http://www.tbims.org/combi/

Documents/training materialsBrain Injury Resource Center of Mount Sinai: Brain Injury Screeninghttp://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/resources/technical-assistance/brain-injury-screeningOhio Valley Center for Brain Injury Prevention and Rehabilitation – TBI Screeninghttp://ohiovalley.org/informationeducation/screening/

Statistics

http://www.hud.gov/local/mi/homeownership/mihoc.cfm

http://www.michigan.gov/mdch/0,1607,7-132-2943_4857_5045---,00.html

http://www.miseniors.net/

http://misilc.org/

http://n4a.org/about-n4a/?fa=aaa-title-VI#MI

http://www.refinancemortgagerates.org/mortgage-guide-for-people-with-disabilities/

http://www.refinancemortgagerates.org/mortgage-guide-for-people-with-disabilities/

http://www.michigan.gov/mshda/0,1607,7-141-5555-22085--,00.html

http://www.hud.gov/offices/pih/pha/contacts/states/mi.cfm

http://www.rurdev.usda.gov/mi/

http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html

http://www.publichealth.va.gov/docs/vhi/traumatic-brain-injury-vhi.pdf

http://www.michigan.gov/documents/cmh_8_1_02_37492_7.PDF

http://www.michigan.gov/dhs

http://www.michigan.gov/dhs/0,1607,7-124-5461---,00.html

http://www.macmhb.org/

http://www.michigan.gov/mdch

http://www.michigan.gov/mde

http://www.michigan.gov/mdcd/0,1607,7-122-25392---,00.html

http://www.michigan.gov/mdcd/0,1607,7-122-25392_41191---,00.html

http://www.tbims.org/combi/

http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/resources/technical-assistance/brain-injury-screening

http://www.mssm.edu/research/centers/brain-injury-research-center-of-mount-sinai/resources/technical-assistance/brain-injury-screening

http://ohiovalley.org/informationeducation/screening/

Agency/organization websitesCenters for Disease Control and Prevention – Traumatic Brain Injury: Topic Home http://www.cdc.gov/node.do/id/0900f3ec8000dbdc

Substance abuseAgency/organization websites

Ohio Valley Center for Brain Injury Prevention and Rehabilitation – SubstanceAbuse and Brain Injurieshttp://ohiovalley.org/informationeducation/substanceuseinformation/Substance Abuse & Mental Health Services Administration – Substance AbuseTreatment Facility Locatorhttp://www.findtreatment.samhsa.gov/

Documents/training materials2004/2005 Regional Coordinating Agencies Contact Listhttp://www.michigan.gov/mdch/0,1607,7-132-2941_4871-14983--,00.html

Questions? Contact Us.

For more information about specific service programs in Michigan, contact:

Michael Daeschlein

Manager, Home and Community-Based Services Section at the Michigan Department ofCommunity Health

[email protected]

For comments and feedback regarding this training: [email protected]

http://www.cdc.gov/node.do/id/0900f3ec8000dbdc

http://ohiovalley.org/informationeducation/substanceuseinformation/

http://www.findtreatment.samhsa.gov/

http://www.michigan.gov/mdch/0,1607,7-132-2941_4871-14983--,00.html



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